Health Information Portability & Accountability ActPresented by Jennifer Coughlinwww.brotherslaw.comEugene, OregonApril 10, 2013

TOPICS OF CONVERSATION

1. STATE LAW PREEMPTION OF HIPAA

2. PATIENTS’ RIGHTS TO REQUEST AND RECEIVE RECORDS UNDER HIPAA

3. PATIENTS’ RIGHTS TO AMEND RECORDS UNDER HIPAA

4. SPECIAL CARE OF SPECIALIZED RECORDS

State Law Preemption of HIPAA

HIPAA’s Privacy Rule is preempted by state laws which are MORE stringent regarding privacy of PHI than the federal standards

The federal standards of the Privacy Rule are the baseline…if Oregon requires more stringent privacy, it wins!

Federal regulatory standard

PATIENT RIGHTS UNDER HIPAA

Right to Receive Notice of Privacy Practices Right to Access Protected Health Information Right to Amend Protected Health Information Right to Accounting of Disclosures of Protected Health

Information Right to Request A Specified Method of Communication Right to Request Restrictions on Use and Disclosure of

Protected Health Information

PATIENT RIGHTS UNDER HIPAA Right to Receive Notice of Privacy Practices

Right to Access Protected Health Information

Right to Amend Protected Health Information

Right to Accounting of Disclosures of Protected Health Information

Right to Request A Specified Method of Communication Right to Request Restrictions on Use and Disclosure of

Protected Health Information

PATHWAYS TO DISCLOSURE OF PROTECTED HEALTH INFORMATION

TreatmentPaymentOperationsPatient

Requests

Do I Need To Comply With HIPAA?

Use computers to send health information for administrative, financial purposes Ie, filing claims for

insurance ORS 192.556(2)(c)

HIPAA COMPLIANT FORMS: ORS 192.566

http://smileoregon.org/wp-content/uploads/2010/06/HIPAA-FORM.pdf

http://orcr.uoregon.edu/index.cfm?action=hipaa_authGo to www.brotherslaw.com/articles for Presentation and Links

Patient has right to see, get a copy of, and amend record

ORS 192.553(1)(b)

What is a “record”?

Identifying Information Subjective Info Told to

Doctor/Nurse/PA Exam/Test Results Treatment Received Medicine Prescribed Dr.’s Notations About

Patient

MINORS’ RIGHTS TO RECORDS

Generally speaking….Parents or guardians have right to get their child’s medical records

EXCEPTIONS: Neglect, harm After 18 Married Consent Birth control, STDs

Power of Attorney* Relevance Required* Only During POA Effective Timeframe

Click icon to add picture

PERSONAL REPRESENTATIVES• Court-Appointed Personal

Representatives • Proof of appointment and

identification• If not an appointed

personal representative, hierarchy of others can request

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HIPAA Form Specifics

Dates being requested Any previous names used Date of birth Social security number Entire record, or just part?

Labs, diagnostic reports or studies, discharge summary, op notes, pertinent package, physician orders, nurses notes, test results, etc.

See record, or get copy of?

SUMMARIESDENIALS

Fee can be charged Understand beforehand Not required Plain language Different language??

30 days Limited circumstances In writing Right to review denial Wrong provider is

requested…duty to inform of proper provider

PATIENTS’ RIGHT TO AMEND

ONLY for inaccurate or missing information Oral vs. writing Denials Minors Form for requesting amendment

http://www.utsouthwestern.edu/edumedia/edufiles/about_us/admin_offices/hipaa_privacy/medical-record-amendment.pdf

http://www.bmc.org/Documents/bmc-RequestCorrection-MedicalRecord.pdf

www.brotherslaw.com/articles

Allowable Charges for Records• ORS 192.563• $30 10 or fewer pages• $.50/page 11-50• $.25/page add’l pages• “Bonus” charge• Postage• X-rays, other

expensive requests• Patient can’t afford…

what to do?

What Would HIPAA do?* Privacy Rule allows a “reasonable fee” based upon actual costs of copying• Labor, supplies• Excludes search and

handling fees

* OCR determination of reasonableness

SPECIALIZED TOPIC RECORDS

ALCOHOL, DRUG & PSYCHIATRIC RECORDS

State and Federal Law Prohibit Disclosure of Information about Alcohol, Drug & Psychiatric Cases

Includes confirmation of admission/discharge Standard Answer, “We cannot, under federal or state

law, comment on such a case.” ORS 426: Mental Health & Developmental Disabilities;

Drug & Alcohol ORS 192.515 to ORS 192.517 42 USC 290: Methods of Disclosure

RESOURCES FOR HIPAA COMPLIANCE

Brothers, Hawn & Coughlin, www.brotherslaw.com/articles Power Points, Outline and details of presentation

4 Steps to HIPAA Compliance This presentation & Links

Oregon HIPAA Forum http://www.oregonhipaaforum.org

Oregon Health Authority http://public.health.oregon.gov/DISEASESCONDITIONS/COMMUNIC

ABLEDISEASE/LOCALHEALTHDEPARTMENTS/Pages/hipaa.aspx

Office for Civil Rights http://www.hhs.gov/ocr/hipaa

Dept. Health & Human Services http://www.hhs.gov/hipaafaq/use/index.html

Psychiatric, Alcohol and Drug http://www.law.cornell.edu/uscode/text/42/290dd-2