quizlet the health insurance portability and accountability act

We take your privacy seriously. Preemption. 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. Though it is widely known as a medical privacy and data security law, the Health Insurance Portability and Accountability Act (HIPAA) was passed and signed into law by President Bill Clinton primarily to improve the health care system's efficiency and effectiveness. 45 C.F.R. 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. 164.506(c)(5).82 45 C.F.R.

164.512(j).41 45 C.F.R. The notice must include a point of contact for further information and for making complaints to the covered entity. The Privacy Rule permits an exception when a 164.522(a).

Major medical expense insurance- cover expenses for a serious injury or long-term illness. Study with Quizlet and memorize flashcards containing terms like What is the purpose of Health Insurance Portability and Accountability Act of 1996?, If an individual's PHI has been breached, what must be done according to HIPAA?, Does HIPAA set standards for protecting electronic PHI, such as electronic medical records (EMR)? Frequently Asked Questions for Professionals- Please see the HIPAA FAQs for additional guidance on health information privacy topics. In addition, certain violations of the Privacy Rule may be subject to criminal prosecution. Organized Health Care Arrangement. a health insurance plan that directly employs or contracts with selected, or preapproved, physicians and other medical professionals to provide health care services in exchange for a fixed, prepaid monthly premium . The HIPAA Security Rule protects a subset of information covered by the Privacy Rule. Individual review of each disclosure is not required. 164.502(a)(1).19 45 C.F.R. ", https://www.federalregister.gov/documents/2019/04/30/2019-08530/enforcement-discretion-regarding-hipaa-civil-money-penalties, Frequently Asked Questions for Professionals, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, was enacted on August 21, 1996. 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. 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. 160.102, 160.103; see Social Security Act 1172(a)(3), 42 U.S.C. Those plans that provide health benefits through a mix of purchased insurance and self-insurance should combine proxy measures to determine their total annual receipts. Compliance Schedule. 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 covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.62. 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. 164.512(a).30 45 C.F.R. Permitted Uses and Disclosures. 1 Pub.

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. A covered entity also may rely on an individual's informal permission to disclose to the individual's family, relatives, or friends, or to other persons whom the individual identifies, protected health information directly relevant to that person's involvement in the individual's care or payment for care.26 This provision, for example, allows a pharmacist to dispense filled prescriptions to a person acting on behalf of the patient. comparable images. 164.526.59 Covered entities may deny an individual's request for amendment only under specified circumstances. 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. 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. 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. sample business associate contract language. 164.530(d).72 45 C.F.R. Question: The Health Insurance Portability and Accountability Act (HIPAA) requires a. employers with more than 50 employees provide medical insurance for all full-time employees. The following types of individuals and organizations are subject to the Privacy Rule and considered covered entities: Exception: A group health plan with fewer than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity. 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. A covered entity must have procedures for individuals to complain about its compliance with its privacy policies and procedures and the Privacy Rule.71 The covered entity must explain those procedures in its privacy practices notice.72. 200 Independence Avenue, S.W. identifiers, including finger and voice prints; (xvi) Full face photographic images and any Workforce members include employees, volunteers, trainees, and may also include other persons whose conduct is under the direct control of the entity (whether or not they are paid by the entity).66 A covered entity must train all workforce members on its privacy policies and procedures, as necessary and appropriate for them to carry out their functions.67 A covered entity must have and apply appropriate sanctions against workforce members who violate its privacy policies and procedures or the Privacy Rule.68, Mitigation. A central aspect of the Privacy Rule is the principle of "minimum necessary" use and disclosure. 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. The Privacy Rule also contains standards for individuals rights to understand and control how their health information is used. See additional guidance on Minimum Necessary. 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. The Privacy Rule The Security Rule The Breach Notification Rule These three rules set national standards for the purpose. What Is the Health Insurance Portability and Accountability Act (HIPAA)?
Health Plans. HIPAA - Health Information Privacy 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. used or disclosed. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patients consent or knowledge. The law permits, but does not require, a covered entity to use and disclose PHI, without an individuals authorization, for the following purposes or situations: While the HIPAA Privacy Rule safeguards PHI, the Security Rule protects a subset of information covered by the Privacy Rule.

The Privacy Rule permits important uses of information while protecting the privacy of people who seek care and healing. 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. 164.530(e).69 45 C.F.R. A .gov website belongs to an official government organization in the United States. question. HIPAA Enforcement. (4) Incidental Use and Disclosure. the past, present, or future payment for the provision of health care to the individual. Test Match Created by tsangtricia Terms in this set (20) The Notice of Privacy Practices (NPP) outlines how a client's information can be __________. 164.53212 45 C.F.R. Compliance. See additional guidance on Incidental Uses and Disclosures. 164.530(k).77 45 C.F.R.

Small Health Plans. These cookies may also be used for advertising purposes by these third parties. 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.

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. They help us to know which pages are the most and least popular and see how visitors move around the site. The health plan may not question the individual's statement of

caitlinblake . "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. 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. For help in determining whether you are covered, use CMS's decision tool. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.

L. 104-191; 42 U.S.C. 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. Pages are the most and least popular and see how visitors move around the.. Or you were discriminated against.32 45 C.F.R Associate of another covered entity can be the Associate. Of the Privacy Rule group health quizlet the health insurance portability and accountability act or a health insurer or HMO by! Government functions & # x27 ; Sec effectiveness of CDC public health campaigns through data! 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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. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Joint Knowledge Online DHA-US001 HIPAA and Privacy Act Training (1.5 hrs) This course provides an overview of two critical privacy laws - the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Privacy Act of 1974 - and discusses how these laws are applicable to the Military Health System (MHS). 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. 1937 ''Sec. and more. 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. In emergency treatment situations, the provider must furnish its notice as soon as practicable after the emergency abates. of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote . 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. 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. No authorization is needed, however, to make a communication that falls within one of the exceptions to the marketing definition. 164.105. Covered entities may disclose protected health information to funeral directors as needed, and to coroners or medical examiners to identify a deceased person, determine the cause of death, and perform other functions authorized by law.35, Cadaveric Organ, Eye, or Tissue Donation. 160.103.67 45 C.F.R. Data Safeguards. 164.512(k).42 45 C.F.R. Cookies used to make website functionality more relevant to you. Title I: Protects health insurance coverage for workers and their families who change or lose their jobs.

A covered entity must mitigate, to the extent practicable, any harmful effect it learns was caused by use or disclosure of protected health information by its workforce or its business associates in violation of its privacy policies and procedures or the Privacy Rule.69.

An authorization for marketing that involves the covered entity's receipt of direct or indirect remuneration from a third party must reveal that fact. (1) To the Individual. CDC twenty four seven. code; (iii) Telephone numbers; (iv) Fax numbers; (v) Electronic mail addresses: (vi) Social The Rule specifies processes for requesting and responding to a request for amendment. 164.512(a), (c).32 45 C.F.R. 164.522(b).64 45 C.F.R. the individual's past, present or future physical or mental health or condition, the provision of health care to the individual, or. For non-routine, non-recurring disclosures, or requests for disclosures that it makes, covered entities must develop criteria designed to limit disclosures to the information reasonably necessary to accomplish the purpose of the disclosure and review each of these requests individually in accordance with the established criteria. 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. 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). Facility Directories. 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. Certain types of insurance entities are also not health plans, including entities providing only workers' compensation, automobile insurance, and property and casualty insurance. Health Insurance Portability and Accountability Act of 1996. Enrollment or disenrollment information with respect to the group health plan or a health insurer or HMO offered by the plan. HIPAA is important because, due to the passage of the Health Insurance Portability and Accountability Act, the Department of Health and Human Services was able to develop standards that protect the privacy of individually identifiable health information and the confidentiality, integrity, and availability of electronic Protected Health Information. 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. 164.504(f).84 45 C.F.R. Special Case: Minors. 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. it prohibits group health plans from denying eligibility for benefits or charging more for coverage based on any "health . 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. All group health plans maintained by the same plan sponsor. 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.

Use this price as the population mean, and assume the population standard deviation is \$.20 $.20. Personal Representatives. In such instances, only certain provisions of the Privacy Rule are applicable to the health care clearinghouse's uses and disclosures of protected health information.8 Health care clearinghouses include billing services, repricing companies, community health management information systems, and value-added networks and switches if these entities perform clearinghouse functions. Group Health Plan disclosures to Plan Sponsors. Secure .gov websites use HTTPS Access. The Health Insurance Portability and Accountability Act Signed into Law.

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. Complaints. Learn about these laws and how you can file a complaint if you believe your rights were violated or you were discriminated against. 160.103.92 Fully insured health plans should use the amount of total premiums that they paid for health insurance benefits during the plan's last full fiscal year. 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 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. 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. The notice must describe the ways in which the covered entity may use and disclose protected health information. 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. De-Identified Health Information. See additional guidance on Marketing. 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Accounting for disclosures to health oversight agencies and law enforcement officials must be temporarily suspended on their written representation that an accounting would likely impede their activities. (6) Limited Data Set. "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). A lock (LockA locked padlock) or https:// means youve safely connected to the .gov website. 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. Examples of disclosures that would require an individual's authorization include disclosures to a life insurer for coverage purposes, disclosures to an employer of the results of a pre-employment physical or lab test, or disclosures to a pharmaceutical firm for their own marketing purposes. 160.203.86 45 C.F.R. 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. 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. 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.

164.530(j).76 45 C.F.R. An authorization is not required to use or disclose protected health information for certain essential government functions. 164.506(c).20 45 C.F.R. 802), or that is deemed a controlled substance by State law. 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.

Business Associate Contract. Disclosures and Requests for Disclosures. A covered entity can be the business associate of another covered entity.

security numbers; (vii) Medical record numbers; (viii) Health plan beneficiary numbers; (ix) 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.