Baseline Information for Evaluating the Implementation of the Health Insurance Portability and Accountability Act of 1996: Final Report. Question E. How is the risk-spreading requirement being implemented?


This question would be addressed using the case studies and monitoring state regulation through updates of the regulatory database. The IHPS individual database captures some measures of state law requiring risk spreading among carriers. Updates of the database would track changes in these regulations nationwide. The case study would be used to gather greater detail about how states are implementing this provision of the law. The case study interview would collect detailed information about the mechanisms that selected states have adopted to meet the risk spreading requirement of HIPAA—e.g. premium caps in risk pools, subsidies for HIPAA eligibles, requiring carriers to contribute to a state fund for risk spreading, other techniques. The interview protocol would include questions about the determination of the mechanism (e.g. the determination of the cap, the subsidy schedule, the carrier assessments), and enforcement procedures.