Healthcare Compliance Series #13
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that was enacted in 1996 to protect the privacy and security of individuals’ health information. The law consists of several rules that govern the use and disclosure of protected health information (PHI) by healthcare providers, health plans, and healthcare clearinghouses and their business associates. In this article, we will explore the 5 main rules of HIPAA and how they help safeguard patient rights and what they mean for healthcare professionals and organizations.
1. Privacy Rule
The Privacy Rule is the first and most well-known rule of HIPAA. It sets national standards for the protection of PHI and gives patients certain rights over their health information. The rule applies to all healthcare providers, health plans, and healthcare clearinghouses that electronically transmit health information.
Key Provisions:
- Patients have the right to access their PHI and request corrections or amendments.
- Patients have the right to request restrictions on the use and disclosure of their PHI.
- Patients have the right to receive an accounting of disclosures of their PHI.
- Healthcare providers must obtain patient authorization before using or disclosing PHI for marketing or fundraising purposes.
- Healthcare providers must provide patients with a Notice of Privacy Practices (NPP) that explains how their PHI will be used and disclosed.
2. Security Rule
The Security Rule sets national standards for the security of electronic protected health information (ePHI). It requires healthcare providers, health plans, and healthcare clearinghouses to implement administrative, physical, and technical safeguards to protect ePHI.
Key Provisions:
- Healthcare providers must conduct a risk analysis to identify potential threats to ePHI.
- Healthcare providers must implement security measures to protect ePHI, such as encryption and access controls.
- Healthcare providers must have policies and procedures in place for responding to security incidents.
- Healthcare providers must train their workforce on security policies and procedures.
3. Transactions Rule
The Transactions Rule sets national standards for the electronic exchange of health information. It requires healthcare providers, health plans, and healthcare clearinghouses to use standardized transactions and code sets when exchanging health information electronically.
Key Provisions:
- Healthcare providers must use standardized transactions, such as claims and eligibility inquiries.
- Healthcare providers must use standardized code sets, such as ICD-10 and CPT.
- Healthcare providers must use a unique identifier, such as a National Provider Identifier (NPI), when exchanging health information electronically.
4. Unique Identifiers Rule
The Unique Identifiers Rule sets national standards for the use of unique identifiers in healthcare. It requires healthcare providers, health plans, and healthcare clearinghouses to use unique identifiers when exchanging health information electronically.
Key Provisions:
- Healthcare providers must use a National Provider Identifier (NPI) when exchanging health information electronically.
- Healthcare plans must use a National Health Plan Identifier (NHI) when exchanging health information electronically.
- Healthcare providers and health plans must use a Standard Unique Employer Identifier (SUEI) when exchanging health information electronically.
5. Enforcement Rule
The Enforcement Rule sets national standards for the enforcement of HIPAA. It requires the Office for Civil Rights (OCR) to investigate complaints and conduct compliance reviews to ensure that healthcare providers, health plans, and healthcare clearinghouses are complying with HIPAA.
Key Provisions:
- The OCR has the authority to investigate complaints and conduct compliance reviews.
- Healthcare providers, health plans, and healthcare clearinghouses must cooperate with OCR investigations and compliance reviews.
- The OCR may impose civil money penalties on healthcare providers, health plans, and healthcare clearinghouses that violate HIPAA.
Understanding Patient Rights under HIPAA
Right of Access
The right of access is a key provision of the Privacy Rule. It gives patients the right to access their PHI and request corrections or amendments. Healthcare providers must provide patients with access to their PHI in a timely manner and in a format that is easy to understand.
Key Provisions:
- Patients have the right to access their PHI.
- Patients have the right to request corrections or amendments to their PHI.
- Healthcare providers must provide patients with access to their PHI in a timely manner.
- Healthcare providers must provide patients with access to their PHI in a format that is easy to understand.
Right to Request Restrictions
The right to request restrictions is another key provision of the Privacy Rule. It gives patients the right to request restrictions on the use and disclosure of their PHI. Healthcare providers must consider patient requests for restrictions, but they are not required to agree to them.
Key Provisions:
- Patients have the right to request restrictions on the use and disclosure of their PHI.
- Healthcare providers must consider patient requests for restrictions.
- Healthcare providers are not required to agree to patient requests for restrictions.
Right to Receive an Accounting of Disclosures
The right to receive an accounting of disclosures is a key provision of the Privacy Rule. It gives patients the right to request an accounting of disclosures of their PHI. Healthcare providers must provide patients with an accounting of disclosures in a timely manner.
Key Provisions:
- Patients have the right to request an accounting of disclosures of their PHI.
- Healthcare providers must provide patients with an accounting of disclosures in a timely manner.
- The accounting of disclosures must include the date, purpose, and recipient of the disclosure.
Notice of Privacy Practices
The Notice of Privacy Practices (NPP) is a key provision of the Privacy Rule. It requires healthcare providers to provide patients with a notice that explains how their PHI will be used and disclosed.
Key Provisions:
- Healthcare providers must provide patients with an NPP.
- The NPP must explain how PHI will be used and disclosed.
- The NPP must include information about patient rights and how to file a complaint.
Security Safeguards
The Security Rule requires healthcare providers, health plans, and healthcare clearinghouses to implement security safeguards to protect ePHI. These safeguards include administrative, physical, and technical safeguards.
Key Provisions:
- Healthcare providers must conduct a risk analysis to identify potential threats to ePHI.
- Healthcare providers must implement security measures to protect ePHI, such as encryption and access controls.
- Healthcare providers must have policies and procedures in place for responding to security incidents.
- Healthcare providers must train their workforce on security policies and procedures.
Risk Analysis and Management
The Security Rule requires healthcare providers, health plans, and healthcare clearinghouses to conduct a risk analysis to identify potential threats to ePHI. This includes identifying vulnerabilities and implementing security measures to mitigate them.
Key Provisions:
- Healthcare providers must conduct a risk analysis to identify potential threats to ePHI.
- Healthcare providers must identify vulnerabilities and implement security measures to mitigate them.
- Healthcare providers must review and update their risk analysis regularly.
Covered Entities
The HIPAA rules apply directly to covered entities, which are healthcare providers, health plans, and healthcare clearinghouses that electronically transmit health information. Covered entities are responsible for ensuring the confidentiality, integrity, and availability of protected health information (PHI).
Key Provisions:
- Covered entities must comply with the HIPAA rules, including the Privacy, Security, and Breach Notification Rules.
- Covered entities must implement policies and procedures to protect PHI, including training employees and designating a privacy officer.
- Covered entities must provide individuals with access to their PHI and allow them to request corrections or amendments to their records.
Business Associates
The HIPAA rules apply not only to healthcare providers, health plans, and healthcare clearinghouses, but also to their business associates. Business associates are individuals or organizations that perform functions or activities on behalf of a covered entity.
Key Provisions:
- Business associates must comply with the HIPAA rules.
- Business associates must enter into a business associate agreement with the covered entity.
- Business associates must implement security safeguards to protect ePHI.
State Law
HIPAA is a federal law, but it does not preempt state laws that are more stringent. Healthcare providers, health plans, and healthcare clearinghouses must comply with both federal and state laws.
Key Provisions:
- HIPAA does not preempt state laws that are more stringent.
- Healthcare providers, health plans, and healthcare clearinghouses must comply with both federal and state laws.
- State laws may provide additional protections for patients.
In conclusion, HIPAA is a complex law that requires covered entities (healthcare providers, health plans, and healthcare clearinghouses) and their business associates to protect the privacy and security of individuals’ health information. The 5 main rules of HIPAA – the Privacy Rule, Security Rule, Transactions Rule, Unique Identifiers Rule, and Enforcement Rule – provide a framework for protecting PHI and ePHI. By understanding these rules, healthcare professionals and organizations can ensure that they are complying with HIPAA and protecting the privacy and security of their patients’ health information.
Stay tuned for next topic: HITECH Act (Healthcare Compliance Series #14)