Does Health Privacy Rule Spare WC?
The final medical privacy regulation released by the U.S. Department of Health and Human Services is a welcome first step but requires close watch for its impact on workers compensation, according to insurer groups.
It remains to be seen whether language in a preamble to the rule can effectively shield workers comp insurers from the rules impact, said Gretchen Schaefer, director of public affairs for the American Insurance Association.
The rule, published initially by HHS in December 2000 and finalized with modifications on Aug. 9, seeks to protect the use of individually identifiable health information by health plans, healthcare clearinghouses, and certain healthcare providers, Washington-based AIA said.
In its initial form, the privacy rule did not specifically apply to workers comp or other forms of property-casualty insurance. But it did require "covered entities"–including physicians, hospitals, health plans and other medical care providers–to disclose only the amount of medical information deemed by the provider to be "minimally necessary" to insurers in workers comp cases.
The insurance industry views this language as effectively requiring medical providers to make legal decisions about what is "minimally necessary" information. The industry fears that medical providers will err on the side of caution by refusing requests for information from workers comp insurers.
Additionally, the industry is concerned that there might be increased fraud in the form of payment of workers comp benefits for injuries that had not occurred on the job, said Kathleen Jensen, insurance services counsel for the Des Plaines, Ill.-based National Association of Independent Insurers. For example, workers comp providers might not be able to find out about claimants past medical histories in processing alleged work-related injury claims, she noted.
Although the preamble now states that the rule is not intended to interfere with state workers comp systems, Ms. Schaefer said the industry continues to have concerns because the "minimally necessary" language remains.
However, Ms. Jensen said that the new preamble wording means that workers comp insurers will now be able to obtain the information needed to accurately process workers comp claims.
The insurance industry had asked HHS to exempt workers comp from the rules reach. But HHS said this was not feasible under statutory requirements. The rule-making process involves, among other things, posting public notice of changes, followed by public hearings–in short, more delay.
Gary Karr, AIA director of federal media relations, noted that both HHS and insurance company groups will be keeping an eye on how implementation of the new regulation plays out. He said that HHS has conceded that the regulation could be revised if problems develop, although Ms. Schaefer noted that this could involve a drawn-out process.
Still, Mr. Karr doubts that HHS "wants to get into the business regulating workers comp," adding, "of course, we dont want them to, either."
The rules compliance date for most healthcare providers is April 14, 2003.
Reproduced from National Underwriter Property & Casualty/Risk & Benefits Management Edition, August 19, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.
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