Affiliated Covered Entity. 164.502(a)(1)(iii).28 See 45 C.F.R. (3) Uses and Disclosures with Opportunity to Agree or Object. Similarly, an individual may request that the provider send communications in a closed envelope rather than a post card. TTD Number: 1-800-537-7697, Content created by Office for Civil Rights (OCR), U.S. Department of Health & Human Services, has sub items, about Compliance & Enforcement, has sub items, about Covered Entities & Business Associates, Other Administrative Simplification Rules, For help in determining whether you are covered, use CMS's decision tool. Business Associate Defined. that is maintained in the same record set as individually identifiable information (i.e., a name, an address, a phone number, etc. Reasonable Reliance. 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. Small Health Plans. Covered entities must establish and implement policies and procedures (which may be standard protocols) for routine, recurring disclosures, or requests for disclosures, that limits the protected health information disclosed to that which is the minimum amount reasonably necessary to achieve the purpose of the disclosure. 164.530(h).75 45 C.F.R. Protected Health Information Flashcards | Quizlet 164.501.23 45 C.F.R. Health plans and covered health care providers must permit individuals to request an alternative means or location for receiving communications of protected health information by means other than those that the covered entity typically employs.63 For example, an individual may request that the provider communicate with the individual through a designated address or phone number. A limited data set is protected health information that excludes the U.S. Department of Health & Human Services Because it is an overview of the Privacy Rule, it does not address every detail of each provision. 164.530(k).77 45 C.F.R. "80 Covered entities in an organized health care arrangement can share protected health information with each other for the arrangement's joint health care operations.81. 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. 160.103.8 45 C.F.R. OCR may impose a penalty on a covered entity for a failure to comply with a requirement of the Privacy Rule. Covered entities may disclose protected health information to health oversight agencies (as defined in the Rule) for purposes of legally authorized health oversight activities, such as audits and investigations necessary for oversight of the health care system and government benefit programs.32, Judicial and Administrative Proceedings. 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. The criminal penalties increase to $100,000 and up to five years imprisonment if the wrongful conduct involves false pretenses, and to $250,000 and up to 10 years imprisonment if the wrongful conduct involves the intent to sell, transfer, or use identifiable health information for commercial advantage, personal gain or malicious harm. HIPPA Flashcards | Quizlet Safeguard your medical and health insurance information and shred any insurance forms, prescriptions, or physician statements. A HIPAA violation is the use or disclosure of Protected Health Information (PHI) in a way that compromises an individual's right to privacy or security and poses a significant risk of financial, reputational, or other harm. ", Serious Threat to Health or Safety. A covered entity is allowed under the privacy rule to disclose protected health information to the patient or authorized representative without prior written approval. Access. sample business associate contract language. Common ownership exists if an entity possesses an ownership or equity interest of five percent or more in another entity; common control exists if an entity has the direct or indirect power significantly to influence or direct the actions or policies of another entity. 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. Marketing. Materials in this section are updated as new information and vaccines become available. 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. Enrollment or disenrollment information with respect to the group health plan or a health insurer or HMO offered by the plan. In the past, family doctors and other health care providers protected the confidentiality of those records by sealing them away in file cabinets and refusing to reveal them to anyone else. Medical Neglect & Vaccinations Reform - Child Usa Protected health information (PHI) under U.S. law is any information about health status, provision of health care, or payment for health care that is created or collected by a Covered Entity (or a Business Associate of a Covered Entity), and can be linked to a specific individual. 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. Covered entities that fail to comply voluntarily with the standards may be subject to civil money penalties. Communications to describe health-related products or services, or payment for them, provided by or included in a benefit plan of the covered entity making the communication; Communications about participating providers in a provider or health plan network, replacement of or enhancements to a health plan, and health-related products or services available only to a health plan's enrollees that add value to, but are not part of, the benefits plan; Communications for treatment of the individual; and. 164.504(g).83 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. GINA covers employers with 15 or more employees, including state and local governments. a notable exclusion of protected health information is quizlet 164.512(a), (c).32 45 C.F.R. Access and Uses. 508(b)(4).46 45 CFR 164.532.47 "Psychotherapy notes" means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the of the individual's medical record. Complaints. 164.522(a). Special statements are also required in the notice if a covered entity intends to contact individuals about health-related benefits or services, treatment alternatives, or appointment reminders, or for the covered entity's own fundraising.52 45 C.F.R. The Privacy Rule does not require that every risk of an incidental use or disclosure of protected health information be eliminated. Individual review of each disclosure is not required. 164.506(c)(5).82 45 C.F.R. Health Care Clearinghouses. 164.528.61 45 C.F.R. It becomes individually identifiable health information when identifiers are included in the same record set, and it becomes protected when . 164.530(f).70 45 C.F.R. 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. However, persons or organizations are not considered business associates if their functions or services do not involve the use or disclosure of protected health information, and where any access to protected health information by such persons would be incidental, if at all. 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. See 45 C.F.R. A covered entity must designate a privacy official responsible for developing and implementing its privacy policies and procedures, and a contact person or contact office responsible for receiving complaints and providing individuals with information on the covered entity's privacy practices.65, Workforce Training and Management. 164.512(k).42 45 C.F.R. In these situations, the Privacy Rule defers to State and other law to determine the rights of parents to access and control the protected health information of their minor children. A health plan satisfies its distribution obligation by furnishing the notice to the "named insured," that is, the subscriber for coverage that also applies to spouses and dependents. Thereafter, the health plan must give its notice to each new enrollee at enrollment, and send a reminder to every enrollee at least once every three years that the notice is available upon request. The Rule contains provisions that address a variety of organizational issues that may affect the operation of the privacy protections. The way to explain what is considered PHI under HIPAA is that health information is any information relating a patients condition, the past, present, or future provision of healthcare, or payment thereof. 164.522(a).62 45 C.F.R. Criminal laws protect children as well by, for example, making nonsupport . 164.502(a).17 45 C.F.R. A covered entity that does not make this designation is subject in its entirety to the Privacy Rule. Penalties will vary significantly depending on factors such as the date of the violation, whether the covered entity knew or should have known of the failure to comply, or whether the covered entity's failure to comply was due to willful neglect. 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. 164.508(a)(2).49 45 C.F.R. In emergency treatment situations, the provider must furnish its notice as soon as practicable after the emergency abates. Certain types of insurance entities are also not health plans, including entities providing only workers' compensation, automobile insurance, and property and casualty insurance. a notable exclusion of protected health information is quizlet 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. 164.520(b)(1)(vi).73 45 C.F.R. Health care providers include all "providers of services" (e.g., institutional providers such as hospitals) and "providers of medical or health services" (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care. 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. 9. Two types of government-funded programs are not health plans: (1) those whose principal purpose is not providing or paying the cost of health care, such as the food stamps program; and (2) those programs whose principal activity is directly providing health care, such as a community health center,5 or the making of grants to fund the direct provision of health care. 164.506(b).25 45 C.F.R. Yes. 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. 4. a notable exclusion of protected health information is: train travel in spain and portugal; new construction homes in port st lucie no hoa; . 58 If a covered entity accepts an amendment request, it must make reasonable efforts to provide the amendment to persons that the individual has identified as needing it, and to persons that the covered entity knows might rely on the information to the individual's detriment.59 If the request is denied, covered entities must provide the individual with a written denial and allow the individual to submit a statement of disagreement for inclusion in the record. The notice must include a point of contact for further information and for making complaints to the covered entity. For help in determining whether you are covered, use CMS's decision tool. The best way to protect yourself against this possibility is to make sure you verify the source before sharing your personal or medical information. Public Health Activities. These transactions include claims, benefit eligibility inquiries, referral authorization requests, or other transactions for which HHS has established standards under the HIPAA Transactions Rule.6 Using electronic technology, such as email, does not mean a health care provider is a covered entity; the transmission must be in connection with a standard transaction. Covered entities may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.40, Essential Government Functions. 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. > Summary of the HIPAA Privacy Rule. Ron Kennedy - a psychiatrist who runs an anti-aging clinic. 160.103.10 45 C.F.R. Health plans that do not report receipts to the Internal Revenue Service (IRS), for example, group health plans regulated by the Employee Retirement Income Security Act 1974 (ERISA) that are exempt from filing income tax returns, should use proxy measures to determine their annual receipts.92 See What constitutes a small health plan? See additional guidance on Minimum Necessary. a notable exclusion of protected health information is quizlet 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. 45 C.F.R. 1232g. endangerment. Health plans must accommodate reasonable requests if the individual indicates that the disclosure of all or part of the protected health information could endanger 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. In March 2002, the Department proposed and released for public comment modifications to the Privacy Rule. 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. 164.512(d).33 45 C.F.R. Covered Entities With Multiple Covered Functions. A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual's treatment. 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). 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. 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. Many of these privacy laws protect information that is related to health conditions . 164.512.29 45 C.F.R. Covered entities must act in accordance with their notices. (6) Limited Data Set. 164.501 and 164.508(a)(3).50 45 C.F.R. 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. 45 C.F.R. 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. 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. Privacy Policies and Procedures. Exception Determination. 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. michael todd soniclear beeping. A covered entity may use or disclose, without an individual's authorization, the psychotherapy notes, for its own training, and to defend itself in legal proceedings brought by the individual, for HHS to investigate or determine the covered entity's compliance with the Privacy Rules, to avert a serious and imminent threat to public health or safety, to a health oversight agency for lawful oversight of the originator of the psychotherapy notes, for the lawful activities of a coroner or medical examiner or as required by law. For Notification and Other Purposes. 164.514(e)(2).44 45 C.F.R. This includes civil laws which permit the removal of a child from the home and other protective interventions. 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. 164.103.80 The Privacy Rule at 45 C.F.R. About Those Inappropriate Medical Exemptions in California If another covered entity makes a request for protected health information, a covered entity may rely, if reasonable under the circumstances, on the request as complying with this minimum necessary standard. 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). ). Personal Representatives. What is Considered PHI under HIPAA? 2023 Update - HIPAA Journal The Rule also contains specific distribution requirements for direct treatment providers, all other health care providers, and health plans. 164.530(e).69 45 C.F.R. Data Safeguards. 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. Each covered entity, with certain exceptions, must provide a notice of its privacy practices.51 The Privacy Rule requires that the notice contain certain elements. 164.526.59 Covered entities may deny an individual's request for amendment only under specified circumstances. Self-insured plans, both funded and unfunded, should use the total amount paid for health care claims by the employer, plan sponsor or benefit fund, as applicable to their circumstances, on behalf of the plan during the plan's last full fiscal year. An authorization is not required to use or disclose protected health information for certain essential government functions. If an insurance entity has separable lines of business, one of which is a health plan, the HIPAA regulations apply to the entity with respect to the health plan line of business. 160.10314 45 C.F.R. Limiting Uses and Disclosures to the Minimum Necessary. 45 C.F.R. 164.530(i).65 45 C.F.R. (4) Incidental Use and Disclosure. Business Associate Contract. > Privacy Group Health Plan disclosures to Plan Sponsors. a notable exclusion of protected health information is: 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. 164.520(c).55 45 C.F.R. See additional guidance on Treatment, Payment, & Health Care Operations. Covered entities may disclose protected health information to: (1) public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect; (2) entities subject to FDA regulation regarding FDA regulated products or activities for purposes such as adverse event reporting, tracking of products, product recalls, and post-marketing surveillance; (3) individuals who may have contracted or been exposed to a communicable disease when notification is authorized by law; and (4) employers, regarding employees, when requested by employers, for information concerning a work-related illness or injury or workplace related medical surveillance, because such information is needed by the employer to comply with the Occupational Safety and Health Administration (OHSA), the Mine Safety and Health Administration (MHSA), or similar state law.30 See additional guidance on Public Health Activities and CDC's web pages on Public Health and HIPAA Guidance. 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. 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.
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