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Introduction to Confidentiality & HIPAA . For Florida KidCare Community Partners September 2009. Confidentiality and the Florida KidCare Community Partner.

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introduction to confidentiality hipaa

Introduction to Confidentiality & HIPAA

For

Florida KidCare Community Partners

September 2009

confidentiality and the florida kidcare community partner
Confidentiality and the Florida KidCare Community Partner

As a Florida KidCare community partner families entrust you to not only help them navigate the Florida KidCare system but to keep the information they share with you confidential and safe.

HIPAA

what is hipaa
What is HIPAA?

HIPAA, the Health Insurance Portability and Accountability Act,was finalized August 2002. This act was created to ensure comprehensive health insurance privacy and security regulations.

HIPAA

hipaa roles
HIPAA Roles

HIPAA requires that privacy and security be built into the policies and practices of healthcare providers and health plans.

HIPAA sets standards for the electronic transmission of patient health, administrative, and financial information.

HIPAA

hipaa policies and practices and florida kidcare
HIPAA Policies and Practices and Florida KidCare

HIPAA sets limits on the type of information permitted for disclosure. Thus Florida KidCare requires a properly completed Florida Healthy Kids Release of Information (ROI) form be on file prior to the release of any account related personal health information (PHI) to third party entities.

HIPAA

release of information roi

Release of Information (ROI)

  • Florida KidCare uses the ROI form to determine who is authorized to access account information.
  • A ROI form should be voluntarily completed by the applicant parent or guardian.
  • One ROI must be properly completed and on file for each enrollee (child) prior to disclosure. Making sure to initial where indicated.
  • ROI form is available in English, Spanish and Creole.
hipaa policies and practices and florida kidcare cont
HIPAA Policies and Practices and Florida KidCare (Cont.)

Within limits, HIPAA allows for the free flow of PHI for treatment, payment and health care operations. This is why the ROI is so important.

HIPAA

privacy
PRIVACY

All Florida KidCare applicants or enrollees have the right to privacy and to keep information about themselves from being disclosed.

Florida KidCare uses the ROI form to determine who is authorized to access account information.

HIPAA

levels of disclosure
Levels of Disclosure

Florida KidCare staff are limited to the type of information they are allowed to disclose to third parties. Such as:

Full disclosure – All account information provided

Minimum disclosure – Information needed to resolve a family’s concerns is provided

Limited disclosure – Confirmation of coverage, and

Dates of coverage, and

Name of child’s health & dental plan, Amount of premium being paid are provided

No disclosure - No information is provided without a completed ROI on file.

HIPAA

contracted community partners account access
Contracted Community Partners Account Access

With the successful completion of the HIPAA training, contracted Florida Healthy Kids Corporation community partners assisting families apply for Florida KidCare may be given “minimum disclosure” to family account information without a ROI.

hipaa non applicant parents
HIPAA & Non-Applicant Parents

Under new legislation a non-applicant parent can have limited disclosure to Florida KidCare account information. In other words, a non-applicant parent can contact Florida KidCare (with the child’s information such as DOB and SSN) and are able to receive the following types of account information without a ROI on file:

  • Confirmation of coverage
  • Dates of coverage
  • Name of child’s health & dental plan
  • Amount of premium being paid

HIPAA

examples of phi
Examples of PHI

Name

Address

Phone Number

Social Security Number

Date of Birth

Premium Payment

  • Relatives
  • E-mail Address
  • Health/Dental Plan #
  • Employer
  • Account Number

HIPAA

notices
Notices

Patients seeking treatment from a health care provider must get a “Notice of Privacy Practices” from their provider.

Florida KidCare sends out a notice of privacy practices to all new enrollees and every 3 years to current enrollees.

HIPAA

safeguards staff training and compliance
Safeguards, Staff Training and Compliance

Covered healthcare organizations must have appropriate technical and administrative safeguards in place to protect patient information such as:

All community partners assisting families apply for Florida KidCare must receive HIPAA training and successfully pass the Florida KidCare HIPAA compliance test.

HIPAA

safeguards staff training compliance cont
Safeguards, Staff Training & Compliance (Cont.)

Every covered healthcare

organization must have a HIPAA

Compliance Officer. Merrio

Tornillo acts as the HIPAA officer

for FHKC, you can reach her at

(850) 701-6167.

HIPAA

security
Security

To ensure an applicant or enrollee’s privacy, certain security safeguards must be in place to:

Protect information from accidental or intentional disclosure to unauthorized persons, and

Protect information from alteration, destruction, or loss.

HIPAA

complaints
Complaints

Who Do I Contact When An Applicant or Enrollee’s Rights Are Violated?

Contact the HIPAA Compliance Officer of the organization that violated the privacy regulation.

File a federal complaint to the United States Department of Health and Human Services Office of Civil Rights.

HIPAA

unauthorized disclosure of protected health information
Unauthorized Disclosure of Protected Health information

Community partners who fail to comply with HIPAA policies and proceduresrisk the discontinuation of their FHKC contract.

HIPAA

penalties for hipaa non compliance
Penalties for HIPAA Non-Compliance

HIPAA calls for severe civil and criminal penalties for non-compliance, including:

Fines up to $25,000 for multiple

violations of the same types of

information in a calendar year

Fines up to $250,000 and/or

imprisonment up to 10 years for

knowingly misusing individually

identifiable health information

HIPAA

why must you comply with hipaa
Why Must You Comply with HIPAA?

You must comply with HIPAA because as a community partner you may receive PHI electronically such as:

Florida KidCare eligibility

determinations

Florida KidCare premium amounts

Florida KidCare enrollment information

HIPAA

what hipaa means for you as a community partner
What HIPAA Means For You as a Community Partner

To maintain HIPAA security you must:

Prevent unauthorized access and disclosure

Prevent loss of information

Secure electronic information

Secure paper records

Overheard Conversations

Be careful what you discuss among staff both inside and outside of the office

HIPAA

what hipaa means for you as a community partner1
What HIPAA Means For You as a Community Partner

Information Left in Public View

All paper files must be collected and stored or shredded every day

To prevent unauthorized disclosures Florida KidCare staff will:

Always check the credentials of a requester

Always check a client’s authorization

Report incidents to your organization’s HIPAA Compliance Officer

HIPAA

e mail encryption
E-mail Encryption

Use encryption when sending an e-mail with PHI. Check with your IT Department on how to encrypt your correspondence.

Do not copy others on an e-mail with PHI without written consent from the client

HIPAA

additional information
Additional Information

For additional information about HIPAA visit the U.S. Department of Health and Human Services at: http://www.hhs.gov/ocr/privacy/index.html

HIPAA