|Code Section||Effective Date||Name of Act||Name of Provision||10yr Revenue Estimate ($millions)|
|9815||3/23/2010||Patient Protection and Affordable Care Act||Conforming Amendments||*See note below|
*Note on Revenue Estimate
See table 3 of CBO estimate letter addressed to Speaker Pelosi on March 20, 2010, http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/amendreconprop.pdf
Explanation of Provision
The provision adds new Code section 9815 which provides that the provisions of part A of title XXVII of the PHSA (as amended by the Act) apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in Subchapter B of Chapter 100 of the Code. To the extent that any HIPAA provision of the Code conflicts with a provision of part A of title XXVII of the PHSA with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such part A generally apply.
The provisions of part A of title XXVII of the PHSA added by section 1001 of the Act that are incorporated by reference in new section 9815 include the following: section 2711 (No lifetime or annual limits); section 2712 (Prohibition on rescissions); section 2713 (Coverage of preventive health services); section 2714 (Extension of dependent coverage); section 2715 (Development and utilization of uniform explanation of coverage documents and standardized definitions); section 2716 (Prohibition of discrimination in favor of highly compensated individuals); section 2717 (Ensuring the quality of care); section 2718 (Bringing down the cost of health care coverage); and section 2719 (Appeals process). These new sections of the PHSA, which relate to individual and group market reforms, are effective six months after the date of enactment (March 23, 2010).
The provisions of part A of title XXVII of the PHSA added by section 1201 of the Act that are incorporated by reference in new section 9815 include the following: section 2704 (Prohibition of preexisting condition exclusions or other discrimination based on health status); section 2701 (Fair health insurance premiums); section 2702 (Guaranteed availability of coverage) section 2703 (Guaranteed renewability of coverage); section 2705 (Prohibiting discrimination against individual participants and beneficiaries based on health status); section 2706 (Non-discrimination in health care); section 2707 (Comprehensive health insurance coverage); and section 2708 (Prohibition on excessive waiting periods). These new sections of the PHSA, which relate to general health insurance reforms, are effective for plan years beginning on or after January 1, 2014.
New section 9815 specifies that section 2716 (Prohibition of discrimination based on salary) and 2718 (Bringing down the cost of health coverage) of title XXVII of the PHSA (as amended by the Act) do not apply under the Code provisions of HIPAA with respect to self-insured group health plans.
As a result of incorporating these PHSA provisions by reference, the excise tax that applies in the event of a violation of present law HIPAA requirements also applies in the event of a violation of these new requirements.