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GAO-01-652R 1 (2001-05-07)

handle is hein.gao/gaocrptanik0001 and id is 1 raw text is: SGAO Accountability * Integrity * Reliability United States General Accounting Office Washington, DC 20548 May 7, 2001 The Honorable James M. Jeffords Chairman Committee on Health, Education, Labor, and Pensions United States Senate Subject: Private Health Insurance: Federal Role in Enforcing New Standards Continues to Evolve Dear Mr. Chairman: In recent years, the Congress has passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and three subsequent laws' that create new federal standards for private health insurance, which covers nearly 175 million Americans under the age of 65. These laws include standards guaranteeing access to health insurance for small employers and individuals with existing health conditions as well as requirements for health plans regarding mental health services, hospital care for mothers and newborns following childbirth, and reconstructive surgery following a mastectomy. Responsibility for enforcing the new federal standards established by these four laws is divided among state insurance regulators and three federal agencies. Specifically, states maintain their traditional responsibility for regulating insurance products sold in their states, but if they fail to substantially enforce the minimum federal standards, the Department of Health and Human Services (HHS), through the Health Care Financing Administration (HCFA), is responsible for enforcing the federal laws. HCFA is also responsible for enforcing the federal standards for nonfederal government health plans, such as health plans offered to state and local government or school district employees. These laws also expanded the Department of Labor's responsibilities for ensuring that private employer-sponsored group health plans meet federal requirements and provided the Department of the Treasury with new authority to impose an excise tax on employers found to violate the federal standards. Because the Congress is currently considering new patient protection standards- and because some proposals would model enforcement on the approach used in HIPAA and other laws-you asked us to provide an update on federal agencies' enforcement of the existing health insurance standards. Specifically, we examined 'The Mental Health Parity Act of 1996, the Newborns' and Mothers' Health Protection Act of 1996, and the Women's Health and Cancer Rights Act of 1998. GAO-O 1-652R Federal Enforcement of Health Insurance Standards

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