Pub.L. 104-192 To amend title 18, United States Code, to carry out the international obligations of the United States under the Geneva Conventions to provide criminal penalties for certain war crimes. <> ...

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       HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996
Public Law 104-191
104th Congress

                                 An Act


 
 To amend the Internal Revenue Code of 1986 to improve portability and 
  continuity of health insurance coverage in the group and individual 
   markets, to combat waste, fraud, and abuse in health insurance and 
health care delivery, to promote the use of medical savings accounts, to 
improve access to long-term care services and coverage, to simplify the 
administration of health insurance, and for other purposes. <<NOTE: Aug. 
                       21, 1996 -  [H.R. 3103]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in <<NOTE: Health Insurance Portability and 
Accountability Act of 1996.>>  Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF <<NOTE: 42 USC 201 note.>>  CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Insurance 
Portability and Accountability Act of 1996''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

       TITLE I--HEALTH CARE ACCESS, PORTABILITY, AND RENEWABILITY

                     Subtitle A--Group Market Rules

       Part 1--Portability, Access, and Renewability Requirements

Sec. 101. Through the Employee Retirement Income Security Act of 1974.

   ``Part 7--Group Health Plan Portability, Access, and Renewability 
                              Requirements

        ``Sec. 701. Increased portability through limitation on 
                            preexisting condition exclusions.
        ``Sec. 702. Prohibiting discrimination against individual 
                            participants and beneficiaries based on 
                            health status.
        ``Sec. 703. Guaranteed renewability in multiemployer plans and 
                            multiple employer welfare arrangements.
        ``Sec. 704. Preemption; State flexibility; construction.
        ``Sec. 705. Special rules relating to group health plans.
        ``Sec. 706. Definitions.
        ``Sec. 707. Regulations.''.
Sec. 102. Through the Public Health Service Act.

 ``TITLE XXVII--ASSURING PORTABILITY, AVAILABILITY, AND RENEWABILITY OF 
                        HEALTH INSURANCE COVERAGE

                     ``Part A--Group Market Reforms

     ``Subpart 1--Portability, Access, and Renewability Requirements

        ``Sec. 2701. Increased portability through limitation on 
                            preexisting condition exclusions.
        ``Sec. 2702. Prohibiting discrimination against individual 
                            participants and beneficiaries based on 
                            health status.

   ``Subpart 2--Provisions Applicable Only to Health Insurance Issuers

        ``Sec. 2711. Guaranteed availability of coverage for employers 
                            in the group market.
        ``Sec. 2712. Guaranteed renewability of coverage for employers 
                            in the group market.
        ``Sec. 2713. Disclosure of information.

        ``Subpart 3--Exclusion of Plans; Enforcement; Preemption

        ``Sec. 2721. Exclusion of certain plans.
        ``Sec. 2722. Enforcement.
        ``Sec. 2723. Preemption; State flexibility; construction.

             ``Part C--Definitions; Miscellaneous Provisions

        ``Sec. 2791. Definitions.
        ``Sec. 2792. Regulations.''.
Sec. 103. Reference to implementation through the Internal Revenue Code 
           of 1986.
Sec. 104. Assuring coordination.

                   Subtitle B--Individual Market Rules

Sec. 111. Amendment to Public Health Service Act.

                    ``Part B--Individual Market Rules

        ``Sec. 2741. Guaranteed availability of individual health 
                            insurance coverage to certain individuals 
                            with prior group coverage.
        ``Sec. 2742. Guaranteed renewability of individual health 
                            insurance coverage.
        ``Sec. 2743. Certification of coverage.
        ``Sec. 2744. State flexibility in individual market reforms.
        ``Sec. 2745. Enforcement.
        ``Sec. 2746. Preemption.
        ``Sec. 2747. General exceptions.''.

            Subtitle C--General and Miscellaneous Provisions

Sec. 191. Health coverage availability studies.
Sec. 192. Report on Medicare reimbursement of telemedicine.
Sec. 193. Allowing federally-qualified HMOs to offer high deductible 
           plans.
Sec. 194. Volunteer services provided by health professionals at free 
           clinics.
Sec. 195. Findings; severability.

    TITLE II--PREVENTING HEALTH CARE FRAUD AND ABUSE; ADMINISTRATIVE 
                SIMPLIFICATION; MEDICAL LIABILITY REFORM

Sec. 200. References in title.

               Subtitle A--Fraud and Abuse Control Program

Sec. 201. Fraud and abuse control program.
Sec. 202. Medicare integrity program.
Sec. 203. Beneficiary incentive programs.
Sec. 204. Application of certain health antifraud and abuse sanctions to 
           fraud and abuse against Federal health care programs.
Sec. 205. Guidance regarding application of health care fraud and abuse 
           sanctions.

     Subtitle B--Revisions to Current Sanctions for Fraud and Abuse

Sec. 211. Mandatory exclusion from participation in Medicare and State 
           health care programs.
Sec. 212. Establishment of minimum period of exclusion for certain 
           individuals and entities subject to permissive exclusion from 
           Medicare and State health care programs.
Sec. 213. Permissive exclusion of individuals with ownership or control 
           interest in sanctioned entities.
Sec. 214. Sanctions against practitioners and persons for failure to 
           comply with statutory obligations.
Sec. 215. Intermediate sanctions for Medicare health maintenance 
           organizations.
Sec. 216. Additional exception to anti-kickback penalties for risk-
           sharing arrangements.
Sec. 217. Criminal penalty for fraudulent disposition of assets in order 
           to obtain medicaid benefits.
Sec. 218. Effective date.

                       Subtitle C--Data Collection

Sec. 221. Establishment of the health care fraud and abuse data 
           collection 
           program.

                  Subtitle D--Civil Monetary Penalties

Sec. 231. Social Security Act civil monetary penalties.
Sec. 232. Penalty for false certification for home health services.

                  Subtitle E--Revisions to Criminal Law

Sec. 241. Definitions relating to Federal health care offense.
Sec. 242. Health care fraud.
Sec. 243. Theft or embezzlement.
Sec. 244. False statements.
Sec. 245. Obstruction of criminal investigations of health care 
           offenses.
Sec. 246. Laundering of monetary instruments.
Sec. 247. Injunctive relief relating to health care offenses.
Sec. 248. Authorized investigative demand procedures.
Sec. 249. Forfeitures for Federal health care offenses.
Sec. 250. Relation to ERISA authority.

                Subtitle F--Administrative Simplification

Sec. 261. Purpose.
Sec. 262. Administrative simplification.

                 ``Part C--Administrative Simplification

        ``Sec. 1171. Definitions.
        ``Sec. 1172. General requirements for adoption of standards.
        ``Sec. 1173. Standards for information transactions and data 
                            elements.
        ``Sec. 1174. Timetables for adoption of standards.
        ``Sec. 1175. Requirements.
        ``Sec. 1176. General penalty for failure to comply with 
                            requirements and standards.
        ``Sec. 1177. Wrongful disclosure of individually identifiable 
                            health information.
        ``Sec. 1178. Effect on State law.
        ``Sec. 1179. Processing payment transactions.''.
Sec. 263. Changes in membership and duties of National Committee on 
           Vital and Health Statistics.
Sec. 264. Recommendations with respect to privacy of certain health 
           information.

   Subtitle G--Duplication and Coordination of Medicare-Related Plans

Sec. 271. Duplication and coordination of Medicare-related plans.

                TITLE III--TAX-RELATED HEALTH PROVISIONS

Sec. 300. Amendment of 1986 Code.

                  Subtitle A--Medical Savings Accounts

Sec. 301. Medical savings accounts.

  Subtitle B--Increase in Deduction for Health Insurance Costs of Self-
                          Employed Individuals

Sec. 311. Increase in deduction for health insurance costs of self-
           employed indi-
           viduals.

            Subtitle C--Long-Term Care Services and Contracts

                       Part I--General Provisions

Sec. 321. Treatment of long-term care insurance.
Sec. 322. Qualified long-term care services treated as medical care.
Sec. 323. Reporting requirements.

                 Part II--Consumer Protection Provisions

Sec. 325. Policy requirements.
Sec. 326. Requirements for issuers of qualified long-term care insurance 
           contracts.
Sec. 327. Effective dates.

           Subtitle D--Treatment of Accelerated Death Benefits

Sec. 331. Treatment of accelerated death benefits by recipient.
Sec. 332. Tax treatment of companies issuing qualified accelerated death 
           benefit riders.

                    Subtitle E--State Insurance Pools

Sec. 341. Exemption from income tax for State-sponsored organizations 
           providing health coverage for high-risk individuals.
Sec. 342. Exemption from income tax for State-sponsored workmen's 
           compensation reinsurance organizations.

            Subtitle F--Organizations Subject to Section 833

Sec. 351. Organizations subject to section 833.

             Subtitle G--IRA Distributions to the Unemployed

Sec. 361. Distributions from certain plans may be used without 
           additional tax to pay financially devastating medical 
           expenses.

 Subtitle H--Organ and Tissue Donation Information Included With Income 
                           Tax Refund Payments

Sec. 371. Organ and tissue donation information included with income tax 
           refund payments.

 TITLE IV--APPLICATION AND ENFORCEMENT OF GROUP HEALTH PLAN REQUIREMENTS

      Subtitle A--Application and Enforcement of Group Health Plan 
                              Requirements

Sec. 401. Group health plan portability, access, and renewability 
           requirements.
Sec. 402. Penalty on failure to meet certain group health plan 
           requirements.

 Subtitle B--Clarification of Certain Continuation Coverage Requirements

Sec. 421. COBRA clarifications.

                        TITLE V--REVENUE OFFSETS

Sec. 500. Amendment of 1986 Code.

                Subtitle A--Company-Owned Life Insurance

Sec. 501. Denial of deduction for interest on loans with respect to 
           company-owned life insurance.

 Subtitle B--Treatment of Individuals Who Lose United States Citizenship

Sec. 511. Revision of income, estate, and gift taxes on individuals who 
           lose United States citizenship.
Sec. 512. Information on individuals losing United States citizenship.
Sec. 513. Report on tax compliance by United States citizens and 
           residents living abroad.

Subtitle C--Repeal of Financial Institution Transition Rule to Interest 
                            Allocation Rules

Sec. 521. Repeal of financial institution transition rule to interest 
           allocation rules.

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