HIPAA: Protecting Patients' Rights
HIPAA: Protecting Patients'Rights
IntroductionIt has been argued that the Health Insurance Portability and Accountability Act of1996 (HIPAA) is essential to health-related information, patients' rights, and thehealth care system. Thus, health care professionals should be familiar with currentHIPAA regulations. This course will review HIPAA regulations, while providing insight onhow current HIPAA regulations relate to the biggest cultural trends impacting today'shealth care system.Section 1: HIPAAThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) may refer tothe specific federal regulations or laws which provide provisions for safeguardingmedical information. HIPAA was enacted by the 104th United States Congress andsigned into action by President Clinton in 1996. Since that time, HIPAA has undergonea variety of different modifications and updates to help increase its scope andeffectiveness in protecting health-related information. Some of the more recentmodifications/updates to HIPAA include the "Privacy Rule", the "Security Rule," and the"Final Omnibus Rule," otherwise referred to as the "Omnibus Rule." That being said,this section of the course will focus on the aforementioned modifications/updates toHIPAA. Relevant details from the Privacy Rule, the Security Rule, and the FinalOmnibus Rule/Omnibus Rule will be highlighted below. The information found in thissection was derived from materials provided by the federal government of the UnitedStates.1,2The Privacy Rule The Standards for Privacy of Individually Identifiable Health Information, otherwisereferred to as the Privacy Rule, establishes a set of national standards for theprotection of certain health information. The Privacy Rule standards address the use and disclosure of individuals’ healthinformation, which is referred to as “protected health information” by organizationssubject to the Privacy Rule. Organizations subject to the Privacy Rule are referredto as “covered entities.” The Privacy Rule also sets standards for individuals'privacy rights to understand and control how their health information is used. One of the major goals of the Privacy Rule is to assure that individuals’ healthinformation is adequately protected while allowing the flow of health informationneeded to provide and promote high quality health care. Another major goal of thePrivacy Rule is to protect the public's health and well being.
The Privacy Rule applies to the following entities: Health plans - in the context of this course, a health plan may refer to anyplan which covers the cost of health care. Health plans that may be affectedby the stipulations of the Privacy Rule include: health, dental, vision, andprescription drug insurers, health maintenance organizations (“HMOs”),Medicare, Medicaid, Medicare Choice and Medicare supplement insurers, andlong-term care insurers (excluding nursing home fixed-indemnity policies).Additional health plans that may be affected by the stipulations of the PrivacyRule include: employer-sponsored group health plans, government and churchsponsored health plans, and multi-employer health plans. Health care providers - essentially, every health care provider, regardless ofsize, who electronically transmits health information in connection withcertain transactions may be considered a covered entity. Health care clearinghouses - in the context of this course, a health careclearinghouses may refer to any entity that processes nonstandard information fromanother entity into a standard format. Examples of health care clearinghouses include:billing services, re-pricing companies, and community health managementinformation systems. Business associate - in the context of this course, a business associate mayrefer to a person or organization, other than a member of a covered entity'sworkforce, that performs certain functions or activities on behalf of, or to, acovered entity that involve the use or disclosure of individually identifiablehealth information. The Privacy Rule safeguards protected health information (PHI). PHI may refer toany information about health status, provision of health care, or payment for healthcare that is created or collected by a covered entity; individually identifiable healthinformation. In essence, the Privacy Rule protects all individually identifiable healthinformation held or transmitted by a covered entity or its business associate(s), inany form or media, whether electronic, paper, or oral. Health care professionals should note that individually identifiable healthinformation is information, including demographic data, that relates to thefollowing: an individual’s past, present or future physical or mental health orcondition, the provision of health care to an individual, or the past, present, orfuture payment for the provision of health care to the individual, and that identifiesthe individual or for which there is a reasonable basis to believe it can be used toidentify the individual (i.e., individually identifiable health information is
information that may be used to identify an individual and their relationship to thehealth care system). Health care professionals should also note that examples ofindividually identifiable health information includes patients': names, birth dates,home addresses, and Social Security Numbers (however, the Privacy Rule excludesfrom protected health information employment records that a covered entitymaintains in its capacity as an employer and certain other records indicated bylaw). The Privacy Rule indicates that there are no restrictions on the use or disclosure ofde-identified health information. De-identified health information may refer toinformation that neither identifies nor provides a reasonable basis to identify anindividual (i.e., information that cannot, necessarily, link an individual to the healthcare system). Health care professionals should note the following two waysinformation may be de-identified: a formal determination by a qualified statisticianmay de-identify information; the removal of specified identifiers of the individualand of the individual’s relatives, household members, and employers is completed,and is adequate only if the covered entity has no actual knowledge that theremaining information could be used to identify the individual. A major purpose of the Privacy Rule is to define and limit the circumstances inwhich an individual’s protected heath information may be used or disclosed bycovered entities. The Privacy Rule stipulates the following: a covered entity may not use or discloseprotected health information, except as the Privacy Rule permits or requires; or asthe individual who is the subject of the information (or the individual’s personalrepresentative) authorizes in writing. Fundamentally, the Privacy Rule determineshow PHI may be used and/or disclosed to protect individuals' privacy. The Privacy Rule indicates that a covered entity may use and disclose protectedhealth information for its own treatment, payment, and health care operationsactivities. Health care professionals should note that treatment, in this context, may refer tothe provision, coordination, or management of health care and related services foran individual/patient by one or more health care professional, includingconsultation between health care professionals regarding a patient and referral of apatient by one health care professional to another. Health care professionals should note that payment, in this context, encompassesactivities of a health plan to obtain premiums, determine or fulfill responsibilitiesfor coverage and provision of benefits, and furnish or obtain reimbursement for
health care delivered to a patient and activities of a health care provider to obtainpayment or be reimbursed for the provision of health care to a patient. Health care professionals should note that health care operations, in this context,may include any of the following activities: quality assessment and improvementactivities, including case management and care coordination; competency assuranceactivities, including health care provider or health plan performance evaluation,credentialing, and accreditation; conducting or arranging for medical reviews,audits, or legal services, including fraud and abuse detection and complianceprograms; specified insurance functions, such as underwriting, risk rating, andreinsuring risk; business planning, development, management, and administration;and business management and general administrative activities of the entity,including but not limited to: de-identifying protected health information, creating alimited data set, and certain fundraising for the benefit of the covered entity. The Privacy Rule indicates the following: informal permission, regarding the use ofPHI, may be obtained by asking an individual outright, or by circumstances thatclearly give an individual the opportunity to agree, acquiesce, or object; when anindividual is incapacitated (e.g., in an emergency situation) or not available,covered entities generally may make such uses and disclosures, if in the exercise oftheir professional judgment, the use or disclosure is determined to be in the bestinterests of an individual. The Privacy Rule does not require that every risk of an incidental use or disclosureof PHI be eliminated. The Privacy Rule indicates the following: covered entities may use and disclose PHIwithout individual authorization as required by law. The Privacy Rule indicates the following: covered entities may disclose PHI to publichealth authorities authorized by law to collect or receive such information forpreventing or controlling disease, injury, or disability and to public health or othergovernment authorities authorized to receive reports of child abuse and neglect. The Privacy Rule indicates the following: covered entities may disclose PHI toentities subject to the United Sates Food and Drug Administration's (FDA) regulationsregarding FDA regulated products or activities for purposes such as adverse eventreporting, tracking of products, product recalls, and post-marketing surveillance. The Privacy Rule indicates the following: covered entities may disclose PHI toindividuals who may have contracted or been exposed to a communicable diseasewhen notification is authorized by law.
The Privacy Rule indicates the following: covered entities may disclose PHI toemployers, regarding employees, when requested by employers, for informationconcerning a work-related illness or injury or workplace related medicalsurveillance, because such information is needed by the employer to comply withorganizations such as the Occupational Safety and Health Administration (OHSA). The Privacy Rule indicates that in certain circumstances, covered entities maydisclose PHI to appropriate government authorities regarding victims of abuse,neglect, or domestic violence. The Privacy Rule indicates that covered entities may use or disclose PHI to facilitatethe donation and transplantation of cadaveric organs, eyes, and/or tissue. The Privacy Rule indicates that covered entities may disclose PHI that they believeis necessary to prevent or lessen a serious and imminent threat to a person or thepublic, when such disclosure is made to someone they believe can prevent or lessenthe threat (including the target of the threat). The Privacy Rule indicates that an authorization is not required to use or discloseprotected health information for certain essential government functions. The Privacy Rule stipulates the following: a covered entity must obtain theindividual’s written authorization for any use or disclosure of PHI that is not fortreatment, payment or health care operations or otherwise permitted or requiredby the Privacy Rule. The Privacy Rule indicates that most uses and disclosures of psychotherapy notes fortreatment, payment, and health care operations purposes require an authorization. The Privacy Rule stipulates the following: a covered entity must obtain anindividual’s authorization to use or disclose psychotherapy notes with the followingexceptions - the covered entity who originated the notes may use them fortreatment; a covered entity may use or disclose, without an individual’sauthorization, the psychotherapy notes, for its own training, and to defend itself inlegal proceedings brought by an individual, for governmental investigations todetermine the covered entity’s compliance with the Privacy Rules, to avert a seriousand imminent threat to public health or safety, to a health oversight agency forlawful oversight of the originator of the psychotherapy notes, for the lawfulactivities of a coroner or medical examiner or as required by law. Health care professionals should note the following: a central aspect of the PrivacyRule is the principle of “minimum necessary” use and disclosure. A covered entitymust make reasonable efforts to use, disclose, and request only the minimum
amount of PHI needed to accomplish the intended purpose of the use, disclosure, orrequest. Essentially, the minimum necessary principle/rule can help prevent thedisclosure of any unnecessary PHI. Health care professionals should always keep theminimum necessary principle/rule in mind when disclosing PHI. The Privacy Rule stipulates the following: a covered entity must establish andimplement policies and procedures (which may be standard protocols) for routine,recurring disclosures, or requests for disclosures, that limits the protected healthinformation disclosed to that which is the minimum amount reasonably necessary toachieve the purpose of the disclosure. The Privacy Rule stipulates the following: a covered entity, with certain exceptions,must provide a notice of its privacy practices. The Privacy Rule stipulates the following: a covered health care provider with adirect treatment relationship with individuals must make a good faith effort toobtain written acknowledgement from patients of receipt of the privacy practicesnotice. The Privacy Rule indicates the following: individuals have a right to an accounting ofthe disclosures of their protected health information by a covered entity or thecovered entity’s business associates. The Privacy Rule indicates the following: individuals have the right to request that acovered entity restrict use or disclosure of PHI for treatment, payment or healthcare operations, disclosure to persons involved in the individual’s health care orpayment for health care, or disclosure to notify family members or others about theindividual’s general condition, location, or death. The Privacy Rule indicates the following: a covered entity must maintain reasonableand appropriate administrative, technical, and physical safeguards to preventintentional or unintentional use or disclosure of PHI in violation of the Privacy Ruleand to limit its incidental use and disclosure pursuant to otherwise permitted orrequired use or disclosure. The Privacy Rule requires a covered entity to treat a personal representative thesame as the individual, with respect to uses and disclosures of the individual’sprotected health information, as well as the individual’s rights under the PrivacyRule. A personal representative may refer to any individual legally authorized tomake health care decisions on an individual’s behalf or to act for a deceasedindividual or the estate.
The Privacy Rule indicates the following: typically, parents are the personalrepresentatives for their minor children (the term minor child may refer to anyindividual under a specific age, typically under the age of 18). Therefore, in mostcases, parents can exercise individual rights, such as access to medical records, onbehalf of their minor children. Health care professionals should note the following: generally, state laws that arecontrary to the Privacy Rule are preempted by the federal requirements, thereforefederal requirements will apply.The Security Rule The Security Standards for the Protection of Electronic Protected HealthInformation, otherwise referred to as the Security Rule, was enacted to establish anational set of security standards for protecting certain health information that isheld or transferred in electronic form. The Security Rule addresses the technical and non-technical safeguards that coveredentities must put in place to secure individuals’ electronic protected healthinformation (e-PHI). The Security Rule was enacted to work in conjunction with the Privacy Rule. One of the major goals of the Security Rule is to protect the privacy of individuals’health information while allowing covered entities to adopt and utilize technologiesto improve the quality and efficiency of patient care (i.e., the aim of the SecurityRule is to establish a means to protect patient-health related information as newtechnologies are incorporated into the health care system). Health care professionals should note the following: the Security Rule applies tohealth plans, health care clearinghouses, and to any health care provider whotransmits health information in electronic form. Health care professionals should note the following: the Security Rule protects asubset of information covered by the Privacy Rule, which is all individuallyidentifiable health information a covered entity creates, receives, maintains ortransmits in electronic form; the Security Rule pertains to electronic healthinformation. Health care professionals should note the following: the Security Rule does notapply to PHI transmitted orally or in writing.
The Security Rule requires covered entities to maintain reasonable and appropriateadministrative, technical, and physical safeguards for protecting e-PHI; the SecurityRule indicates that electronic patient information must be protected. The Security Rule requires that covered entities ensure the confidentiality, integrity,and availability of all e-PHI they create, receive, maintain or transmit; coveredentities identify and protect against reasonably anticipated threats to the securityor integrity of the information; covered entities protect against reasonablyanticipated, impermissible uses or disclosures; covered entities ensure complianceby their workforce (i.e., health care organizations must make sure health careprofessionals adhere to the stipulations put forth by the Security Rule). Health care professionals should note that according to the Security Rule, the termconfidentiality refers to the following: e-PHI is not available or disclosed tounauthorized persons. The Security Rule allows covered entities to analyze their own needs and implementsolutions appropriate for their specific environments. The Administrative Safeguards provisions in the Security Rule requires coveredentities to perform risk analysis as part of their security management processes(i.e., covered entities must assess the implementation of all related electronicsafeguards established to protect e-PHI). Health care professionals should note thatthe process of risk analysis should be ongoing. The Security Rule indicates that a covered entity must identify and analyzepotential risks to e-PHI, and must safeguard individuals against potential risks to ePHI. The Security Rule indicates that a covered entity designate a security official who isresponsible for developing and implementing its security policies and procedures.Health care professionals should be aware of their health care organization'ssecurity official. Health care professionals should apply the minimum necessary principle/rule to ePHI. The minimum necessary rule can help prevent the disclosure of anyunnecessary e-PHI. Health care professionals should always keep the minimumnecessary rule in mind when disclosing e-PHI. The Security Rule requires a covered entity to implement policies and proceduresfor authorizing access to e-PHI only when such access is appropriate based on theuser or recipient
1996 (HIPAA) is essential to health-related information, patients' rights, and the health care system. Thus, health care professionals should be familiar with current HIPAA regulations. This course will review HIPAA regulations, while providing insight on how current HIPAA regulations relate to the biggest cultural trends impacting today's
Overview of HIPAA How Does HIPAA Impact EMS? HIPAA regulations affect how EMS person-nel use and transfer patient information HIPAA requires EMS agencies to appoint a “Compliance Officer” and create HIPAA policy for the organization to follow HIPAA mandates training for EMS personnel and administrative support staffFile Size: 229KB
Chapter 1 - HIPAA Basics A-1: Discussing HIPAA fundamentals 1 Who's impacted by HIPAA? HIPAA impacts health plans, health care clearinghouses, and health care providers that send or receive, directly or indirectly, HIPAA-covered transactions. These entities have to meet the requirements of HIPAA.
What is HIPAA? HIPAA is the Health Insurance Portability and Accountability Act of 1996. HIPAA is a Federal Law. HIPAA is a response, by Congress, to healthcare reform. HIPAA affects the health care industry. HIPAA is mandatory.
Basics of HIPAA and HITECH 4 What exactly is HIPAA? 4 Covered entities v. business associates 5 The HIPAA Omnibus Rule 6 7 H C E T I H HIPAA Compliance Simplified 8 Five security-thought-leader tips for HIPAA Compliance 8 Three specific HIPAA tips you need to know post-omnibus 11 Checklist: How to Make Sure You're Compliant 13
Tel: 515-865-4591 email: Bob@training-hipaa.net HIPAA Compliance Template Suites Covered Entity HIPAA Compliance Tool (Less than 50 employees) . HIPAA SECURITY CONTINGENCY PLAN TEMPLATE SUITE Documents in HIPAA Contingency Plan Template Suite: . Business Impact Analysis Policy includes following sub document (12 pages) Business .
Tel: 515-865-4591 email: Bob@training-hipaa.net HIPAA Compliance Template Suites Covered Entity HIPAA Compliance Tool (Less than 50 employees) . HIPAA SECURITY CONTINGENCY PLAN TEMPLATE SUITE Documents in HIPAA Contingency Plan Template Suite: . Business Impact Analysis Policy includes following sub document (12 pages) Business Impact .
transactions, the HIPAA standard uses NCPDP (National Council for Prescription Drug Programs) transactions. This book includes an overview of HIPAA, and then specific information relating to the installation and contents of SeeBeyond's HIPAA implementations. 1.1 Introduction to HIPAA HIPAA amends the Internal Revenue Service Code of 1986.
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