Comprehensive Wellness Initiative -- Spotlight

10/22/09

State Health Plan members recently received notification of a “HIPAA Waiver” in the announcement of the Comprehensive Wellness Initiative.  Here’s what it means:

  1. HIPAA stands for Health Information Portability and Accountability Act.  It is a federal law and has two parts: Title I and Title II.  
  2. Title I sets forth various provisions about how health care coverage is provided. Because the State Health Plan is self-funded and a non-federal government plan, Title I gives the Plan the authority to exempt itself from some of the provisions.  For example: Exemption areas include special enrollment periods, preexisting condition limitations, being able to treat individual participants and beneficiaries differently based on health status, and other areas.

    In order to implement a state-mandated wellness initiative (called the Comprehensive Wellness Initiative), North Carolina, like other states with similar programs, has chosen to seek a health status exemption.  It is called a HIPAA waiver and it permits the Plan to focus on smoking/tobacco cessation and obesity programs.

    Note: Smoking/tobacco use and obesity are the two areas chosen by the NC General Assembly for the wellness initiative because they are leading risk factors for a number of chronic diseases, including heart disease, cancer, stroke and diabetes.  They are responsible for 69% of preventable deaths in North Carolina.
  3. Title II governs the transmission of health information.  It protects the privacy and security of members’ individual health information and prevents unauthorized use or disclosure.  These provisions cannot be waived. The State Health Plan reaffirms that members’ health information will be protected, according to Title II of HIPAA and state laws, in the process of implementing the Comprehensive Wellness Initiative.  The Plan will also continue to develop procedures to ensure protection of privacy and to prevent any accidental disclosure of protected information. 

The Comprehensive Wellness Initiative became law (Session Law 2009-16) in April 2009. The State Health Plan then developed the Comprehensive Wellness Initiative in compliance with HIPAA and other applicable laws.  The Plan will continue to monitor the program’s compliance with state and federal laws.

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