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HIPAA

HIPAA. Compliance. An Overview of HIPAA. Presented by the Office of the General Counsel. H ealth I nsurance P ortability and A ccountability A ct. HIPAA. Compliance. HIPAA. HIPAA. Compliance. HIPAA’s Goals. Simplify the Administration of Electronic Health Information

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HIPAA

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  1. HIPAA Compliance An Overview of HIPAA Presented by the Office of the General Counsel

  2. Health Insurance Portability and Accountability Act HIPAA Compliance HIPAA

  3. HIPAA Compliance HIPAA’s Goals • Simplify the Administration of Electronic Health Information • Protect an Individual’s Privacy Rights with regard to Health Information

  4. HIPAA Compliance When is HIPAA effective? • First Deadline: October 2002 • Possible Extension until Oct. 2003 • AU must have Compliance plan • Privacy Regulations: April 2003 • AU target date for compliance

  5. HIPAA Compliance Who Must Comply? “ Each Covered Entity who maintains or transmits health information” • Health Plans • Health Care Clearinghouse • Health Care Providers

  6. HIPAA Compliance Who is a Provider? “Any person or entity that furnishes, bills, or is paid for health care in the normal course of business.” • Health Care = any “care, services, or supplies related to the health of an individual”

  7. Athletic Department Hearing / Eye Clinics Self – Insurance Health Plans HIPAA Compliance Examples of Providers / Plans • Student Health Center • Psychology Clinics • EAP

  8. HIPAA Compliance 4 Key HIPAA Elements • Electronic Transaction & Code Set Standards • Security Standards • Privacy Regulations • National Identifiers

  9. HIPAA Compliance Electronic Transaction & Code Set Standards • General Rule: “If a covered entity (either itself or through an agent) conducts a Covered Transaction electronically, the transaction must be conducted using the HIPAA form.”

  10. HIPAA Compliance Electronic Transaction & Code Set Standards Required Elements • Covered Entity • Electronically transmits • Covered Transaction

  11. Submission of Claims for payment Checking eligibility Enrollment & Disenrollment Referrals and pre-certification Claims attachments Payment & claims remittance Coordination of Benefits Checking claims’ status HIPAA Compliance Covered Transactions

  12. HIPAA Compliance Electronic Transaction & Code Set Standards Requirements of ETS • Standard Formats • Standard Data Content • Standard Codes

  13. HIPAA Compliance Electronic Transaction & Code Set Standards Where to find the ETS standards: • http://aspe.hhs.gov/admnsimp • www.wpc-edi.com/HIPAA • www.afehct.org

  14. HIPAA Compliance Security Standards • Intended to protect against • Unauthorized access • Accidental / Intentional disclosure to unauthorized persons • Alteration, destruction, or loss

  15. HIPAA Compliance Security Standards Who is Covered? • Any covered entity • That Storesinformation electronically • Does not have to be a covered transaction

  16. HIPAA Compliance Security Standards - Elements - • Administrative Procedures • Protects health info • Manages personnel Conduct • Physical Safeguards • Protects physical systems / buildings • Technical Security • Controls access to health information

  17. HIPAA Compliance Administrative Procedures • Security Analysis • Information access privileges • Password & Authentication policies • Plans for disasters & security breaches • Disciplinary process & penalties • Employee & Vendor Training • Security Officer

  18. HIPAA Compliance Physical Safeguards • Document ways computer & physical records are protected • Use of keys, locks, etc. to control access to computers • Restriction of access to authorized persons • Tracking of medical records • Workstation location policy

  19. HIPAA Compliance Technical Security • Single sign-on technology • New user ID’s, passwords • Audit trails for health info

  20. HIPAA Compliance Security Standards General Comments • Still in proposed form • Not technically specific • Amount of security required is scalable based on dept. size and resources

  21. HIPAA Compliance Privacy Regulations • General Rule: “A covered entity may not use or disclose Protected Health Information (PHI) except as permitted by the privacy regulations.”

  22. HIPAA Compliance Privacy Regulations • PHI – Protected Health Information • Individually Identifiable • Any form or medium • Electronic, Oral, or Written • Created or Received • Relates to past, present, future condition or payment of individual • Exception: FERPA records

  23. HIPAA Compliance Privacy Regulations • General Requirement: “Must make reasonable efforts to limit the use and disclosure of PHI to the minimum necessary to accomplish intended purpose.”

  24. HIPAA Compliance Privacy Regulations Main Elements • Rules for Use & Disclosure of PHI • Patient’s Rights to Health Info • Administrative Procedures • Business Partner Requirement

  25. HIPAA Compliance Rules for Use & Disclosure Consent vs. Authorization Consent: If a general written consent is obtained, a provider may use/disclose PHI for “TPO” Authorization: If use/disclosure is not for “TPO”, use/disclosure forbidden without a more specific authorization “TPO” = Treatment/Payment/Health Care Operations

  26. HIPAA Compliance Rules for Use & Disclosure “TPO” = Treatment / Payment / Health Care Operations Treatment: Provision, coordination, management of healthcare Payment: Actions to obtain payment Operations: Internal day-to-day business Ex: QA, Peer Review, Customer Service

  27. HIPAA Compliance Rules for Use & Disclosure Consent • Must be in plain language • Must specify use of PHI • Can make a prerequisite to treatment (Can refuse treatment) • Exceptions: Emergency, Required by Law, Communication barriers,

  28. HIPAA Compliance Rules for Use & Disclosure Authorization • Cannot be a condition of treatment • Must Inform about specific use and right to refuse, revoke, and inspect • Psychotherapy Notes require Authorization • Examples • Research • Marketing • Fundraising

  29. HIPAA Compliance Patient’s Rights • Right to Notice of Privacy Practices • Right of Access to PHI • Right to Accounting of Disclosures for 6 years • Right to request restriction of TPO use to family members • Not required to agree if TPO

  30. HIPAA Compliance Administrative Procedures • Document policies, procedures, & systems to achieve compliance • Complaint Mechanisms • Employee Sanctions • Documented training of employees • Mitigation of harmful effects • Designated Privacy officer

  31. HIPAA Compliance Business Associates • General Rule: • A covered entity must have a business associate contract to ensure that its business associates also are in compliance with HIPAA’s protection of PHI.

  32. HIPAA Compliance Business Associates • Business Associates… • Perform a function involving use / disclosure of PHI on behalf of the covered entity • Perform legal, accounting, consulting, data aggregation, administrative, management, or financial services involving PHI for the covered entity

  33. HIPAA Compliance Business Associates • Examples: • Billing companies • Computer Vendors • Attorneys, Accountants, Auditors • Consultants • Document storage / destruction companies

  34. HIPAA Compliance Business Associates • Business Associate Contracts: • Restrict use & disclosure of PHI • Require appropriate safeguards • Require similar requirements of subcontractors • Require B.A. to disclose breaches • Require B.A. to remedy breaches or risk termination of contract

  35. HIPAA Compliance

  36. HIPAA Compliance Hybrid Entity • Requirements • Single Legal Entity • Primary business is not healthcare • Advantages • Only “Healthcare Components” must comply with HIPAA • Disadvantage • Firewall between HC Components and Non-Components

  37. HIPAA Compliance Hybrid Entity • Auburn must… • Identify Healthcare Components • Identify Business Associates of the HC Components • Erect the ‘firewalls’ between HC Components & Non-Components

  38. HIPAA Compliance Penalties for Non-Compliance ** Both Individuals & Entities can incur criminal and/or civil penalties Civil Penalties: $100 - $25,000 Criminal Penalties: Max 10 yrs. Prison Max $250,000 fine

  39. HIPAA Compliance HIPAA Timeline • ETS Standards: October 16, 2002 • Extended to Oct. 2003 w/ University extension • Privacy Regs: April 14, 2003 • Security Regs: Date expected by August 2002

  40. HIPAA Compliance Next Steps toward Compliance • Fill out the AU HIPAA Survey • Review how PHI is stored, accessed, protected, & destroyed • Think about easy steps to better protect PHI • Designate 1+ person to review specific HIPAA policies

  41. HIPAA Compliance For more HIPAA info… • www.hipaa.org • Links to complete final rules & proposed rules • www.hipaadvisory.com • News, primers, and complete rules • www.hrm.uab.edu/HIPAA • UAB’s training site

  42. Additional Questions? Contact the Provost’s Office

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