HIPAA Breach Notification Rule – Complete Guide

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HIPAA Breach Notification Rule – Complete Guide

hippaThe Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security Rules, and Breach Notification Rules protect the privacy and security of health information and provide individuals with certain rights to their health information.

This publication discusses:

● The Privacy Rule, which sets national standards for when protected health information (PHI) may be used and disclosed.

● The Security Rule, which specifies safeguards that covered entities and their business associates must implement to protect the confidentiality, integrity, and availability of electronic protected health information (ePHI)

● The Breach Notification Rule, which requires covered entities to notify affected individuals, U.S. Department of Health & Human Services (HHS), and in some cases, the media of a breach of unsecured PHI You play a vital role in protecting the privacy and security of patient information. This publication gives an overview of the rules, and it outlines the information protected by and who must comply with those rules.
HIPAA Privacy Rule
The HIPAA Privacy Rule establishes standards for the protection of PHI held by

● Health plans
● Health care clearinghouses
● Those health care providers that conduct certain health care transactions electronically
● Their business associates

HIPAA Basics for Providers:
The Privacy Rule gives patients important rights with respect to their health information,including rights to examine and obtain a copy of their health records in the form and manner they request, and to ask for corrections to their information. Also, the Privacy
Rule permits the use and disclosure of health information needed for patient care and other important purposes.

Protected Health Information
The Privacy Rule protects individually identifiable health information, called PHI, held or transmitted by a covered entity or its business associate, in any form, whether electronic, paper, or verbal. PHI includes information that relates to all of the following:
● The individual’s past, present, or future physical or mental health or condition
● The provision of health care to the individual
● The past, present, or future payment for the provision of health care to the individual

PHI includes many common identifiers, such as name, address, birth date, and Social Security number.

HIPAA Security Rule
The HIPAA Security Rule specifies safeguards that covered entities and their business associates must implement to protect the confidentiality, integrity, and availability of ePHI.

Covered entities and business associates must develop and implement policies and procedures to protect the security of ePHI they create, receive, maintain, or transmit.Each entity must analyze the risks to ePHI in its environment and create solutions appropriate for its own situation. What is reasonable and appropriate depends on the nature of the entity’s business, as well as its size, complexity, and resources.
Specifically, covered entities must:

● Ensure the confidentiality, integrity, and availability of all ePHI they create, receive,maintain, or transmit.

● Identify and protect against reasonably anticipated threats to the security or
integrity of the ePHI

● Protect against reasonably anticipated, impermissible uses or disclosures

● Ensure compliance by their workforce.

Who Must Comply With HIPAA Rules?
Covered entities and business associates, as applicable, must follow HIPAA rules. If an entity does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA rules.

Covered Entities

Covered entities electronically transmit health information. The following covered entities must follow HIPAA standards and requirements:

Covered Health Care Provider: Any provider of medical or other health care services or supplies who transmits any health information in electronic form in connection with a transaction for which HHS has adopted a standard, such as:

Chiropractors
Clinics
Dentists
Doctors
Nursing homes
Pharmacies
Psychologists

Health Plan: Any individual or group plan that provides or pays the cost of health care, such as:
Company health plans
Government programs that pay for health care, such as Medicare, Medicaid,
and the military and veterans’ health care programs
Health insurance companies
Health maintenance organizations (HMOs)

Health Care Clearinghouse: A public or private entity that processes another entity’s health care transactions from a standard format to a non-standard format,or vice versa, such as:
Billing services
Community health management information systems
Repricing companies
Value-added networks

Business Associates

A business associate is a person or organization, other than an employee of a covered entity, that performs certain functions on behalf of, or provides certain services to, a covered entity that involve access to PHI. A business associate can also be a subcontractor responsible for creating, receiving, maintaining, or transmitting PHI on behalf of another business associate. Business associates provide services to covered entities that include:

● Accreditation
● Billing
● Claims processing
● Consulting
● Data analysis
● Financial services
● Legal services
● Management administration
● Utilization review
NOTE: A covered entity can be a business associate of another covered entity.
If a covered entity enlists the help of a business associate, then a written contract orother arrangement between the two must:
● Detail the uses and disclosures of PHI the business associate may make
● Require that the business associate safeguard the PHI

Enforcement
The HHS Office for Civil Rights enforces the HIPAA Privacy, Security, and Breach Notification Rules. Violations may result in civil monetary penalties. In some cases,criminal penalties enforced by the U.S. Department of Justice may apply.

Common noncompliance issues include:
● Impermissible PHI uses and disclosures
● Lack of PHI safeguards
● Lack of patients’ access to their PHI
● Use or disclosure of more than the minimum necessary PHI
● Lack of administrative ePHI safeguards

The following are actual case examples:

Settlement: Two covered entities inadvertently posted ePHI for 6,800 individuals on the web, including patient status, vital signs, medications, and laboratory results.The investigation found that neither entity made efforts to assure the security of
the server hosting the ePHI or confirm it contained adequate software protections.Neither entity developed an adequate risk management plan that addressed potential threats and hazards to ePHI. The entities agreed to pay a combined settlement of $4.8 million and enter into corrective action plans.

Criminal prosecution: A former hospital employee pleaded guilty to criminal HIPAA charges after obtaining PHI with the intent to use it for personal gain. He faced up to 10 years in prison.

This is work in Progress and for more information Please contact us.

Tier3 is an IT firm which specializes in consultancy and development of Hipaa Compliant Software Development and health management systems.

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