HIPAA Overview (Health Insurance Portability and Accountability Act 1996)

HIPAA Overview (Health Insurance Portability and

Accountability Act 1996)

PCS HIPAA Privacy Rule Training - 04/20/23

What is HIPAA?Health Insurance Portability & Accountability

Act of 1996 Public Law 104-191 Sponsored by - Kennedy & Kassebaum

Five Titles: Title 1: Insurability and Portability Title 2: Administrative Simplification Title 3: Tax Implications Title 4: Group Health Title 5: Revenue

What is the purpose of HIPAA ?

Reduce health care costs/fraud/abuse Control use/disclosure of “protected health

information” (PHI) Identify provider responsibilities and

accountability Increase consumer’s rights - PHI Regulate how PHI is transferred/managed by

technology, individuals, and agencies Provide consistent standards Assure privacy and security of confidential

protected healthcare information (PHI)

Administrative Simplification HIPAA Regulations and Deadlines

Privacy Regulations - Identifies what health care information is protected. Deadline April 14, 2003

Electronic Transaction/Code Sets - Sets uniform standards. Deadline: October 2003 with Extension

Security Regulations - Identifies how information is to

be protected. Deadline: April 21, 2005

Identifier Standards - Employer, Payer, National.

Deadline: Employer ID finalized/Others Pending

HIPAA Definitions

The nuts and bolts!

Healthcare Operations

Includes “general administrative and business

functions” necessary for a covered entity to

remain a viable business (i.e., audits, quality

improvement functions, assessments)

Health Information Any information recorded in any form ormedium which:

Is created/received by a Covered Entity that creates, receives, uses, or transmits PHI;

Relates to the past, present, or future

physical/mental health condition of an

individual, their participation in, or payment for

such services, and

Identifies the individual.

Protected Health Information (PHI)

All individually identifiable health care data or information collected, maintained, or transferred by a Covered Entity

Protected Health Information (PHI) Examples

Name Address Social Security # Birth Date Demographic

info. (some) Email address

Health Plan # License/Certificate # Vehicle identifiers Bio-metric identifiers Telephone numbers Place of employment Account numbers

Privacy Notice Written document in plain language Posted & shared with consumers at

intake Explains how their PHI will be

used/disclosed by agency Identifies consumer’s rights Lists agency/provider duties to protect

PHI, abide by the Privacy Notice Identifies how changes in notice will be

communicated

Designated Record Set

A group of records maintained by or for a covered entity/agency

Includes any records used, in whole or in part, to make decisions, about the consumer’s treatment (medical record, billing, etc.)

PCS Clinical Records Policy

Use vs. DisclosureUse

Sharing, utilization,

examination, &

analysis of PHI

maintained internally

within the agency

Disclosure

Release, transfer,

access to, or sharing

in any manner PHI

outside the agency

maintaining the

information

Minimum Necessary Rule

Rule applies to Uses/Disclosures

Covered Entities must make reasonable efforts to

limit use, disclosure, & requests for PHI to the

“minimum necessary” in order to accomplish the

intended purpose except when an authorization is

obtained

Minimum Necessary Rule Amount of information needed to achieve the purpose

Applies to all forms of communication Use - Requires policies & procedures classifying staff by

role/position and the PHI to which they may have access Disclosure - Requires policies & procedures addressing criteria to

limit disclosure & reviewing of requests Must limit requests to that which is necessary Does not apply to consumer requests/authorizations, disclosures

required by law or healthcare provider for treatment purposes

Access to PHI (Protected Health Information)

Opportunity to approach, inspect, review,

and make use of data or information

Actions by a consumer or healthcare

provider with appropriate

authorization

HIPAA’s Privacy Rule

Privacy Rule Applies to all protected healthcare

information (PHI)

Does not prohibit the exchange of PHI for treatment, payment, or health care operations (TPO) within the agency

Written Acknowledgement required

Privacy Rule Highlights Protects privacy of medical records and covers:

Electronic records & printouts of records Written records Oral communications

Consumer acknowledgement that PHI may be used for

routine purposes (TPO)

Privacy Notice - Documents consumer’s rights and the

agency’s responsibilities to protect and manage PHI

Consumers’ Rights under HIPAAConsumers may:

Inspect/copy their medical record information Request to amend information if they believe it to

be inaccurate or incomplete

Request must to be in writing Agency must respond within 15 days (VA law) If request is denied - consumer may appeal this

decision to the CSB or federal government

Consumer’s Rights under HIPAA

Request a Disclosure History

Request confidential communications through alternative addresses/phone numbers

Have access to a designated individual or Office of Civil Rights at Health & Human Services to report violations of their rights

Request restriction on use/disclosure of their PHI

Consumers may:

Privacy Regulations

Allow flow of PHI for treatment, payment, & related health care operations (TPO)

Prohibit flow of PHI unless voluntarily authorized by the consumer

Allow consumer to know who is accessing their PHI outside of TPO use

Allow consumers to obtain access to their records & request amendment of records if the consumer feels they are inaccurate or incomplete

Provider Responsibilities

Provide formal complaint handling system Allow use of de-identified data Follow “minimum necessary” requirements Establish Business Associate Agreements Duty to mitigate damage if violations occur Establish sanctions for HIPAA violations

Privacy Penalties Wrongful Disclosure Offense: $50,000 fine,imprisonment of not more than one year,or both.

Offense Under False Pretenses: $100,000,imprisonment, or not more than 5 years, or both.

Offense with Intent to Sell Information:$250,000 fine, imprisonment of not more than 10 years, or both.

Uses/Disclosures not requiring Authorization

To the consumer or legally authorized representative of the consumer

To health oversight agencies To the Department of Health & Human Services for

investigation and enforcement purposes By court order (as outlined in CFR 42 - strictest)


To U.S. Public Health Authorities - to prevent or control disease, injury, or disability

In following disclosure procedures for deceased consumers as outlined in VA law

To consumers exposed to communicable disease or at risk of contracting or spreading disease - under law & public health intervention/investigation


For reports of suspected child abuse or neglect to

the appropriate authority For reports about an adult victim of abuse, neglect, or domestic violence

State’s mandatory reporting laws Inform the individual of the report Seek the individual’s agreement when possible Can report without the individual’s agreement


Healthcare Oversight Activities Authorized by Law:

• Audits• Investigations (as permitted by CFR 42)• Inspections (i.e., Health Inspection of facilities)• Civil/criminal/administrative proceeding/action by a

properly executed court order (CFR 42)• Other appropriate oversight actions:

Government regulatory programsGovernment benefit programs - for eligibility

Privacy Preemption

HIPAA Will preempt

other federal or state laws relating

to PHI

(Except for those more stringent

than HIPAA)

HIPAA is not added red tape but...

Applying BEST PRACTICES to protect Mr. Hipp’s confidential healthcare information in a world where inappropriate sharing of PHI could result in: Identity theft Loss of privacy and control over

healthcare information Possible discrimination practices Consumer Rights violations

How does the Privacy Rule affect Piedmont CSB?

New HIPAA Forms & Policies Privacy Notice Right to Access Policy Request For Amendment Policy Minimum Necessary Policy & Procedure Tele-facsimile Policy Email Policy Business Associates Agreement Authorization to Release Information

Privacy Notice

Replaces the “Your Rights” Form Describes use and disclosure of health

information. Special circumstances for disclosure. Other uses and disclosure only with

authorizations. Describes revisions to policy. Lists, Privacy Officer, Regional Advocate and

Office of Health & Human Services contact numbers.

MUST BE POSTED AT ALL SERVICE SITES

Right to Access PHI

All individuals and/or legally appointed representatives have a right to inspect and/or obtain a copy of their medical record.

Exceptions Use in civil, criminal proceeding Inmate of correctional facility and if could jeopardize health &

safety Involved in research that includes treatment he/she agreed not to

have access to the information. The individuals psychiatrist or psychologist has determined that

the information could be injurious to the individuals mental or physical well-being.

Procedures outlined in policy

Request to Amend Medical Record

All consumer have a right to request an amendment to his/her medical record.

Must be requested in writing to the primary clinician.

PCS has 60 days to respond to the request. Can request an extension of 30 days.

Denial of Request to Amend

a. May deny the request if the information was not created by the agency;

b. May deny the request if the individual who created the information that the individual served wants amended is no longer an employee of the agency;

c. May deny the request if the information in the record is currently accurate and complete.

Amendment Approved a. The agency shall make the amendment. The minimum amendment

accepted is identifying the information to be amended then providing a link to the amended information.

b. Inform the individual served that the amendment(s) is accepted.

c. Obtain from the individual served the names and addresses of individuals who need to have the amended information.

d. Attempt to reach those individuals who need to have the amended information.

e. Attempt to contact other persons or business associates regarding the amended information if the information was detrimental to the client.

Minimum Necessary Policy

Privacy Rule requires that covered entities take reasonable steps to limit the use and disclosure of PHI.

Only the information necessary to meet the request is to be released.

The medical record in it’s entirety will not routinely be released.

All release of information must be approved by the lead clinician.

Fax Policy

All personnel must strictly observe fax policies.

May be faxed under certain circumstances

May not be faxed under certain circumstances

Protocol for faxing PHI. Security of PHI when faxing.

Email Policy

The e-mail system and all messages generated or handled by PCS’s equipment is considered part of business operations.

PCS reserves the right to monitor, audit, delete email messages.

It is not the policy of PCS to routinely monitor the contents of email. Only when a situation warrants such an action.

All emails containing PHI MUST BE encrypted before sending.

Email encryption procedures will be forthcoming. Until then, no PHI should be sent via email.

Business Associates Agreement

Business Associates - An entity that does things on our behalf and with whom we share/give access to PHI

Business Associate Agreement - Establishes permitted uses, disclosures, and safeguards for PHI

Examples: CSB Attorney, CARF, social services, auditors…

Authorization to Release Info Changes made to the disclaimer

statement.

Authorizations must be on file before any information can be released.

All releases of information must be recorded and made available to consumers upon request.

Frequently Asked Questions Documentation on PCS Intranet.

Other questions, contact Kippy Cassell

HIPAA is basically instituting best practices to protect the consumers privacy and confidentially.