a notable exclusion of protected health information is quizlet

For internal uses, a covered entity must develop and implement policies and procedures that restrict access and uses of protected health information based on the specific roles of the members of their workforce. Disclosures and Requests for Disclosures. ). Covered entities may disclose protected health information to health oversight agencies (as defined in the Rule) for purposes of legally authorized health oversight activities, such as audits and investigations necessary for oversight of the health care system and government benefit programs.32, Judicial and Administrative Proceedings. If an insurance entity has separable lines of business, one of which is a health plan, the HIPAA regulations apply to the entity with respect to the health plan line of business. 1232g. 164.501.23 45 C.F.R. PHI is essentially any . 164.530(h).75 45 C.F.R. Covered entities may disclose protected health information to funeral directors as needed, and to coroners or medical examiners to identify a deceased person, determine the cause of death, and perform other functions authorized by law.35, Cadaveric Organ, Eye, or Tissue Donation. Not later than the first service encounter by personal delivery (for patient visits), by automatic and contemporaneous electronic response (for electronic service delivery), and by prompt mailing (for telephonic service delivery); By posting the notice at each service delivery site in a clear and prominent place where people seeking service may reasonably be expected to be able to read the notice; and. Yes. For help in determining whether you are covered, use CMS's decision tool. All authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data. 164.530(d).72 45 C.F.R. 164.512(i).39 45 CFR 164.514(e).40 45 C.F.R. You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. After making this designation, most of the requirements of the Privacy Rule will apply only to the health care components. In March 2002, the Department proposed and released for public comment modifications to the Privacy Rule. See additional guidance on Marketing. (3) Uses and Disclosures with Opportunity to Agree or Object. These transactions include claims, benefit eligibility inquiries, referral authorization requests, or other transactions for which HHS has established standards under the HIPAA Transactions Rule.6 Using electronic technology, such as email, does not mean a health care provider is a covered entity; the transmission must be in connection with a standard transaction. A covered entity must mitigate, to the extent practicable, any harmful effect it learns was caused by use or disclosure of protected health information by its workforce or its business associates in violation of its privacy policies and procedures or the Privacy Rule.69. The Rule also contains specific distribution requirements for direct treatment providers, all other health care providers, and health plans. See additional guidance on Personal Representatives. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided.33, Law Enforcement Purposes. Sections 261 through 264 of HIPAA require the Secretary of HHS to publicize standards for the electronic exchange, privacy and security of health information. Exception Determination. 164.522(b).64 45 C.F.R. Washington, D.C. 20201 The Department of Health and Human Services, Office for Civil Rights (OCR) is responsible for administering and enforcing these standards and may conduct complaint investigations and compliance reviews. Two types of government-funded programs are not health plans: (1) those whose principal purpose is not providing or paying the cost of health care, such as the food stamps program; and (2) those programs whose principal activity is directly providing health care, such as a community health center,5 or the making of grants to fund the direct provision of health care. In addition, a restriction agreed to by a covered entity is not effective under this subpart to prevent uses or disclosures permitted or required under 164.502(a)(2)(ii), 164.510(a) or 164.512.63 45 C.F.R. A covered entity must maintain, until six years after the later of the date of their creation or last effective date, its privacy policies and procedures, its privacy practices notices, disposition of complaints, and other actions, activities, and designations that the Privacy Rule requires to be documented.75, Fully-Insured Group Health Plan Exception. 164.506(c)(5).82 45 C.F.R. The Privacy Rule calls this information "protected health information (PHI)."12. Health care providers include all "providers of services" (e.g., institutional providers such as hospitals) and "providers of medical or health services" (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care. 164.501 and 164.508(a)(3).50 45 C.F.R. The notice must describe individuals' rights, including the right to complain to HHS and to the covered entity if they believe their privacy rights have been violated. a notable exclusion of protected health information is quizlet This information is called protected health information (PHI), which is generally individually identifiable health information that is transmitted by, or maintained in, electronic media or any other form or medium. Reasonable Reliance. A health plan must distribute its privacy practices notice to each of its enrollees by its Privacy Rule compliance date. 160.103.8 45 C.F.R. See additional guidance on Minimum Necessary. 164.530(i).65 45 C.F.R. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. See additional guidance on Incidental Uses and Disclosures. 45 C.F.R. Account numbers; (x) Certificate/license numbers; (xi) Vehicle identifiers and serial numbers, Individuals have a right to an accounting of the disclosures of their protected health information by a covered entity or the covered entity's business associates.60 The maximum disclosure accounting period is the six years immediately preceding the accounting request, except a covered entity is not obligated to account for any disclosure made before its Privacy Rule compliance date. Any covered entity may condition compliance with a confidential communication request on the individual specifying an alternative address or method of contact and explaining how any payment will be handled. 164.504(f).84 45 C.F.R. 164.510(b).27 45 C.F.R. the past, present, or future payment for the provision of health care to the individual. A covered entity must obtain an authorization to use or disclose protected health information for marketing, except for face-to-face marketing communications between a covered entity and an individual, and for a covered entity's provision of promotional gifts of nominal value. 164.514(e)(2).44 45 C.F.R. 160.103 identifies five types of organized health care arrangements: 81 45 C.F.R. The Privacy Rule does not require accounting for disclosures: (a) for treatment, payment, or health care operations; (b) to the individual or the individual's personal representative; (c) for notification of or to persons involved in an individual's health care or payment for health care, for disaster relief, or for facility directories; (d) pursuant to an authorization; (e) of a limited data set; (f) for national security or intelligence purposes; (g) to correctional institutions or law enforcement officials for certain purposes regarding inmates or individuals in lawful custody; or (h) incident to otherwise permitted or required uses or disclosures. a notable exclusion of protected health information is quizletsplit bill app. 160.102, 160.103; see Social Security Act 1172(a)(3), 42 U.S.C. 164.103, 164.105.78 45 C.F.R. An organized system of health care in which the participating covered entities hold themselves out to the public as part of a joint arrangement and jointly engage in utilization review, quality assessment and improvement activities, or risk-sharing payment activities. Communications to describe health-related products or services, or payment for them, provided by or included in a benefit plan of the covered entity making the communication; Communications about participating providers in a provider or health plan network, replacement of or enhancements to a health plan, and health-related products or services available only to a health plan's enrollees that add value to, but are not part of, the benefits plan; Communications for treatment of the individual; and. A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual's treatment. 164.512(j).41 45 C.F.R. Individual review of each disclosure is not required. These penalty provisions are explained below. Covered entities may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.40, Essential Government Functions. In addition, covered entities may use or disclose a limited data set (protected health information (PHI) that excludes certain identifiers) for research, public health, or health care operations purposes without obtaining consent. 164.512.29 45 C.F.R. What is appropriate for a particular covered entity will depend on the nature of the covered entity's business, as well as the covered entity's size and resources. 164.520(c).55 45 C.F.R. A covered entity must notify the Secretary if it discovers a breach of unsecured protected health information. No authorization is needed, however, to make a communication that falls within one of the exceptions to the marketing definition. The transaction standards are established by the HIPAA Transactions Rule at 45 C.F.R. 164.502(d)(2), 164.514(a) and (b).15 The following identifiers of the individual or of relatives, employers, or household members of the individual must be removed to achieve the "safe harbor" method of de-identification: (A) Names; (B) All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census (1) the geographic units formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000; (C) All elements of dates (except year) for dates directly related to the individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; (D) Telephone numbers; (E) Fax numbers; (F) Electronic mail addresses: (G) Social security numbers; (H) Medical record numbers; (I) Health plan beneficiary numbers; (J) Account numbers; (K) Certificate/license numbers; (L) Vehicle identifiers and serial numbers, including license plate numbers; (M) Device identifiers and serial numbers; (N) Web Universal Resource Locators (URLs); (O) Internet Protocol (IP) address numbers; (P) Biometric identifiers, including finger and voice prints; (Q) Full face photographic images and any comparable images; and any other unique identifying number, characteristic, or code, except as permitted for re-identification purposes provided certain conditions are met.