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. Safeguard your medical and health insurance information and shred any insurance forms, prescriptions, or physician statements. See 45 C.F.R. 45 C.F.R. 164.522(a). What is appropriate for a particular covered entity will depend on the nature of the covered entity's business, as well as the covered entity's size and resources. 164.504(f).84 45 C.F.R. 164.512(g).36 45 C.F.R. A covered entity is allowed under the privacy rule to disclose protected health information to the patient or authorized representative without prior written approval. 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. 160.103 identifies five types of organized health care arrangements: 81 45 C.F.R. 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. The Rule permits covered entities to disclose protected health information (PHI) to law enforcement officials, without the individual's written authorization, under specific circumstances summarized below. 164.502(d)(2), 164.514(a) and (b).15 The following identifiers of the individual or of relatives, employers, or household members of the individual must be removed to achieve the "safe harbor" method of de-identification: (A) Names; (B) All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census (1) the geographic units formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000; (C) All elements of dates (except year) for dates directly related to the individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; (D) Telephone numbers; (E) Fax numbers; (F) Electronic mail addresses: (G) Social security numbers; (H) Medical record numbers; (I) Health plan beneficiary numbers; (J) Account numbers; (K) Certificate/license numbers; (L) Vehicle identifiers and serial numbers, including license plate numbers; (M) Device identifiers and serial numbers; (N) Web Universal Resource Locators (URLs); (O) Internet Protocol (IP) address numbers; (P) Biometric identifiers, including finger and voice prints; (Q) Full face photographic images and any comparable images; and any other unique identifying number, characteristic, or code, except as permitted for re-identification purposes provided certain conditions are met. "78) To be a hybrid entity, the covered entity must designate in writing its operations that perform covered functions as one or more "health care components." 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. 164.512(f).35 45 C.F.R. The transaction standards are established by the HIPAA Transactions Rule at 45 C.F.R. For help in determining whether you are covered, use CMS's decision tool. Not later than the first service encounter by personal delivery (for patient visits), by automatic and contemporaneous electronic response (for electronic service delivery), and by prompt mailing (for telephonic service delivery); By posting the notice at each service delivery site in a clear and prominent place where people seeking service may reasonably be expected to be able to read the notice; and. 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. 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. Authorization. Protected health information of the group health plan's enrollees for the plan sponsor to perform plan administration functions. GINA covers employers with 15 or more employees, including state and local governments. These penalty provisions are explained below. 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. Ron Kennedy - a psychiatrist who runs an anti-aging clinic. L. 104-191; 42 U.S.C. Overview: Each time a patient sees a doctor, is admitted to a hospital, goes to a pharmacist or sends a claim to a health plan, a record is made of their confidential health information. 164.530(g).74 45 C.F.R. U.S. Department of Health & Human Services A covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.62. A covered entity must maintain, until six years after the later of the date of their creation or last effective date, its privacy policies and procedures, its privacy practices notices, disposition of complaints, and other actions, activities, and designations that the Privacy Rule requires to be documented.75, Fully-Insured Group Health Plan Exception. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. 164.512(j).41 45 C.F.R. In addition, protected health information may be disclosed for notification purposes to public or private entities authorized by law or charter to assist in disaster relief efforts. All states try to protect children from neglect, abandonment and mistreatment, such as deprivation of clothing, shelter, food and medical care. 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. Small Health Plans. Tier 3: Obtaining PHI for personal gain or with malicious intent - Up to 10 years in jail. Civil Money Penalties. Group Health Plan disclosures to Plan Sponsors. 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. HIPAA stands for Health Insurance Portability and Accountability Act of 1996 (HIPAA) goal of HIPAA improving efficiency in healthcare by improving portability and continuity of healthcare coverage, addressing the problem of pre-existing conditions, and regulating privacy and security of health information Department of Health and Human Services For a complete understanding of the conditions and requirements for these disclosures, please review the exact regulatory text at the . 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. A covered entity must maintain reasonable and appropriate administrative, technical, and physical safeguards to prevent intentional or unintentional use or disclosure of protected health information in violation of the Privacy Rule and to limit its incidental use and disclosure pursuant to otherwise permitted or required use or disclosure.70 For example, such safeguards might include shredding documents containing protected health information before discarding them, securing medical records with lock and key or pass code, and limiting access to keys or pass codes. 164.508.45 A covered entity may condition the provision of health care solely to generate protected health information for disclosure to a third party on the individual giving authorization to disclose the information to the third party. 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. 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. An authorization for marketing that involves the covered entity's receipt of direct or indirect remuneration from a third party must reveal that fact. Compliance Schedule. 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. a notable exclusion of protected health information is quizlet; a notable exclusion of protected health information is quizlet. Protected Health Information. 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. 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. 164.506(c)(5).82 45 C.F.R. 164.520(c).53 45 C.F.R. In addition, covered entities may use or disclose a limited data set (protected health information (PHI) that excludes certain identifiers) for research, public health, or health care operations purposes without obtaining consent. In such situations, the individual must be given the right to have such denials reviewed by a licensed health care professional for a second opinion.57 Covered entities may impose reasonable, cost-based fees for the cost of copying and postage. Victims of Abuse, Neglect or Domestic Violence. Data Safeguards. It becomes individually identifiable health information when identifiers are included in the same record set, and it becomes protected when . 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. HIPAA applies to physicians and other individual and institutional health care providers (e.g., dentists, psychologists, hospitals, clinics, pharmacies, etc.). Is necessary for State reporting on health care delivery or costs, Is necessary for purposes of serving a compelling public health, safety, or welfare need, and, if a Privacy Rule provision is at issue, if the Secretary determines that the intrusion into privacy is warranted when balanced against the need to be served; or.

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