A group health plan, or a health insurer or HMO with respect to the group health plan, that intends to disclose protected health information (including enrollment data or summary health information) to the plan sponsor, must state that fact in the notice. code; (iii) Telephone numbers; (iv) Fax numbers; (v) Electronic mail addresses: (vi) Social These penalty provisions are explained below. 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. Among other things, the covered entity must identify to whom individuals can submit complaints to at the covered entity and advise that complaints also can be submitted to the Secretary of HHS. 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. In most cases, parents are the personal representatives for their minor children. The Privacy Rule does not require that every risk of an incidental use or disclosure of protected health information be eliminated. 1320d-1(a)(3). 164.502(a)(2).18 45 C.F.R. HIPPA Flashcards | Quizlet 160.202.87 45 C.F.R. 160.30488 Pub. 164.512(f).35 45 C.F.R. This is a summary of key elements of the Privacy Rule including who is covered, what information is protected, and how protected health information can be used and disclosed. "Research" is any systematic investigation designed to develop or contribute to generalizable knowledge.37 The Privacy Rule permits a covered entity to use and disclose protected health information for research purposes, without an individual's authorization, provided the covered entity obtains either: (1) documentation that an alteration or waiver of individuals' authorization for the use or disclosure of protected health information about them for research purposes has been approved by an Institutional Review Board or Privacy Board; (2) representations from the researcher that the use or disclosure of the protected health information is solely to prepare a research protocol or for similar purpose preparatory to research, that the researcher will not remove any protected health information from the covered entity, and that protected health information for which access is sought is necessary for the research; or (3) representations from the researcher that the use or disclosure sought is solely for research on the protected health information of decedents, that the protected health information sought is necessary for the research, and, at the request of the covered entity, documentation of the death of the individuals about whom information is sought.38 A covered entity also may use or disclose, without an individuals' authorization, a limited data set of protected health information for research purposes (see discussion below).39 See additional guidance on Research and NIH's publication of "Protecting Personal Health Information in Research: Understanding the HIPAAPrivacy Rule. February 5, 2015. 45 C.F.R. Part 162.7 45 C.F.R. Tier 3: Obtaining PHI for personal gain or with malicious intent - Up to 10 years in jail. Collectively these are known as the. by . A covered entity must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request.50 A covered entity must develop and implement policies and procedures to reasonably limit uses and disclosures to the minimum necessary. A covered entity is allowed under the privacy rule to disclose protected health information to the patient or authorized representative without prior written approval. Protected health information - Wikipedia Business Associate Contract. The notice must describe the ways in which the covered entity may use and disclose protected health information. 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). A health plan with annual receipts of not more than $5 million is a small health plan.91 Health plans that file certain federal tax returns and report receipts on those returns should use the guidance provided by the Small Business Administration at 13 Code of Federal Regulations (CFR) 121.104 to calculate annual receipts. What You Can Do to Protect Your Health Information For internal uses, a covered entity must develop and implement policies and procedures that restrict access and uses of protected health information based on the specific roles of the members of their workforce. 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. L. 104-191; 42 U.S.C. a notable exclusion of protected health information is: Kenneth Stoller. All states try to protect children from neglect, abandonment and mistreatment, such as deprivation of clothing, shelter, food and medical care. Except in certain circumstances, individuals have the right to review and obtain a copy of their protected health information in a covered entity's designated record set.55 The "designated record set" is that group of records maintained by or for a covered entity that is used, in whole or part, to make decisions about individuals, or that is a provider's medical and billing records about individuals or a health plan's enrollment, payment, claims adjudication, and case or medical management record systems.56 The Rule excepts from the right of access the following protected health information: psychotherapy notes, information compiled for legal proceedings, laboratory results to which the Clinical Laboratory Improvement Act (CLIA) prohibits access, or information held by certain research laboratories. Related to Medical Exemption. 164.500(b).9 45 C.F.R. Breach Reporting | HHS.gov security numbers; (vii) Medical record numbers; (viii) Health plan beneficiary numbers; (ix) And others have been called out in the media for writing excessive numbers . 164.501.48 45 C.F.R. a notable exclusion of protected health information is: It becomes individually identifiable health information when identifiers are included in the same record set, and it becomes protected when . HIPAA: Privacy rule exclusions - OpenAnesthesia Criminal laws protect children as well by, for example, making nonsupport . 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). U.S. Department of Health & Human Services Every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity. Organized Health Care Arrangement. 164.512(h).37 The Privacy Rule defines research as, "a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge." a notable exclusion of protected health information is quizlet This information is called protected health information (PHI), which is generally individually identifiable health information that is transmitted by, or maintained in, electronic media or any other form or medium. HIPAA applies to physicians and other individual and institutional health care providers (e.g., dentists, psychologists, hospitals, clinics, pharmacies, etc.). Required by Law. 164.530(h).75 45 C.F.R. 164.501.21 45 C.F.R. a notable exclusion of protected health information is: train travel in spain and portugal; new construction homes in port st lucie no hoa; . Similarly, a covered entity may rely upon requests as being the minimum necessary protected health information from: (a) a public official, (b) a professional (such as an attorney or accountant) who is the covered entity's business associate, seeking the information to provide services to or for the covered entity; or (c) a researcher who provides the documentation or representation required by the Privacy Rule for research. In certain circumstances, covered entities may disclose protected health information to appropriate government authorities regarding victims of abuse, neglect, or domestic violence.31, Health Oversight Activities. 164.530(e).69 45 C.F.R. (1) To the Individual. For information included within the right of access, covered entities may deny an individual access in certain specified situations, such as when a health care professional believes access could cause harm to the individual or another. 45 C.F.R. 164.520(d).54 45 C.F.R. L. 104-191; 42 U.S.C. 164.512(j).41 45 C.F.R. Legally separate covered entities that are affiliated by common ownership or control may designate themselves (including their health care components) as a single covered entity for Privacy Rule compliance.79 The designation must be in writing. A health plan may condition enrollment or benefits eligibility on the individual giving authorization, requested before the individual's enrollment, to obtain protected health information (other than psychotherapy notes) to determine the individual's eligibility or enrollment or for underwriting or risk rating. When a covered entity uses a contractor or other non-workforce member to perform "business associate" services or activities, the Rule requires that the covered entity include certain protections for the information in a business associate agreement (in certain circumstances governmental entities may use alternative means to achieve the same protections). All group health plans maintained by the same plan sponsor. Resource Locators (URLs); (xiv) Internet Protocol (IP) address numbers; (xv) Biometric There are exceptionsa group health plan with less than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity. 164.512(i).39 45 CFR 164.514(e).40 45 C.F.R. Marketing. Access and Uses. The Rule also contains specific distribution requirements for direct treatment providers, all other health care providers, and health plans. Privacy Practices Notice. A covered entity may not retaliate against a person for exercising rights provided by the Privacy Rule, for assisting in an investigation by HHS or another appropriate authority, or for opposing an act or practice that the person believes in good faith violates the Privacy Rule.73 A covered entity may not require an individual to waive any right under the Privacy Rule as a condition for obtaining treatment, payment, and enrollment or benefits eligibility.74, Documentation and Record Retention. 164.526(a)(2).60 45 C.F.R. Permitted Uses and Disclosures. Covered entities may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.36, Research. Similarly, a covered entity may rely on an individual's informal permission to use or disclose protected health information for the purpose of notifying (including identifying or locating) family members, personal representatives, or others responsible for the individual's care of the individual's location, general condition, or death. Hybrid Entity. 200 Independence Avenue, S.W. A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.44 A covered entity may not condition treatment, payment, enrollment, or benefits eligibility on an individual granting an authorization, except in limited circumstances.45. 164.506(c).20 45 C.F.R. 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. 1320d-6.90 45 C.F.R. In addition to the removal of the above-stated identifiers, the covered entity may not have actual knowledge that the remaining information could be used alone or in combination with any other information to identify an individual who is subject of the information. Protecting the Privacy of Patients' Health Information | ASPE 164.512(l).43 45 C.F.R. 1320d-5.89 Pub. The Privacy Rule requires a covered entity to treat a "personal representative" the same as the individual, with respect to uses and disclosures of the individual's protected health information, as well as the individual's rights under the Rule.84 A personal representative is a person legally authorized to make health care decisions on an individual's behalf or to act for a deceased individual or the estate. After making this designation, most of the requirements of the Privacy Rule will apply only to the health care components. 164.103.79 45 C.F.R. Kelly Sutton - an holistic and anthroposophic doctor. 164.502(a).17 45 C.F.R. A clinically-integrated setting where individuals typically receive health care from more. 164.103.80 The Privacy Rule at 45 C.F.R. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual's relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15, General Principle for Uses and Disclosures, Basic Principle. The Privacy Rule permits use and disclosure of protected health information, without an individual's authorization or permission, for 12 national priority purposes.28 These disclosures are permitted, although not required, by the Rule in recognition of the important uses made of health information outside of the health care context. In addition, if OCR states that it intends to impose a penalty, a covered entity has the right to request an administrative hearing to appeal the proposed penalty. 164.530(g).74 45 C.F.R. a notable exclusion of protected health information is quizlet; a notable exclusion of protected health information is quizlet. Complaints. L. 104-191.2 65 FR 82462.3 67 FR 53182.4 45 C.F.R. Many California docs are being investigated for writing inappropriate medical exemptions, including: Bob Sears. 164.534.91 45 C.F.R. Public Health Activities. A covered entity that performs multiple covered functions must operate its different covered functions in compliance with the Privacy Rule provisions applicable to those covered functions.82 The covered entity may not use or disclose the protected health information of an individual who receives services from one covered function (e.g., health care provider) for another covered function (e.g., health plan) if the individual is not involved with the other function. Organizational groups and regulations that affect medical records. 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. 164.530(c).71 45 C.F.R. 45 C.F.R. 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. For a complete understanding of the conditions and requirements for these disclosures, please review the exact regulatory text at the . 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. Most uses and disclosures of psychotherapy notes for treatment, payment, and health care operations purposes require an authorization as described below.23 Obtaining "consent" (written permission from individuals to use and disclose their protected health information for treatment, payment, and health care operations) is optional under the Privacy Rule for all covered entities.24 The content of a consent form, and the process for obtaining consent, are at the discretion of the covered entity electing to seek consent. 164.502(a)(1)(iii).28 See 45 C.F.R. 160.102, 160.103.5 Even if an entity, such as a community health center, does not meet the definition of a health plan, it may, nonetheless, meet the definition of a health care provider, and, if it transmits health information in electronic form in connection with the transactions for which the Secretary of HHS has adopted standards under HIPAA, may still be a covered entity.6 45 C.F.R. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official's request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person's death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.34, Decedents. 164.501.22 45 C.F.R. You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. In the Journals: Impact of CA SB277 Removing Non-medical Exemptions 164.530(k).77 45 C.F.R. 164.530(j).76 45 C.F.R. The Privacy Rule permits covered entities to disclose protected health information, without authorization, to persons or entities activities including: Required by Law or Judicial and Administrative Proceedings Prevention or control of disease, injury, or disability Child or adult abuse, neglect, or domestic Violence Exceptions to the HIPAA Privacy Policy - UniversalClass.com A covered entity must notify the Secretary if it discovers a breach of unsecured protected health information. a notable exclusion of protected health information is quizlet Because it is an overview of the Privacy Rule, it does not address every detail of each provision. 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. Therefore the flexibility and scalability of the Rule are intended to allow covered entities to analyze their own needs and implement solutions appropriate for their own environment. Individuals have a right to an accounting of the disclosures of their protected health information by a covered entity or the covered entity's business associates.60 The maximum disclosure accounting period is the six years immediately preceding the accounting request, except a covered entity is not obligated to account for any disclosure made before its Privacy Rule compliance date. HIPAA Privacy Rule - Centers for Disease Control and Prevention a notable exclusion of protected health information is quizlet 164.502(e), 164.504(e).11 45 C.F.R. "Individually identifiable health information" is information, including demographic data, that relates to: and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number). Members of the clergy are not required to ask for the individual by name when inquiring about patient religious affiliation. It may allow use and disclosure of protected health information by the covered entity seeking the authorization, or by a third party. 164.504(g).83 45 C.F.R. 164.512.29 45 C.F.R. The . 9. 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. 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. 164.530(f).70 45 C.F.R. In addition, a restriction agreed to by a covered entity is not effective under this subpart to prevent uses or disclosures permitted or required under 164.502(a)(2)(ii), 164.510(a) or 164.512.63 45 C.F.R. 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. A covered entity that does not make this designation is subject in its entirety to the Privacy Rule. Limiting Uses and Disclosures to the Minimum Necessary. According to the Health Insurance Portability and Accountability Act (HIPAA), protected health information (PHI) is any health information that can identify an individual that is in possession of or transmitted by a "covered entity" or its business associates that relates to a patient's past, present, or future health. A covered entity may deny the request if it: (a) may exclude the information from access by the individual; (b) did not create the information (unless the individual provides a reasonable basis to believe the originator is no longer available); (c) determines that the information is accurate and complete; or (d) does not hold the information in its designated record set. Individual review of each disclosure is not required. The Privacy Rule permits a covered entity that is a single legal entity and that conducts both covered and non-covered functions to elect to be a "hybrid entity. elgin mental health center forensic treatment program. A group health plan and the health insurer or HMO offered by the plan may disclose the following protected health information to the "plan sponsor"the employer, union, or other employee organization that sponsors and maintains the group health plan:83, Other Provisions: Personal Representatives and Minors. See our Combined Regulation Text of All Rules section of our site for the full suite of HIPAAAdministrative Simplification Regulations and Understanding HIPAA for additional guidance material. A covered entity must develop and implement written privacy policies and procedures that are consistent with the Privacy Rule.64, Privacy Personnel. Covered entities may disclose protected health information as authorized by, and to comply with, workers' compensation laws and other similar programs providing benefits for work-related injuries or illnesses.42 See additional guidance on Workers' Compensation. Before OCR imposes a penalty, it will notify the covered entity and provide the covered entity with an opportunity to provide written evidence of those circumstances that would reduce or bar a penalty.
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