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...

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 EP 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 EP 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 RAPEP 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

H E A L T H A D V O C A C YH E A L T H A D V O C A C Y

HIPAA HIPAA

Health Insurance Portability & Accountability Act



HIPAAHIPAA

Does not preempt more protective state law

First federal privacy law



Covered EntitiesCovered Entities Health Care Providers Health Plans Health Care Clearinghouses

Key - Transmit information electronicallyCompliance by April 14, 2003



Does Not IncludeDoes Not Include

Employers (with special rules)

Casualty and property insurers

Workers compensation carriers



Civil and criminal penalties

No right to a federal lawsuit

EnforcementEnforcement



HIPAAHIPAA 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



HIPAAHIPAA

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



HIPAAHIPAAUse & disclosure of protected health information without consent: For their own treatment

Payment

Health care operations

To other covered entities for specified purposes



HIPAAHIPAA

Patients have a right to inspect, copy, amend & receive an accounting of disclosures



HIPAAHIPAAPatient 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



Patient Ability to Restrict DisclosurePatient 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



Psychotherapy NotesPsychotherapy Notes Entities must obtain authorization from the

individual to use and disclose psychotherapy notes

Notes can be disclosed in certain circumstances



MinorsMinors 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



Minors Right to ConsentMinors 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)




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




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)



Reporting RequirementsReporting 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



CAUTIONCAUTIONIndividuals 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



EmployersEmployers 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



HIPAAHIPAA 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



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



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



Are you a health care provider?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?



Health Care ServicesHealth 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



Health Care ServicesHealth Care Services Outpatient physical therapy

Rural health clinic services & federally qualified health center services

Qualified psychologist services

Clinical social worker services



Business AssociatesBusiness Associates

An entity that conducts an activity involving the use and disclosure of protected health information on behalf of a covered entity




Covered entities are not required to have business associate contracts with providers to whom they

disclose information for treatment of an individual




Sign a business associate contract?

Obtain a release of information?

Protect your confidentiality privilege



Hybrid entitiesHybrid entities

Be clear

Establish policies



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



If you are a covered entityIf 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



ResourcesResources

http://www.hhs.gov/ocr/hipaa/

http://www.healthprivacy.org

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