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HIPAA . Health Insurance Portability & Accountability Act. HIPAA. Does not preempt more protective state law First federal privacy law. Covered Entities. Health Care Providers Health Plans Health Care Clearinghouses. Key - Transmit information electronically Compliance by April 14, 2003.

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Hipaa

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa1

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 D O M E S T I C V I O L E N C E

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 RAPE


Covered entities

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 D O M E S T I C V I O L E N C E

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 RAPE


Does not include

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 D O M E S T I C V I O L E N C E

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 RAPE


Enforcement

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa2

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa3

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa4

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa5

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa6

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 D O M E S T I C V I O L E N C E

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 RAPE


Patient ability to restrict disclosure

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 D O M E S T I C V I O L E N C E

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 RAPE


Psychotherapy notes

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 D O M E S T I C V I O L E N C E

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 RAPE


Minors

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 D O M E S T I C V I O L E N C E

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 RAPE


Minors right to consent

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 D O M E S T I C V I O L E N C E

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 RAPE


Minors right to consent1

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 D O M E S T I C V I O L E N C E

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 RAPE


Minors right to consent2

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 D O M E S T I C V I O L E N C E

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 RAPE


Reporting requirements

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 D O M E S T I C V I O L E N C E

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 RAPE


Caution

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 D O M E S T I C V I O L E N C E

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 RAPE


Employers

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa7

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 D O M E S T I C V I O L E N C E

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 RAPE


So now what

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 D O M E S T I C V I O L E N C E

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 RAPE


Are you a health care provider

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 D O M E S T I C V I O L E N C E

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 RAPE


Are you a health care provider1

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 D O M E S T I C V I O L E N C E

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 RAPE


Health care services

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 D O M E S T I C V I O L E N C E

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 RAPE


Health care services1

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 D O M E S T I C V I O L E N C E

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 RAPE


Business associates

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 D O M E S T I C V I O L E N C E

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 RAPE


Business associates1

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa

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 D O M E S T I C V I O L E N C E

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 RAPE


Hipaa

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 D O M E S T I C V I O L E N C E

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 RAPE


If you are a covered entity

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 D O M E S T I C V I O L E N C E

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 RAPE


If you are a covered entity1

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 D O M E S T I C V I O L E N C E

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 RAPE


Resources

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 D O M E S T I C V I O L E N C E

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 RAPE


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