The Portability of Health Insurance and Accountability Act of 1996 ( HIPAA ; Pub.L. 104-191, 110 Stat.1936, enacted 21 August 1996) is enforced by the United States Congress and signed by President Bill Clinton in 1996. It has been known as the Kennedy-Kassebaum Act or the Kassebaum-Kennedy Act after its two main sponsors. This Act consists of five Headings. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for service providers, health insurance plans, and employers. Title III establishes guidelines for pre-tax medical expenditure accounts, Title IV establishes guidelines for group health plans, and Title V governs the life insurance policies of the company.
Video Health Insurance Portability and Accountability Act
Title
There are five parts to acting, known as titles.
Title I: Health Care Access, Portability and Update
Title I of HIPAA regulates the availability and breadth of individual group health plans and individual health insurance policies. This amended the Pensione Revenue Income Law, the Public Health Service Act, and the Internal Revenue Code.
Title I requires coverage and also limits restrictions that group health plans may place benefits for pre-existing conditions. The group health plan may refuse to provide benefits in respect of pre-existing conditions for 12 months after registration in the plan or 18 months in the case of registration delay. Title I allows individuals to reduce the exception period by the amount of time they have to have "credible coverage" before enrolling in the plan and after "significant lag" in coverage. "Credible coverage" is defined broadly enough and covers almost all individual health groups and plans, Medicare, and Medicaid. "Significant reserves" in coverage are defined as any 63-day period with no creditable coverage. Along with exceptions, allow employers to bind premiums or joint payments for tobacco use, or body mass index.
Title I also requires the insurer to issue an unqualified policy to those who abandon group health plans with creditable coverage (see above) exceeding 18 months, and update individual policies as long as they are offered or provide alternatives to discontinued plans as long as the insurance company remains in the market without exception regardless of health condition.
Some health care plans are exempt from Title I requirements, such as long-term health plans and limited scope plans such as dental plans or visions offered separately from general health plans. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if a new plan offers dental benefits, then it should calculate the continuing coverage that can be credited under the old health plan against each exception period for dental benefits.
An alternative method for calculating the creditable sustainable coverage is available for health plans under Title I. That is, the 5 categories of health coverage may be considered separately, including dental coverage and vision. Anything not under these 5 categories should use a general calculation (for example, a beneficiary can be calculated with 18 months of general coverage, but only 6 months of dental coverage, since the recipient does not have a general health plan that includes dental care up to 6 months prior to the date of application ). Since a limited scope plan is excluded from the HIPAA requirement, an odd case exists where the applicant for the general group health plan can not obtain a certificate of continuous coverage that can be credited for an independent limited scope plan, such as the gear to apply to the exclusion period of the new. plans covering such coverage.
Hidden exception periods are not authorized by Title I (e.g. "Accidents, to be discussed, must occur when the recipient is covered under this same health insurance contract"). Such clauses should not be followed up by a health plan. Also, they should be rewritten so they can comply with HIPAA.
Title II: Prevent Fraud and Misuse of Health Care; Administrative Simplification; Medical Liability Reform
Title II of the HIPAA establishes policies and procedures to safeguard privacy and security of individually identifiable health information, outlines many violations related to health care, and establishes civil and criminal penalties for offenses. It also created several programs to control fraud and abuse in health care systems. However, the most significant provision of Title II is the Administrative Simplification rule. Title II requires the Department of Health and Human Services (HHS) to improve the efficiency of health care systems by creating standards for the use and dissemination of health information.
These rules apply to "closed entities", as defined by HIPAA and HHS. Included companies include health plans, health care centers (such as billing services and public health information systems), and health care providers that transmit health care data in a manner regulated by HIPAA.
Subject to the requirements of Title II, HHS has announced five rules on Administrative Simplification: Privacy Rules, Transactions, and Code Set Codes, Security Rules, Unique Rules of Regulation, and Enforcement Regulations.
Privacy Rules
The effective compliance date of the Privacy Rule is April 14, 2003, with a one year extension for certain "small plans". The HIPAA Privacy Rule governs the use and disclosure of protected health information (PHI) held by "closed entities" (generally, health care centers, corporate sponsored health plans, health insurance, and medical providers involved in certain transactions). By law, DHH extends HIPAA's privacy rules to independent contractors of closed entities that fit the definition of "business associates". IRC is any information held by a closed entity with regard to health status, provision of health care, or payment of health services that can be attributed to any individual. This is interpreted more broadly and includes part of a medical record or a person's payment history. The closed company must disclose the IRC to the individual within 30 days on request. Also, they should disclose the IRC when asked to do so by law such as reporting allegations of child abuse to a state child welfare agency.
Closed companies may disclose protected health information to law enforcement authorities for law enforcement purposes as required by law (including court orders, court orders ordered, summons from courts) and administrative requests; or to identify or locate suspects, fugitives, material witnesses, or missing persons.
A protected entity may disclose the IRC to certain parties to facilitate care, payment or medical care without the written consent of the patient. Other disclosures of the IRC require closed entities to obtain written authorization from individuals for disclosure. In any case, when a closed entity discloses any PHI, it must make reasonable efforts to disclose only the minimum information required to achieve its objectives.
The Privacy Rule gives the individual the right to request a closed entity to correct an inaccurate PHI. In addition, it takes a closed entity to take some reasonable steps to ensure the confidentiality of communication with individuals. For example, an individual may request to be called at his office number instead of a home or mobile phone number.
The Privacy Rule requires that the entity be closed to notify individuals about their IRC usage. Closed companies should also track the disclosure of the IRC and the privacy policies and procedures of the documents. They must appoint a Privacy Officer and a liaison who is responsible for receiving complaints and training all members of their workforce in procedures related to the IRC.
A person who believes that a Privacy Rule is not enforced may file a complaint with the Department of Health and Human Services for Civil Rights (OCR). However, according to Wall Street Journal , OCR has a long backlog and ignores most complaints. "Complaints of privacy violations have accumulated in the Department of Health and Human Services.Under April 2003 and November 2006, the agency deployed 23,886 complaints related to the medical privacy regulations, but has not taken law enforcement action against hospitals, doctors, insurers or anyone for rule violations. A spokeswoman for the agency said it had closed down three quarters of the complaints, usually due to non-infringement or subsequently providing informal guidance to the parties involved. "However, in July 2011, UCLA agreed to pay $ 865,500 in the settlement of potential HIPAA violations. The HHS Office for Civil Rights Investigation shows that from 2005 to 2008, unauthorized employees repeatedly and without valid reasons saw electronic health-protected information from many UCLAHS patients.
Omnibus Update Regulation 2013
In January 2013, HIPAA is updated through the Omnibus Final Rules. Updates include changes to the Security Rules and Notice of Violations section of the HITECH Act. The most significant changes are related to the expansion of requirements to include business partners, where only the closed entity originally held to enforce this section of law.
In addition, the definition of "significant harm" to an individual in violation analysis is updated to provide more supervision to a closed entity with the intention of revealing a previously unreported offense. Previously, an organization needs evidence that damage has occurred while the organization now has to prove that the damage did not occur.
Protection of PHI changed from unlimited to 50 years after death. More severe penalties for violation of PHI's privacy requirements are also approved.
HIPAA Privacy Rules can be ignored during natural disasters. This is the case of Hurricane Harvey in 2017.
HITECH Act: Privacy Terms
See the Privacy section of Health Information Technology for the Economic and Clinical Health Act (HITECH Act).
Right to access your PHI
Privacy Rules require medical providers to give individuals access to their IRC. After a person requests information in writing (usually using a provider form for this purpose), the provider has up to 30 days to provide a copy of the information to that individual. A person may request information in electronic or hard copy form, and the provider is obliged to try to adjust to the requested format. For providers who use electronic health records (EHR) systems that are certified under CEHRT (Certified Electronic Health Record Technology) criteria, individuals should be allowed to obtain an IRC in electronic form. Providers are encouraged to provide information quickly, especially in terms of electronic record requests.
Individuals have the right to access all health-related information, including health conditions, care plans, notes, drawings, lab results, and billing information. Explicitly excluded are private psychotherapy records from providers, and information collected by providers to defend against the lawsuit.
Providers may charge a fair amount of fees related to their providing a copy, however, no fees are allowed when providing data electronically from a certified EHR using the "see, download and transfer" features required for certification. When sent to an individual in electronic form, an individual may authorize sending using encrypted or unencrypted email, delivery using media (USB drive, CD, etc., which may involve costs), direct messages (secure email technology commonly used in the healthcare industry) , or maybe another method. When using unencrypted emails, individuals must understand and accept the risks to privacy using this technology (information can be tapped and checked by others). Regardless of the delivery technology, providers should continue to fully secure the temporary PHI in their system and may refuse delivery methods if it poses an additional risk to the IRC while in their system.
A person may also request (in writing) that their IRC is sent to a designated third party such as a family service provider.
One may also request (in writing) that the provider sends the IRC to the designated service used to collect or manage their records, such as the Personal Health Records application. For example, a patient may request in writing that his ob-gyn provider digitally sends a record of his last prenatal visit to a pregnancy self-care app he has on his cell phone.
Disclosure to relatives
According to their interpretation of HIPAA, hospitals will not disclose information over the phone to confessing patient relatives. This in some cases hampers the location of missing people. After the crash of Flight Asiana Airlines 214 San Francisco, some hospitals were reluctant to reveal the identity of the passengers they cared for, making it difficult for Asiana and relatives to find them. In one instance, a man in Washington state was unable to obtain information about his injured mother.
Janlori Goldman, director of the Health Privacy Project advocacy group, said some hospitals were being "overcautious" and misapplied the law, the Times reported. Suburban Hospital in Bethesda, Md., Has interpreted federal regulations that require hospitals to allow patients to not get into the hospital directory as meaning that patients want to stay out of the directory unless they specifically say otherwise. Consequently, if the patient is unconscious or unable to choose to be included in the directory, relatives and friends may not be able to find it, Goldman said.
Transaction and Code Set Code
HIPAA is intended to make the health care system in the United States more efficient by standardizing health care transactions. HIPAA added a new Part C entitled "Administrative Simplification" to Title XI of the Social Security Act. This should simplify health care transactions by requiring all health plans to engage in health care transactions in a standardized way.
The HIPAA/EDI provisions are scheduled to come into force on 16 October 2003, with a one year extension for certain "small plans". However, due to the widespread confusion and difficulties in the application of the rules, CMS provides a one-year extension to all parties. On January 1, 2012 the newer version, ASC X12 005010 and NCPDP D.0 became effective, replacing previous ASC X12 004010 and NCPDP 5.1 mandates. The ASC X12 005010 version provides mechanisms that allow the use of ICD-10-CM as well as other improvements.
After July 1, 2005, most electronically submitted medical providers must file their electronic claims using the HIPAA standard to be paid.
Under HIPAA, health plans covering HIPAA are now required to use standard HIPAA electronic transactions. See, 42 USC Ã, § 1320d-2 and 45 CFR Section 162. Information about this can be found in the last rule for HIPAA electronic transaction standards (74 Fed Reg.3296, published in the Federal Register on January 16, 2009), and at CMS website.
The key EDI (X12) transactions used for HIPAA compliance are:
The Health Care Claims Transaction Set of EDI (837) is used to submit health care claims billing information, meeting information, or both, except for retail pharmacy claims (see Pharma EDI Claims Transaction). This can be sent from the health care provider to the payer, either directly or through a biller intermediary and claim clearinghouses. It may also be used to submit health care claims and bill payment information between payers with different payment responsibilities in which necessary benefits coordination or between payers and regulatory agencies to monitor rendering, billing, and/or payment of health care services in industry-specific segments of care health/insurance.
For example, state mental health agencies may mandate all healthcare claims, Providers and health plans that trade healthcare professional (medical) claims electronically should use 837 Health Care Claims: Professional standards for submitting claims. Since there are many different business applications for Health Care claims, there may be less derivation to cover claims involving unique claims such as for institutions, professionals, chiropractors, and dentists, etc.
Retail Pharmaceutical Claims Transaction EDI (NCPDP Telecommunications Standard version 5.1) is used to file retail pharmaceutical claims to payers by health care professionals who deliver drugs, either directly or through biller intermediaries and clearinghouses claims. It may also be used to submit claims for retail pharmaceutical services and bill payment information between payers with different payment responsibilities in which necessary benefits coordination or between payers and regulatory bodies to monitor the rendering, billing, and/or payment of retail pharmaceutical services in industrial segments health care/pharmaceutical insurance.
The EDI Claims Payment/Claim Settings EDI (835) can be used to make payments, send Benefit Explanations (EOB), send explanatory payment (EOP) explanations, or make payments and send EOP payment suggestions only from a health insurer to a healthcare provider either directly or through a financial institution.
Set of Enrollment and Maintenance of EDI Benefits (834) may be used by companies, unions, government agencies, associations or insurance agents to register members to payers. Payers are health care organizations that pay claims, manage insurance or benefits or products. Examples of payers include insurance companies, healthcare professionals (HMOs), selected provider organizations (PPOs), government agencies (Medicaid, Medicare, etc.) or any organization that may be contracted by one of the earlier groups.
EDI Salary Payments and other Premium Payment Groups for Insurance Products (820) is the set of transactions to make premium payments for insurance products. This can be used to order financial institutions to make payments to the payee.
EDI Health Care Eligibility/Benefit Inquiry (270) is used to inquire about the benefits of health care and customer-related or dependent feasibility.
EDI Health Care Eligibility/Benefit Response (271) is used to respond to requests to ask about the benefits of health care and customer-related or dependent feasibility.
Request for EDI Healthcare Claim Status (276) This set of transactions may be used by the provider, the recipient of the health care product or service or its authorized agent to claim health care claim status.
EDI Healthcare Claims Notification Notice (277) This set of transactions may be used by health-care payers or authorized agents to inform an authorized provider, recipient or agent of health care claim or meeting status, or to request information add-ons from claim-related providers or health care meetings. This transaction set is not intended to replace Health Insurance Payment Arrangements/Advice Suggestions (835) and is therefore not used for posting account payments. This notification is at the level of summary detail or service line. Notifications can be requested or not requested.
EDI Health Check Information (278) This set of transactions may be used to transmit health care service information, such as customer, patient, demographic, diagnosis or treatment data for the purpose of requesting a review, certification, notice or reporting results health care services.
Set Transactional Functional Endorsement EDI (997) This set of transactions can be used to define the control structure for a series of thanks to show the syntactic analysis results of documents that are encoded electronically. Although not specifically mentioned in the HIPAA Legislation or the Last Rule, this is necessary for processing X12 transaction sets. The encoded document is a set of transactions, grouped in functional groups, used in defining transactions for the exchange of business data. This standard does not include the semantic meaning of the encoded information in the transaction set.
Brief 5010 Transactions and Code Sets Update Summary Rules
- The Transaction Set (997) will be replaced by Transaction Set (999) "acceptance report".
- The size of many {segment element} fields will be expanded, leading to the need for all IT providers to expand the fields, elements, files, GUI, paper media, and corresponding databases.
- Some segments have been removed from the existing Transaction Set.
- Many segments have been added to the existing Transaction Set so as to enable greater cost tracking and reporting of patient meetings.
- The capacity to use "International Classification of Illness" version 9 (ICD-9) and 10 (ICD-10-CM) was added.
Security Rules
HIPAA covered bodies such as providers who complete electronic transactions, health care centers and major health plans should use only the National Provider Identifier (NPI) to identify health care providers covered in standard transactions as of May 23, 2007. Small health plans may only use NPIs by 23 May 2008. Effective from May 2006 (May 2007 for small health plans), all closed entities using electronic communications (eg, doctors, hospitals, health insurance companies, etc.) should use a new NPI. NPIs replace all other identifiers used by health plans, Medicare, Medicaid, and other government programs. However, the NPI does not change the provider's DEA number, country license number, or tax identification number. NPI is 10 digits (alphanumeric), with the last digit in the form of checksum. NPI can not load embedded intelligence; in other words, the NPI is just a number that has no additional meaning. NPIs are unique and national, never reused, and except for institutions, providers can usually have only one. An institution may obtain multiple NPIs for different "sub-sections" such as cancer centers or free standing rehabilitation facilities.
Enforcement Rule
On February 16, 2006, HHS issued a Final Regulation on HIPAA enforcement. This became effective on March 16, 2006. The Enforcement Regulation provides for civil penalties for violating HIPAA rules and establishing procedures for investigation and trial for HIPAA violations. Over the years there have been several prosecutions for offenses.
This may have changed with a $ 50,000 fine to Hospice of North Idaho (HONI) as the first entity to be fined for violations of the potential HIPAA Security Rules affecting less than 500 people. Rachel Seeger, a spokesman for HHS, stated, "HONI does not conduct an accurate and thorough risk analysis of the secrecy of ePHI as part of its security management process from 2005 to 17 January 2012." This investigation began with the theft of an unencrypted employee laptop vehicle containing 441 patient records.
In March 2013, the US Department of Health and Human Resources (HHS) has investigated over 19,306 completed cases by requiring changes in privacy practices or by corrective action. If non-compliance is determined by HHS, the entity shall apply corrective action. Complaints have been investigated against various types of businesses such as national pharmaceutical chains, major health care centers, insurance groups, hospital chains and other small providers. There were 9,146 cases in which HHS investigations found that HIPAA was followed correctly. There were 44,118 cases of HHS not finding eligible causes for law enforcement; for example, a violation commencing before HIPAA begins; cases pursued by pursuers; or activities that do not actually violate the Rules. According to the HHS website, the following lists issues that have been reported by frequency:
- Abuse and disclosure of the PHI
- There is no protection in place of health information
- Patients can not access their health information
- Use or disclose more than the minimum protected health information required
- There is no electronic health-protected information security.
The most common entities required to take corrective action to be in voluntary compliance in accordance with HHS are listed by frequency:
- Personal Practice
- Hospital
- Outpatient Facilities
- Group plan such as insurance group
- Pharmacy
Title III standardizes the amount that can be deposited per person in a pre-tax medical savings account. Beginning in 1997, medical savings accounts ("MSA") are available to employees covered by deduction plans compensated by small entrepreneurs and individual corporate-sponsored entrepreneurs.
Title IV: Application and enforcement of group health insurance requirements
Title IV sets out provisions for group health plans regarding the coverage of persons with pre-existing conditions, and modifies the continuation of coverage requirements. It also explains the ongoing coverage requirements and includes COBRA clarification.
Title V: A revenue balance that sets tax-deductions for employers
Title V includes provisions relating to life insurance owned by the company for an employer providing life insurance premiums owned by the company, prohibiting the withholding of interest tax on life insurance loans, corporate endowments, or contracts related to the company. It also revoked the rules of financial institutions for interest allocation rules. Finally, it alters the legal provisions relating to people who give up US citizenship or permanent residency, extending the expatriate tax to be assessed against those who are considered to be giving up their US status for tax reasons, and making the names of former citizens of the public record through the creation of the Individual Quarterly Publication that has been Selected for Expatriate.
Maps Health Insurance Portability and Accountability Act
Effects on clinical research and care
Endorsement of Privacy and Security Rules has led to major changes in the way doctors and medical centers operate. The complex laws and harsh penalties associated with HIPAA, as well as improvements in documents and implementation costs, are a cause of concern among doctors and medical centers. An August 2006 article in the journal Annals of Internal Medicine details some of the concerns about HIPAA implementation and effects.
Effects on research
HIPAA restrictions on researchers have influenced their ability to conduct retrospective graphical studies as well as their ability to prospectively evaluate patients by contacting them for follow-up. A study from the University of Michigan showed that the adoption of the HIPAA Privacy rule resulted in a decrease from 96% to 34% in the proportion of follow-up surveys completed by patients who were followed up after a heart attack. Another study, detailing the effects of HIPAA on recruitment for studies on cancer prevention, suggests that HIPAA mandated changes lead to a 73% reduction in patient accrual, triple the time spent on recruiting patients, and triple the average recruitment cost.
In addition, the informed consent form for research studies is now required to include extensive details on how the participant's protected health information will be kept confidential. Although such information is important, the addition of a long legalistic part of privacy can make this complex document even less friendly for patients who are required to read and sign it.
These data indicate that HIPAA privacy rules, as currently applicable, may have a negative impact on the cost and quality of medical research. Dr Kim Eagle, professor of internal medicine at the University of Michigan, quoted in the article Annals, said: "Privacy is important, but research is also important to improve care, we hope that we will think about this and do it right. "
Effects on clinical care
The complexity of HIPAA, combined with potentially harsh penalties for offenders, can lead doctors and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rules by the US Government Accountability Office found that healthcare providers "are unconvinced about their legal privacy responsibilities and are often responded to with an overly maintained approach to disclosing information... than is necessary to ensure compliance with the Privacy Rules". This uncertainty report continues.
Cost of implementation
In the immediate period prior to the enactment of HIPAA Privacy and Security Acts, medical centers and medical practice are required to "comply". With an initial emphasis on potentially severe penalties related to offenses, many practices and personal switching centers, the nonprofit "HIPAA consultant" is very familiar with the details of the law and offers their services to ensure that doctors and medical centers are fully "in compliance". In addition to the costs of developing and improving systems and practices, improvements in documents and staff time required to comply with HIPAA legal requirements may have an impact on the medical center's finances and practices as Medicare insurance and reimbursement also declines..
Education and training
Education and training of healthcare providers is essential to improve the implementation of HIPAA Privacy and Security Acts. Effective training should explain the background and legal goals and objectives of HIPAA and a general summary of the key principles and provisions of the Privacy Rules.
Violation
According to the US Department of Health and Human Services for Civil Rights, between April 2003 and January 2013, he received 91,000 complaints of HIPAA violations, where 22,000 caused enforcement actions of various types (from settlement to fine) and 521 led to referrals to the US Department of Justice as an act criminal. Examples of significant violations of protected information and other HIPAA violations include:
- The biggest loss of data affecting 4.9 million people by Tricare Management of Virginia in 2011
- The largest fines of $ 5.5 million are levied on Memorial Healthcare Systems in 2017 to access the confidential information of 115,143 patients and $ 4.3 million imposed on Cignet Health of Maryland in 2010 for ignoring patient requests to obtain copies of their own records and repeated abandonment of federal officials' questions
- The first criminal indictment was filed in 2011 against a Virginia physician who shared information with the employer of the patient "under false pretenses that the patient was a serious and immediate threat to public safety, when in fact he knew that the patient was not a threat like that." >
According to Koczkodaj et al., 2018, the number of people affected since October 2009 was 173,398,820.
The differences between civil and criminal penalties are summarized in the following table:
Legislative information
- Pub.L. 104-191, 110 Stat.Ã, 1936
- H.R. 3103; H. Rept. 104-469, part 1; H. Rept. 104-736
- S. 1028; S. 1698; S. Rept. 104-156
- HHS Security Standard, 45 C.F.R. 160 , 162, and 164
- The HHS Standard for the Privacy of Individually Identifiable Health Information, 45 C.F.R. 160 and 164
References
External links
- California Office Implementation HIPAA (CalOHI)
- "HIPAA", Medicare and Medicaid Service Centers
- Congressional Research Service (CRS) reports on HIPAA, University of North Texas Library
- Full text of the Portability and Accountability Act of Health Insurance (PDF/TXT) US Government Printing Office
- The full text of the Health Insurance Portability and Accountability Act (HTM) Legal Archiver
- Rights page for Civil Rights at HIPAA
- Definition of the HIPAA Health Privacy Knowledge Base
Source of the article : Wikipedia
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