HIPAA Minimum Necessary Grasp the Concept. Tara Scrogin, J.D. Privacy Officer
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1 HIPAA Minimum Necessary Grasp the Concept Tara Scrogin, J.D. Privacy Officer
2 Purpose Who can I share PHI with? What are the rules of the road??
3 Minimum Necessary General Standard: 45 CFR (b) When using or disclosing PHI or when requesting PHI from another covered entity (CE), a CE must make reasonable efforts to limit PHI to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request. Use = internal; Disclosure = external What is internal and what is external? What is the ACE? You might be surprised!
4 (IRBs) HIPAA Legal Structure University of Nebraska Board of Regents (Hybrid Entity) Covered Healthcare Components Health Plans (3) Barkley Center UNMC UNL Student Health UNMC Physicians University Dental Associates Children s Pediatric Practice Other Children s Nebraska Health Network (NHN) Nebraska Orthopedic Hospital (NOH) VA Bellevue Medical Center & Medical Staff The Nebraska Medical Center & Medical Staff Hybrid Affiliated Covered Entity (ACE) Organized Healthcare Arrangement (OHCA) 05/01/2015 Business Associates 45 CFR August 1, 2009
5 Minimum Necessary Implementation Specifications Role-based Access: 45 CFR (d) A) Identify workforce persons or classes of persons who need PHI to carry out their duties; and B) For each, identify categories of PHI needed, and any conditions appropriate to such access *System Administrators/Information Custodians responsible for this. Information Custodian for One Chart is Carisa Masek
6 Requests for PHI PHI: individually identifiable health information; contains at least one of 18 individual identifiers (see IM.12 for list) HIPAA does not apply to de-identified information Minimum Necessary does not apply to uses and disclosures to: Health care providers for treatment purposes. Disclosures required by Law Disclosures made pursuant to authorization Disclosures made to DHHS for enforcement Electronic data elements transmitted in electronic claims
7 Responding to Requests for PHI 1. Ask: For what purposes will you use the information? 2. Determine if purpose of use is permissible under HIPAA 3. Verify that amount of PHI disclosed is minimum necessary to accomplish purpose 4. Document information released and specific description of stated use 5. Verify what service area is to be included in the report.
8 Use & Disclosure of Protected Health Information (PHI) The HIPAA Privacy Rule specifies how PHI can be used and disclosed with and without patient written authorization. Primary Uses/Disclosures without authorization: Treatment Payment Health care operations Business Support Activities Performance Improvement/patient safety Risk Management Training health care professionals such as UNMC students
9 Okay, so what s a permissible use of PHI under HIPAA? IM.12: Use and Disclosure of PHI policy contains full information: Treatment, Payment and Health Care Operations Treatment includes: Communication between health care providers Consults and Referrals
10 Treatment, Payment and Health Care Operations (TPO) Payment includes: Activities to obtain reimbursement for health care Determinations of insurance coverage Billing and collection activities Claims management Medical necessity determinations Utilization review activities, including precertification and preauthorization
11 Treatment, Payment and Health Care Operations (TPO) Health Care Operations includes: QA, PI, outcomes evaluation, development of clinical guidelines Activities relating to improving health or reducing costs Protocol development Case management Risk assessment Reviewing competence or qualifications & accrediting/licensing of providers When does QA become research?
12 Treatment, Payment and Health Care Operations (TPO) Health Care Operations includes: Training future health care professionals Accreditation activities (JCAHO, etc.) Legal services Business planning and development Administrative and business functions Medical reviews and auditing Insurance activities Resolution of internal grievances Fundraising (several restrictions)
13 Research PHI may be used and disclosed for research, as long as requestor provides you with IRB approval number IRB ensures HIPAA requirements met before approving research requests If requestor wants PHI in preparation for research, direct the caller to the Health Information Dept (Judith ) Covered entities may use and disclose health information that is deidentified remove 18 identifiers
14 Patient Authorization All other uses and disclosures of PHI not described in the sections above are prohibited unless the patient signs an authorization specifically permitting the use/disclosure
15 Fundraising If information requests are for fundraising, direct the requestor to Nebraska Medicine Office of Development and/or the NU Foundation Only the following information may be used or disclosed to business associates and institutionally-related foundations for fundraising (see Policy MI 10, Corporate Fundraising Guidelines): 1. Demographic information relating to an individual, including name, address, other contact information, age, gender,and date of birth; 2. Dates of health care provided to an individual; 3. Department of service information; 4. Treating physician; 5. Outcome information; and 6. Health insurance status. Disclosure of all other types of PHI for fundraising purposes is prohibited unless the patient signs an authorization All fundraising materials must clearly and conspicuously explain how the individual may opt out of receiving any further fundraising communications for an individual campaign or for all future fundraising
16 Marketing Individual authorization required before PHI can be used for marketing Very narrow HIPAA definition. The following is NOT Marketing: 1. Communications to describe a health-related product or service provided Communications for treatment of the individual; 2. Communications for case management or care coordination for the individual, or to direct or recommend alternative treatments, therapies, health care providers, or settings of care to the individual; 3. Providing refill reminders or otherwise communicating about a drug or biologic that is currently being prescribed for the individual, only if any financial remuneration received by Hospital in exchange for making the communication is reasonably related to the covered entity s cost of making the communication (such as the cost of mailing); and 4. Communications to describe a health related product or service that is provided by or included in a plan of benefits of the Hospital, including communications about: (i) the entities participating in a health care provider network or health plan network; (ii) replacement of, or enhancements to, a health plan; and (iii) health-related products orservices available only to a health plan enrollee that add value to, but are not a part of, a plan of benefits;
17 Disclosures permitted/required by Law Anytime a state or federal law permits or requires disclosure of PHI, it is a permissible disclosure under HIPAA Examples: Registries mandated by law Infectious disease reporting Suspected child abuse reporting Reports to the FDA Many more
18 Disclosures to Law Enforcement Several types of disclosures to law enforcement are permitted under HIPAA Contact Privacy Officer, Risk Management, or Medical Records Dept if you receive such a request.
19 Sale of PHI Selling protected health information is prohibited unless the patient signs an authorization specifically permitting the sale
20 You may use & disclose PHI for the following purposes If it is necessary to do your job that is, to support the range of services you provide, which may include: Training healthcare professionals including students, residents & trainees For patient treatment purposes - including continuation of care, obtaining consults, and communications necessary for patient safety. Healthcare operations such as quality improvement initiatives Billing/Payment activities
21 Electronic Health Record Access Minimum Necessary Only the minimum amount of PHI necessary to accomplish the intended purpose should be used and disclosed for payment and health care operations activities.
22
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