Transcript No Slide Title

H E A L T H
A D V O C A C Y
HIPAA
Health Insurance Portability &
Accountability Act
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA

Does not preempt more protective state law

First federal privacy law
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Covered Entities
Health Care Providers
 Health Plans
 Health Care Clearinghouses

Key - Transmit information electronically
Compliance by April 14, 2003
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Does Not Include

Employers (with special rules)

Casualty and property insurers

Workers compensation carriers
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Enforcement

Civil and criminal penalties

No right to a federal lawsuit
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA
Covers:
All health information including electronic
and paper records as well as oral
communication
Patient consent is not required (with some
exceptions)/patient must be notified of
rights & how information will be used
disclosed
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA

Entities are required to make a “good faith
effort” to inform patients in a notice of
privacy practices about how sensitive
information is used disclosed

Reasonable efforts must be made to
use/disclose minimum amount of
information necessary
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA
Use & disclosure of protected health information
without consent:
 For their own treatment

Payment

Health care operations

To other covered entities for specified purposes
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA

Patients have a right to inspect, copy,
amend & receive an accounting of
disclosures
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA
Patient must be informed in advance and be given
opportunity to agree to, object to or restrict
certain uses and disclosures

Info in health care facility directory

Disclosure to person’s involved with the patient’s
care
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Patient Ability to Restrict
Disclosure

Patient must be provided with the opportunity to
restrict disclosure for treatment, payment and
health care operations

Health care providers and plans must accommodate
reasonable requests about how and where to
communicate with patient/may require statement
re: danger

Entities may refuse to treat person’s personal
representative & refuse access to patient’s health
info
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Psychotherapy Notes


Entities must obtain authorization from the
individual to use and disclose psychotherapy
notes
Notes can be disclosed in certain
circumstances
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Minors

A parent is the personal representative of an
unemancipated minor/in most cases minor does not
have rights associated with his/her own medical
information

Exception - minors authorized by law to consent to
treatment, parent/guardian assents to an agreement of
confidentiality between provider and minor
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Minors Right to Consent


To test for or treat pregnancy, STDs and
AIDS (HIV testing)
To receive contraceptives, including
emergency contraception from clinics
receiving federal funding for family
planning services through Title X (law
silent on other providers)
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Minors Right to Consent




Medical care for sexual assault with the
exception of child abuse
Diagnosis or treatment of drug and/or
alcohol abuse
14 and up - voluntary inpatient mental
health treatment (parents are notified)
14 and up -no law re: outpatient mental
health counseling
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Minors Right to Consent


Under 18 - if graduated from high school,
married, has been pregnant
Female who is or has been married or
given birth may consent to all health care
services for her child (law silent on males)
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Reporting Requirements
Health info may be disclosed for limited public policy purposes:

Child abuse and neglect
Abuse, neglect or domestic violence under certain circumstances individual agrees; disclosure required by law, statute or regulation;
victim must be informed unless there is a perceived risk


Law- enforcement under certain circumstances
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
CAUTION
Individuals seeking health information in
judicial and administrative proceedings
must make reasonable efforts to notify
individuals who are the subject of the
information that their health information
had been requested
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Employers
Those with health care components
and those that sponsor group health plans
must erect firewalls, adopt policies and
identify individuals that can have access to
health information to ensure that information
is not used in employment determinations
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
HIPAA

Entities must obtain authorization to use and
disclose health information for purposes other
than treatment, payment and health care
operations

Health plans may condition enrollment,
eligibility for benefits, payment of claims for
certain benefits on the individual signing an
authorization to disclose information
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
So now what?
Health plans - payers or insurers of health care
Health care clearinghouses- entities that engage
in activities such as billing services, repricing,
community health info systems & “Value
added” networks that receive or process health
info
Health care providers - only providers or health
or medical services who transmit info in
electronic forum in connection with certain
insurance related transactions
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Are you a health care
provider?
Health care services related to the health of an
individual
 Preventative, diagnostic, therapeutic,
rehabilitative, maintenance or palliative care,
counseling, service, assessment or procedure
with respect to the physical or mental condition
or functional status of an individual or that
affects the structure or function of the body
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Are you a health care
provider?

Sale or dispensing of a drug, device,
equipment, or other item in accordance
with a prescription

Do you furnish or provide, bill for or
receive payment for health care services
in the normal course of business?
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Health Care Services
Physician services
 Services commonly furnished by physician
offices
 Hospital services incident to physician’s
services rendered to outpatients
 Various diagnostic services provided by a
hospital

P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Health Care Services

Outpatient physical therapy

Rural health clinic services & federally qualified health
center services

Qualified psychologist services

Clinical social worker services
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Business Associates
An entity that conducts an activity involving
the use and disclosure of protected health
information on behalf of a covered entity
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Business Associates
Covered entities are not required to have business
associate contracts with providers to whom they
disclose information for treatment of an
individual
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Business Associates
Sign a business associate contract?
Obtain a release of information?
Protect your confidentiality privilege
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Hybrid entities
Be clear
Establish policies
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
If you are a covered entity?



Designate a privacy official responsible for
policies and a contact person to receive
complaints
Retain copies of policies for 6 years from date
of implementation or change
Develop safeguards to protect the privacy of
health info
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
If you are a covered entity

Develop a complaint process and document all
complaints received and disposition

Train all of the workforce on HIPAA and
document the training

Provide clients with a notice of privacy
practices
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE
H E A L T H
A D V O C A C Y
Resources

http://www.hhs.gov/ocr/hipaa/

http://www.healthprivacy.org
P E N N S Y L V A N I A
C O A L I T I O N
A G A I N S T
P E N N S Y L V A N I A
C O A L I T I O N
D O M E S T I C
V I O L E N C E
A G A I N S T
RAPE