a notable exclusion of protected health information is quizlet a notable exclusion of protected health information is quizlet

The Rule also contains specific distribution requirements for direct treatment providers, all other health care providers, and health plans. 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. 1 Pub. The transaction standards are established by the HIPAA Transactions Rule at 45 C.F.R. Resource Locators (URLs); (xiv) Internet Protocol (IP) address numbers; (xv) Biometric 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. 164.510(b).27 45 C.F.R. Privacy Practices Notice. Related to Medical Exemption. identifiers, including finger and voice prints; (xvi) Full face photographic images and any The covered entity who originated the notes may use them for treatment. (i) A public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, including but not limited to, the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health (1) To the Individual. 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. Washington, D.C. 20201 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. Safeguard your medical and health insurance information and shred any insurance forms, prescriptions, or physician statements. 160.103.8 45 C.F.R. "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." 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. 164.501.21 45 C.F.R. 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. There are some federal and state privacy laws (e.g., 42 CFR Part 2, Title 10) that require health care providers to obtain patients' written consent before they disclose their health information to other people and organizations, even for treatment. Access. 164.502(b) and 164.514 (d).51 45 C.F.R. See additional guidance on Personal Representatives. 164.522(a).62 45 C.F.R. See additional guidance on Minimum Necessary. Preemption. See additional guidance on Marketing. 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. ). A clinically-integrated setting where individuals typically receive health care from more. Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. Protected Health Information is health information (i.e., a diagnosis, a test result, an x-ray, etc.) Small Health Plans. 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. In addition, preemption of a contrary State law will not occur if HHS determines, in response to a request from a State or other entity or person, that the State law: Enforcement and Penalties for Noncompliance. 164.500(b).9 45 C.F.R. 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. The notice must state the covered entity's duties to protect privacy, provide a notice of privacy practices, and abide by the terms of the current notice. a notable exclusion of protected health information is quizlet; a notable exclusion of protected health information is quizlet. Covered entities that fail to comply voluntarily with the standards may be subject to civil money penalties. 552a; and (e) information obtained under a promise of confidentiality from a source other than a health care provider, if granting access would likely reveal the source. 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. 164.530(e).69 45 C.F.R. 200 Independence Avenue, S.W. 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. 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. 164.512(a), (c).32 45 C.F.R. elgin mental health center forensic treatment program. Therefore, in most cases, parents can exercise individual rights, such as access to the medical record, on behalf of their minor children. 164.512(d).33 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. ", Serious Threat to Health or Safety. 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. Compliance. 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 health care provider may rely on an individual's informal permission to list in its facility directory the individual's name, general condition, religious affiliation, and location in the provider's facility.25 The provider may then disclose the individual's condition and location in the facility to anyone asking for the individual by name, and also may disclose religious affiliation to clergy. 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. 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. 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. "Summary health information" is information that summarizes claims history, claims expenses, or types of claims experience of the individuals for whom the plan sponsor has provided health benefits through the group health plan, and that is stripped of all individual identifiers other than five digit zip code (though it need not qualify as de-identified protected health information). The Privacy Rule identifies relationships in which participating covered entities share protected health information to manage and benefit their common enterprise as "organized health care arrangements. See additional guidance on Incidental Uses and Disclosures. HIPAA applies to physicians and other individual and institutional health care providers (e.g., dentists, psychologists, hospitals, clinics, pharmacies, etc.). 45 C.F.R. 164.520(d).54 45 C.F.R. 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. Disclosure Accounting. sample business associate contract language. For more information about medical identity theft, visit the Federal . michael todd soniclear beeping. Definition. Consistent with the principles for achieving compliance provided in the Privacy Rule, OCR will seek the cooperation of covered entities and may provide technical assistance to help them comply voluntarily with the Privacy Rule. A covered entity may deny access to individuals, without providing the individual an opportunity for review, in the following protected situations: (a) the protected health information falls under an exception to the right of access; (b) an inmate request for protected health information under certain circumstances; (c) information that a provider creates or obtains in the course of research that includes treatment for which the individual has agreed not to have access as part of consenting to participate in the research (as long as access to the information is restored upon completion of the research); (d) for records subject to the Privacy Act, information to which access may be denied under the Privacy Act, 5 U.S.C. Individual review of each disclosure is not required. 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. A covered entity must notify the Secretary if it discovers a breach of unsecured protected health information. 164.524.56 45 C.F.R. 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. 164.510(a).26 45 C.F.R. (5) Public Interest and Benefit Activities. 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. The Rule specifies processes for requesting and responding to a request for amendment. 164.502(a)(2).18 45 C.F.R. An authorization for marketing that involves the covered entity's receipt of direct or indirect remuneration from a third party must reveal that fact. comparable images. 164.522(a). In general, a business associate is a person or organization, other than a member of a covered entity's workforce, that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of individually identifiable health information. 164.501 and 164.508(a)(3).50 45 C.F.R. 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. Tier 3: Obtaining PHI for personal gain or with malicious intent - Up to 10 years in jail. Organized Health Care Arrangement. 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. 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 notable exclusion of protected health information is: June 22, 2022 . Treatment, Payment, & Health Care Operations, CDC's web pages on Public Health and HIPAA Guidance, NIH's publication of "Protecting Personal Health Information in Research: Understanding the HIPAAPrivacy Rule. 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. Extended Health Care Plan The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.. Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time, other than . 164.501.38 45 C.F.R. An authorization must be written in specific terms. These penalty provisions are explained below. 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. 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. 1232g. 160.103.13 45 C.F.R. 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. 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. 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 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. 160.103.67 45 C.F.R. 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. 164.520(a) and (b). 160.202.87 45 C.F.R. 160.30488 Pub. Protected Health Information. 4. a notable exclusion of protected health information is: train travel in spain and portugal; new construction homes in port st lucie no hoa; . The Privacy Rule permits an exception when a 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. 45 C.F.R. 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. Civil Money Penalties. The Department of Justice is responsible for criminal prosecutions under the Priv. 45 C.F.R. These standards are intended to protect the privacy of patients. In addition, certain violations of the Privacy Rule may be subject to criminal prosecution. Criminal Penalties. 164.512(f).35 45 C.F.R. situs link alternatif kamislot a notable exclusion of protected health information is: . 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 March 2002, the Department proposed and released for public comment modifications to the Privacy Rule. These restrictions must include the representation that the plan sponsor will not use or disclose the protected health information for any employment-related action or decision or in connection with any other benefit plan. 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? The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. 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. Yes. It limits the circumstances under which these providers can disclose "protected health information" or "PHI.". Exception Determination. 164.514(e)(2).44 45 C.F.R. 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 No authorization is needed, however, to make a communication that falls within one of the exceptions to the marketing definition. 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. 164.103.80 The Privacy Rule at 45 C.F.R. 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. Special Case: Minors. The Privacy Rule calls this information "protected health information (PHI)."12. An organized system of health care in which the participating covered entities hold themselves out to the public as part of a joint arrangement and jointly engage in utilization review, quality assessment and improvement activities, or risk-sharing payment activities. Covered entities may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.36, Research. HHS recognizes that covered entities range from the smallest provider to the largest, multi-state health plan. The covered entities in an organized health care arrangement may use a joint privacy practices notice, as long as each agrees to abide by the notice content with respect to the protected health information created or received in connection with participation in the arrangement.53 Distribution of a joint notice by any covered entity participating in the organized health care arrangement at the first point that an OHCA member has an obligation to provide notice satisfies the distribution obligation of the other participants in the organized health care arrangement. security numbers; (vii) Medical record numbers; (viii) Health plan beneficiary numbers; (ix) "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. 164.512(e).34 45 C.F.R. 1320d-1(a)(3). Minimum Necessary. 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. If State and other law is silent concerning parental access to the minor's protected health information, a covered entity has discretion to provide or deny a parent access to the minor's health information, provided the decision is made by a licensed health care professional in the exercise of professional judgment. 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. Specific conditions or limitations apply to each public interest purpose, striking the balance between the individual privacy interest and the public interest need for this information. > For Professionals Privacy Policies and Procedures. A central aspect of the Privacy Rule is the principle of "minimum necessary" use and disclosure. the Department of Justice has imposed a criminal penalty for the failure to comply (see below). If requested by the plan sponsor, summary health information for the plan sponsor to use to obtain premium bids for providing health insurance coverage through the group health plan, or to modify, amend, or terminate the group health plan. 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.