HIPAA Basics. Health Insurance Portability and Accountability Act of 1996

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1 HIPAA Basics Health Insurance Portability and Accountability Act of 1996

2 HIPAA: What Is HIPAA? Protects the privacy of healthcare for all Americans, including the individuals you support Protects the privacy of Protected Health (PHI) Sets rules and limits on who can look at and receive PHI Provides the freedom of movement of between health care benefit plans

3 What are a person s rights under HIPAA? Access: The right to review and obtain a copy of their protected health Amendment: The right to amend or have made to their protected health Disclosure The right to know how their protected health has been shared

4 What are a person s rights under HIPAA? Request: The right to request that the sharing of certain protected health be restricted under certain circumstances The right to request an say a post office box instead of a home address, or means, for instance via e mail instead of by telephone, for receiving of their PHI

5 Who does HIPAA apply to? Health Care Providers: Most doctors, nurses, pharmacies, hospitals, clinics, nursing homes, healthcare and other providers Health Plans: Health insurance companies, HMOs and employer health plans Business Associates: Persons or companies that perform services for Health Care Providers or Health Plans that involve the use or sharing of health Employees of Health Care Providers or Health Plans

6 Who does HIPAA apply to? Basically, HIPAA applies to anyone who provides care, hears and has access to a person s health and/or bills for healthcare services.

7 What does HIPAA protect? Protected Health (PHI) is defined as individually health that is transmiwed or maintained in any form of medium (electronically, oral, or wriwen), as it relates to: The past, present, or future physical or mental health of a person The provision of health care to a person The past, present, or future payment for the provision of health care to a person

8 What does HIPAA protect? becomes individually if it defines the person or there is a reasonable basis to believe the can be used to the person.

9 What does HIPAA protect? Personal (Name, Address, SS#, etc.) Health Status (Diagnosis, Medical Records) Provision of Care (Services received) Payment of Services (How payment will be made) Billing

10 What does HIPAA protect? Anyone of us has the to violate an individual s privacy and This is why it is important for you to know and understand how HIPAA compliance protects the privacy and of those you support.

11 What does HIPAA protect? HIPAA is all about the use and disclosure of including: Who uses it? Who it is released to? How much is released? Why is released?

12 What does HIPAA protect? Individuals you support have the right to privacy when it comes to the disclosure of their personal health They have the right to control their personal and to not have it divulged or used by others against their wishes. You must maintain by making a conscious effort to keep private ANY provided by anyone on behalf of the individuals you support in the process of receiving services.

13 What does HIPAA protect? As Direct Care professionals, you are responsible to monitor your own behavior and the behavior of others. You are legally responsible for the health of the individuals you support.

14 When can PHI be shared? Protected Health may be shared for: Treatment services, day programs) Payment (billing for services) Health Care (quality assurance, program oversight) Only the minimum amount of necessary to accomplish the intended purpose should be provided.

15 When can PHI be shared? Accessing PHI with no need or without specific purpose to deliver care is a of an Individual s As Direct Support Professionals, you must be careful to not become casual with PHI remembering always your responsibility to keep private private.

16 When can PHI be shared? There are a number of other possible circumstances when PHI may be disclosed for public need purposes without These include, but are not limited to: Government Audits Public Health and Safety A subpoena from the Courts

17 When is an to share PHI needed? An must be obtained in for any use or sharing of protected health that is not for treatment, payment, health care or otherwise allowed. All must be wriwen in plain language.

18 When is an to share The must: PHI needed? Describe the protected health to be shared the person(s) who may share and receive the PHI, as well as the purpose of the sharing

19 When is an to share Other requirements include: An date PHI needed? Statements to cancelling and re sharing of Giving the individual a copy of the once it has been signed and dated

20 What steps must be taken to protect a person s PHI? HIPAA requires that a person s protected health remains secure. It is your responsibility to be aware and to follow the policies and procedures set forth by your employer with respect to the integrity, and availability of protected health

21 What steps must be taken to protect a person s PHI? Confiden'ality means that protected health is only used by authorized people. Integrity means that PHI is not altered or destroyed. Availability means that PHI can be used as needed by an authorized person. It is also important for you to protect against threats, hazards, or misuse of PHI.

22 What steps must be taken to protect a person s PHI? Don t discuss about individuals you support in a public place where others can overhear Make sure files are not le` where unauthorized people can see them and that they are in a secure when not in use When sending a FAX, make sure an authorized person is on the other end to receive it

23 What steps must be taken to Computers: protect a person s PHI? All computers should be password protected Your computer screen should face away from public area/viewing When stepping away from a computer in use, you can protect by closing all and using a screen saver Do not send PHI via e mail unless it is encrypted

24 What steps must be taken to protect a person s PHI? Verify the of any person an Individual s personal health to ensure they can receive the Do not give out over the telephone unless you have to do so Do not take an Individual s personal health out of the home or work program unless authorized to do so

25 What steps must be taken to protect a person s PHI? Keep When in doubt, do not give any out You should review your employer s policies and with respect to keeping PHI secure and

26 How to dispose of documents containing PHI? Anything containing PHI has to be disposed of in a way that makes the unreadable, such as shredding.

27 How to report a If you suspect or are aware of a HIPAA regarding protected health you must act. Follow the specific wriwen policies and procedures set forth by your employer which may include immediately your supervisor or your agency s Privacy Officer, or filling out a wriwen report.

28 How to report a In if you are able to take reasonable to lessen the HIPAA you should do so immediately.

29 What can happen if you violate the HIPAA law or your company s privacy A person who purposely uses or shares individually health in of HIPAA faces a fine of $50,000 and up to one year in jail The criminal increase to $100,000 and up to five years in jail if the involves false pretenses or lying If the involves the sale or use of individually health for personal gain or malicious harm, the criminal increase to $250,000 and up to ten years imprisonment

30 What can happen if you violate the HIPAA law or your company s privacy A of your employer s HIPAA privacy can lead to company up to and including of your job You could lose any professional license(s) that you may need to perform your job Please remember that simply viewing the PHI of anyone who is not under your care and sharing such with others is a of HIPAA

31 What can happen if you violate the HIPAA law or your company s privacy The bowom line is that just one of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine, and a jail term HIPAA is serious business and needs your undivided

32 How do you prevent this from happening to you? Follow Employer policies and procedures: Your employer should have policies and procedures that cover almost any HIPAA issue that you are likely to encounter Strictly observe Minimum Necessary (Need to Know): Only use specific that you require for that job

33 How do you prevent this from happening to you? Be Never view or use protected health unless you have a proper reason for doing so Use and share PHI only as permiwed by law and your applicable employment policies and procedures Use common sense and when in doubt, ASK

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