quizlet the health insurance portability and accountability act
(2) Treatment, Payment, Health Care Operations. 164.530(a).66 45 C.F.R. it prohibits group health plans from denying eligibility for benefits or charging more for coverage based on any "health . HIPAA is the Health Insurance Portability and Accountability Act, which sets a standard for patient data protection. After making this designation, most of the requirements of the Privacy Rule will apply only to the health care components. Covered entities may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.36, Research. 164.530(k).77 45 C.F.R. c. It prohibits group In the context of health care legislations, which of the following is true of the Health Insurance Portability and Accountability Act (HIPAA)? If you're dealing with protected health information, then HIPAA compliance is the primary requirement and concern. In the business associate contract, a covered entity must impose specified written safeguards on the individually identifiable health information used or disclosed by its business associates.10 Moreover, a covered entity may not contractually authorize its business associate to make any use or disclosure of protected health information that would violate the Rule. Sections 261 through 264 of HIPAA require the Secretary of HHS to publicize standards for the electronic exchange, privacy and security of health information. 21, 1996 110 STAT. A person who knowingly obtains or discloses individually identifiable health information in violation of the Privacy Rule may face a criminal penalty of up to $50,000 and up to one-year imprisonment. Covered entities, whether direct treatment providers or indirect treatment providers (such as laboratories) or health plans must supply notice to anyone on request.52 A covered entity must also make its notice electronically available on any web site it maintains for customer service or benefits information. The average price of a gallon of unleaded regular gasoline was reported to be \$2.34 $2.34 in northern Kentucky (The Cincinnati Enquirer, January 21, ~2006 21, 2006 ). A covered entity must obtain an authorization to use or disclose protected health information for marketing, except for face-to-face marketing communications between a covered entity and an individual, and for a covered entity's provision of promotional gifts of nominal value. Where the individual is incapacitated, in an emergency situation, or not available, covered entities generally may make such uses and disclosures, if in the exercise of their professional judgment, the use or disclosure is determined to be in the best interests of the individual. The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. the Department of Justice has imposed a criminal penalty for the failure to comply (see below). 164.512(e).34 45 C.F.R. That's not easy to answer. Minimum Necessary. A group health plan and the health insurer or HMO that insures the plan's benefits, with respect to protected health information created or received by the insurer or HMO that relates to individuals who are or have been participants or beneficiaries of the group health plan. The Health Insurance Portability and Accountability Act of 1996 ( HIPAA or the Kennedy - Kassebaum Act [1] [2]) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. used or disclosed. An authorization is not required to use or disclose protected health information for certain essential government functions. Covered entities that had an existing written contract or agreement with business associates prior to October 15, 2002, which was not renewed or modified prior to April 14, 2003, were permitted to continue to operate under that contract until they renewed the contract or April 14, 2004, whichever was first.11 See additional guidance on Business Associates and sample business associate contract language. the past, present, or future payment for the provision of health care to the individual. Cookies used to make website functionality more relevant to you. Compliance. All information these cookies collect is aggregated and therefore anonymous. Complaints. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.45 C.F.R. Saving Lives, Protecting People, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Selected Local Public Health Counsel Directory, Bordering Countries Public Health Counsel Directory, CDC Public Health Law Educational Opportunities, Apply to Be a Host Site for CDCs Public Health Law Fellowship, U.S. Department of Health & Human Services. question. Individual and group plans that provide or pay the cost of medical care are covered entities.4 Health plans include health, dental, vision, and prescription drug insurers, health maintenance organizations ("HMOs"), Medicare, Medicaid, Medicare+Choice and Medicare supplement insurers, and long-term care insurers (excluding nursing home fixed-indemnity policies). The Privacy Rule does not require accounting for disclosures: (a) for treatment, payment, or health care operations; (b) to the individual or the individual's personal representative; (c) for notification of or to persons involved in an individual's health care or payment for health care, for disaster relief, or for facility directories; (d) pursuant to an authorization; (e) of a limited data set; (f) for national security or intelligence purposes; (g) to correctional institutions or law enforcement officials for certain purposes regarding inmates or individuals in lawful custody; or (h) incident to otherwise permitted or required uses or disclosures. 164.103.80 The Privacy Rule at 45 C.F.R. Any covered entity may condition compliance with a confidential communication request on the individual specifying an alternative address or method of contact and explaining how any payment will be handled. Affiliated Covered Entity. Informal permission may be obtained by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object. Preemption. Communications for case management or care coordination for the individual, or to direct or recommend alternative treatments, therapies, health care providers, or care settings to the individual. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Individuals have the right to request that a covered entity restrict use or disclosure of protected health information for treatment, payment or health care operations, disclosure to persons involved in the individual's health care or payment for health care, or disclosure to notify family members or others about the individual's general condition, location, or death.61 A covered entity is under no obligation to agree to requests for restrictions. Privacy Policies and Procedures. For more information, visit HHSsHIPAA website. [3] Enrollment or disenrollment information with respect to the group health plan or a health insurer or HMO offered by the plan. 164.522(a).62 45 C.F.R. 160.103.8 45 C.F.R. See additional guidance on Minimum Necessary. Payment encompasses activities of a health plan to obtain premiums, determine or fulfill responsibilities for coverage and provision of benefits, and furnish or obtain reimbursement for health care delivered to an individual21 and activities of a health care provider to obtain payment or be reimbursed for the provision of health care to an individual. The health plan may not question the individual's statement of The Security Rule does not apply to PHI transmitted orally or in writing. Similarly, an individual may request that the provider send communications in a closed envelope rather than a post card. 164.526.59 Covered entities may deny an individual's request for amendment only under specified circumstances. L. 104-191; 42 U.S.C. Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat). 802), or that is deemed a controlled substance by State law. Health care clearinghouses are entities that process nonstandard information they receive from another entity into a standard (i.e., standard format or data content), or vice versa.7 In most instances, health care clearinghouses will receive individually identifiable health information only when they are providing these processing services to a health plan or health care provider as a business associate. See additional guidance on Notice. 160.103.10 45 C.F.R. Therefore, in most cases, parents can exercise individual rights, such as access to the medical record, on behalf of their minor children. The Health Insurance Portability and Accountability Act ( HIPAA) lays out three rules for protecting patient health information. Consistent with the principles for achieving compliance provided in the Privacy Rule, OCR will seek the cooperation of covered entities and may provide technical assistance to help them comply voluntarily with the Privacy Rule. Covered entities may disclose protected health information in a judicial or administrative proceeding if the request for the information is through an order from a court or administrative tribunal. All authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data. 45 C.F.R. A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual's protected heath information may be used or disclosed by covered entities. Treatment is the provision, coordination, or management of health care and related services for an individual by one or more health care providers, including consultation between providers regarding a patient and referral of a patient by one provider to another.20. All covered entities, except "small health plans," must have been compliant with the Privacy Rule by April 14, 2003.90 Small health plans, however, had until April 14, 2004 to comply. 164.53212 45 C.F.R. The HIPAA Security Rule protects a subset of information covered by the Privacy Rule. These policies and procedures must identify the persons, or classes of persons, in the workforce who need access to protected health information to carry out their duties, the categories of protected health information to which access is needed, and any conditions under which they need the information to do their jobs. They talk about his physical description and use his doctor's name. In general, State laws that are contrary to the Privacy Rule are preempted by the federal requirements, which means that the federal requirements will apply.85 "Contrary" means that it would be impossible for a covered entity to comply with both the State and federal requirements, or that the provision of State law is an obstacle to accomplishing the full purposes and objectives of the Administrative Simplification provisions of HIPAA.86 The Privacy Rule provides exceptions to the general rule of federal preemption for contrary State laws that (1) relate to the privacy of individually identifiable health information and provide greater privacy protections or privacy rights with respect to such information, (2) provide for the reporting of disease or injury, child abuse, birth, or death, or for public health surveillance, investigation, or intervention, or (3) require certain health plan reporting, such as for management or financial audits. A covered entity must disclose protected health information in only two situations: (a) to individuals (or their personal representatives) specifically when they request access to, or an accounting of disclosures of, their protected health information; and (b) to HHS when it is undertaking a compliance investigation or review or enforcement action.17 See additional guidance on Government Access. covered entity has a reasonable belief that the personal representative may be abusing or neglecting the individual, or that treating the person as the personal representative could otherwise endanger the individual. 164.501.57 A covered entity may deny an individual access, provided that the individual is given a right to have such denials reviewed by a licensed health care professional (who is designated by the covered entity and who did not participate in the original decision to deny), when a licensed health care professional has determined, in the exercise of professional judgment, that: (a) the access requested is reasonably likely to endanger the life or physical safety of the individual or another person; (b) the protected health information makes reference to another person (unless such other person is a health care provider) and the access requested is reasonably likely to cause substantial harm to such other person; or (c) the request for access is made by the individual's personal representative and the provision of access to such personal representative is reasonably likely to cause substantial harm to the individual or another person. Account numbers; (x) Certificate/license numbers; (xi) Vehicle identifiers and serial numbers, identifiers, including finger and voice prints; (xvi) Full face photographic images and any Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. CDC twenty four seven. A use or disclosure of this information that occurs as a result of, or as "incident to," an otherwise permitted use or disclosure is permitted as long as the covered entity has adopted reasonable safeguards as required by the Privacy Rule, and the information being shared was limited to the "minimum necessary," as required by the Privacy Rule.27 See additional guidance on Incidental Uses and Disclosures. b. HHS recognizes that covered entities range from the smallest provider to the largest, multi-state health plan. 164.520(b)(1)(vi).73 45 C.F.R. 45 C.F.R. 164.502(a)(1).19 45 C.F.R. A covered health care provider may rely on an individual's informal permission to list in its facility directory the individual's name, general condition, religious affiliation, and location in the provider's facility.25 The provider may then disclose the individual's condition and location in the facility to anyone asking for the individual by name, and also may disclose religious affiliation to clergy. Official websites use .gov L. 104-191; 42 U.S.C. 164.530(f).70 45 C.F.R. "Summary health information" is information that summarizes claims history, claims expenses, or types of claims experience of the individuals for whom the plan sponsor has provided health benefits through the group health plan, and that is stripped of all individual identifiers other than five digit zip code (though it need not qualify as de-identified protected health information). A covered entity may use and disclose protected health information for its own treatment, payment, and health care operations activities.19 A covered entity also may disclose protected health information for the treatment activities of any health care provider, the payment activities of another covered entity and of any health care provider, or the health care operations of another covered entity involving either quality or competency assurance activities or fraud and abuse detection and compliance activities, if both covered entities have or had a relationship with the individual and the protected health information pertains to the relationship. Hospital Indemnity. The Privacy Rule permits important uses of information while protecting the privacy of people who seek care and healing. Covered entities that fail to comply voluntarily with the standards may be subject to civil money penalties. Organized Health Care Arrangement. A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual's personal representative) authorizes in writing.16. The notice must describe the ways in which the covered entity may use and disclose protected health information. 164.512(g).36 45 C.F.R. Such functions include: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.41. A covered health care provider may condition treatment related to research (e.g., clinical trials) on the individual giving authorization to use or disclose the individual's protected health information for the research. No authorization is needed, however, to make a communication that falls within one of the exceptions to the marketing definition. This evidence must be submitted to OCR within 30 days of receipt of the notice. Individual review of each disclosure is not required. A covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.62. caitlinblake . 164.520(c).55 45 C.F.R. Facility Directories. Protected Health Information. Health care operations are any of the following activities: (a) quality assessment and improvement activities, including case management and care coordination; (b) competency assurance activities, including provider or health plan performance evaluation, credentialing, and accreditation; (c) conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; (d) specified insurance functions, such as underwriting, risk rating, and reinsuring risk; (e) business planning, development, management, and administration; and (f) business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the covered entity.22. HIPAA Enforcement. The only administrative obligations with which a fully-insured group health plan that has no more than enrollment data and summary health information is required to comply are the (1) ban on retaliatory acts and waiver of individual rights, and (2) documentation requirements with respect to plan documents if such documents are amended to provide for the disclosure of protected health information to the plan sponsor by a health insurance issuer or HMO that services the group health plan.76. When the minimum necessary standard applies to a use or disclosure, a covered entity may not use, disclose, or request the entire medical record for a particular purpose, unless it can specifically justify the whole record as the amount reasonably needed for the purpose. A covered entity is permitted, but not required, to use and disclose protected health information, without an individual's authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) Opportunity to Agree or Object; (4) Incident to an otherwise permitted use and disclosure; (5) Public Interest and Benefit Activities; and (6) Limited Data Set for the purposes of research, public health or health care operations.18 Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make. Fail to comply voluntarily with the agreed restrictions, except for purposes of treating individual. Security Rule does not apply to PHI transmitted orally or in writing multi-state plan. That fail to comply ( see below ) plan or a health insurer or HMO offered by Privacy. 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