Otis Singleton
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards to protect sensitive health information from disclosure without a patient's consent. The act has five titles, each addressing different aspects of health insurance and privacy. Title I protects health insurance coverage for individuals who lose or change jobs, while Title II, also known as the Administrative Simplification provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title III includes tax-related provisions and guidelines for medical care, while Title IV offers guidelines for group healthcare plans. Title V includes provisions related to company-owned life insurance and the treatment of those who lose their U.S. citizenship for income tax purposes. While the act applies to a wide range of entities, including health plans, health care clearinghouses, and health care providers, it is unclear how it specifically applies to electric companies.
| Characteristics | Values |
|---|---|
| Year of Enactment | 1996 |
| Full Form | Health Insurance Portability and Accountability Act |
| Titles | 5 |
| Purpose | To provide continuous health insurance coverage for workers who lose or change their job and to ultimately reduce the cost of healthcare by standardizing the electronic transmission of administrative and financial transactions |
| Applicability | All healthcare providers, regardless of size, who electronically transmit health information in connection with certain transactions |
| Compliance | While there is no official HIPAA compliance certification program, training companies offer certification credentials to indicate an understanding of the guidelines and regulations specified by the act |
| Privacy Rule | The Privacy Rule requires medical providers to give individuals access to their PHI |
| Security Rule | The Security Rule establishes a national set of security standards to protect certain health information that is maintained or transmitted in electronic form |
| Exceptions | A group health plan with fewer than 50 participants administered solely by the establishing and maintaining employer is not covered |
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What You'll Learn
The Privacy Rule
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards to protect sensitive health information from disclosure without a patient's consent. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement HIPAA requirements. The Privacy Rule standards address the use and disclosure of individuals' protected health information (PHI) by entities subject to the rule. These entities are called "covered entities".
To comply with the Privacy Rule, covered entities must ensure the confidentiality, integrity, and availability of all PHI. They must also detect and safeguard against anticipated threats to the security of the information and protect against impermissible uses or disclosures that are not allowed by the rule. Covered entities should rely on professional ethics and best judgment when considering requests for permissive uses and disclosures.
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The Security Rule
To comply with the Security Rule, covered entities must detect and safeguard against anticipated threats to the security of ePHI and protect against impermissible uses or disclosures that are not allowed by the rule. They should rely on professional ethics and best judgment when considering requests for permissive uses and disclosures. The Security Rule also requires regulated entities to notify individuals, the Secretary of Health and Human Services (HHS), and in some cases, the media, when certain information has been acquired, accessed, used, or disclosed in a manner not permitted by the Privacy Rule.
The Administrative Simplification provisions of HIPAA require the Secretary of HHS to adopt standards to ensure that covered entities maintain reasonable and appropriate safeguards for the security of individually identifiable health information. These standards aim to ensure the integrity and confidentiality of the information, protect against anticipated threats, and ensure compliance with HIPAA by the officers and employees of covered entities.
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Administrative Simplification
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards to protect sensitive health information from disclosure without a patient's consent. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement HIPAA requirements. The HIPAA Security Rule protects specific information covered by the Privacy Rule. The Privacy Rule standards address the use and disclosure of individuals' protected health information (PHI) by entities subject to the rule.
The Administrative Simplification provisions of HIPAA require the Secretary of HHS to adopt specific code sets for diagnoses and procedures to be used in all transactions. The Administrative Simplification rules apply to health plans, health care clearinghouses, and any healthcare provider that transmits health information electronically in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA. These covered entities include health, dental, vision, and prescription drug insurers, health maintenance organizations, Medicare, Medicaid, long-term care insurers, employer-sponsored group health plans, government and church-sponsored health plans, and multi-employer health plans.
The Security Rule sets forth the administrative, physical, and technical safeguards that covered entities and their business associates must put in place to secure individuals' electronic protected health information (ePHI). The Security Rule is designed to be flexible, scalable, and technology-neutral, enabling regulated entities to implement policies, procedures, and technologies that suit their size, structure, and risks to ePHI.
To comply with the HIPAA Security Rule, covered entities must ensure the confidentiality, integrity, and availability of all ePHI, detect and safeguard against anticipated threats to the security of the information, and protect against anticipated impermissible uses or disclosures not allowed by the rule. The Security Rule complements the privacy standards established in the Privacy Rule and the requirements of the Breach Notification Rule, which mandates that covered entities notify individuals, the Secretary of HHS, and sometimes the media when certain information has been acquired, accessed, used, or disclosed in a manner not permitted by the Privacy Rule. Together, the Privacy, Security, and Breach Notification Rules help protect the privacy and security of PHI.
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Protected Health Information (PHI)
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards to protect sensitive health information from disclosure without a patient's consent. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement HIPAA requirements. The Privacy Rule addresses the use and disclosure of individuals' protected health information (PHI) by entities subject to the rule.
PHI is any information in a medical record or designated record set that can be used to identify an individual and was created, used, or disclosed in the course of providing a healthcare service such as diagnosis or treatment. PHI includes "individually identifiable health information" relating to an individual's past, present, or future physical or mental health, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual. This includes common identifiers such as names, addresses, birth dates, and Social Security Numbers.
PHI is protected when it is transmitted or maintained in any form by a covered entity. Covered entities include health plans, health care clearinghouses, and qualifying healthcare providers that conduct electronic transactions for which the Department of Health and Human Services (HHS) has published standards. The HIPAA Privacy Rule stipulates what uses and disclosures of PHI are required, permissible, or need written authorization from the individual. For example, disclosures to a life insurer for coverage purposes or disclosures to a pharmaceutical firm for their marketing purposes would require authorization.
The HIPAA Security Rule protects a subset of information covered by the Privacy Rule. This subset is all individually identifiable health information that a covered entity creates, receives, maintains, or transmits in electronic form, known as electronic protected health information (ePHI). The Security Rule sets forth the administrative, physical, and technical safeguards that covered entities and their business associates must put in place to secure individuals' ePHI.
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Compliance and Enforcement
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards to protect sensitive health information from disclosure without a patient's consent. The US Department of Health and Human Services (HHS) is responsible for enforcing the Privacy and Security Rules of HIPAA. HHS's Office for Civil Rights (OCR) administers and enforces these standards and may conduct complaint investigations and compliance reviews. The OCR seeks the cooperation of covered entities and may provide technical assistance to help achieve compliance.
The OCR's enforcement activities have resulted in systemic changes that have improved the privacy protection of health information for all individuals served by covered entities. The OCR has the power to impose civil monetary penalties (CMPs) on covered entities found to be in violation of the Privacy or Security Rules. If CMPs are imposed, the covered entity may request a hearing before an HHS administrative law judge to decide if the penalties are supported by the evidence.
To comply with the HIPAA Security Rule, covered entities must ensure the confidentiality, integrity, and availability of all electronic protected health information (ePHI). This includes detecting and safeguarding against anticipated threats to the security of the information and protecting against impermissible uses or disclosures not allowed by the rule. Covered entities should rely on professional ethics and best judgment when considering requests for permissive uses and disclosures.
Regulated entities must comply with all applicable requirements of the Security Rule. They must perform periodic technical and non-technical assessments of their policies and procedures to ensure they meet the requirements of the Security Rule. As part of this assessment, entities must evaluate their security safeguards to demonstrate and document their compliance with their security policy and the Security Rule. They must also assess the need for a new evaluation based on changes to their security environment, such as new technology or responses to newly recognized risks.
The HIPAA Privacy Rule establishes a set of national standards for the use and disclosure of an individual's protected health information (PHI) by covered entities. Covered entities are required to disclose PHI to an individual upon request within 30 days. They may also disclose PHI to law enforcement upon receiving court orders, subpoenas, or administrative requests. Any other disclosures of PHI require the individual's prior written authorization. Individuals have the right to an accounting of the disclosures of their PHI by a covered entity or its business associates, with some exceptions, such as for treatment, payment, or healthcare operations.
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Frequently asked questions
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards protecting sensitive health information from disclosure without patient consent.
The Security Rule sets forth the administrative, physical, and technical safeguards that covered entities and business associates must put in place to secure individuals' electronic protected health information (ePHI).
HIPAA has two main purposes: to provide continuous health insurance coverage for workers who lose or change their jobs and to ultimately reduce the cost of healthcare by standardizing the electronic transmission of administrative and financial transactions.
There are five Titles in HIPAA:
- Title I: Protects health insurance coverage for individuals and their families during job changes or losses.
- Title II: Addresses healthcare fraud and abuse, implements medical liability reform, and promotes administrative simplification by establishing national standards for electronic healthcare transactions.
- Title III: Provides guidelines for pre-tax medical spending accounts and introduces changes to health insurance laws and deductions for medical insurance.
- Title IV: Offers guidelines for group healthcare plans, including modifications to health coverage provisions.
- Title V: Regulates company-owned life insurance policies and the treatment of those who lose their U.S. citizenship for income tax purposes.
The Privacy Rule safeguards Protected Health Information (PHI) and applies to health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically. The Security Rule protects a subset of information covered by the Privacy Rule, specifically all individually identifiable health information that a covered entity creates, receives, maintains, or transmits in electronic form.
