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This is a summary Effective Communication Through Person Centered Care key elements of the Privacy Rule including who is covered, what information is protected, and how protected health information can be used and disclosed. Because it is an overview of the Privacy Rule, it does not address every detail of each provision. The U. The Rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the Rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed. This is a summary of key elements of the Privacy Rule and not a complete or comprehensive guide to compliance. Entities regulated by the Rule are obligated to comply with all of its applicable requirements and should not rely on this summary as a source of legal information or advice.
To make it easier for entities to review the complete requirements of the Rule, provisions of the Rule referenced in this summary are cited in the end notes. In the event of a conflict between this summary and the Rule, the Rule governs.
What you need to know
Collectively these are known as the Administrative Simplification provisions. HIPAA required the Secretary to issue privacy regulations governing individually identifiable health information, if Congress did not enact privacy legislation within three years of the passage of HIPAA. Because Congress did not enact privacy legislation, HHS developed a proposed rule and released it for public comment on November 3, The Department received over 52, public comments. The final regulation, the Privacy Rule, was published December 28, In Marchthe Department proposed and released for public comment modifications to the Privacy Rule.
The Department received over 11, comments. The final modifications were published in final form on August 14, For help in determining here you are covered, use CMS's decision tool.
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Health Plans. Individual and group plans that provide or pay the cost of medical care are covered entities. Health plans also include employer-sponsored group health plans, government and church-sponsored health plans, and multi-employer health plans. There are exceptions—a group health plan with less than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity. Two types of government-funded programs are not health plans: 1 those whose principal purpose is not providing or paying the cost of health care, such as the food stamps program; and 2 those programs whose principal activity is directly providing health care, such as a community health center, 5 or the making of grants to fund the direct provision of health care. If an insurance entity has separable lines of business, one of which is a health plan, the HIPAA regulations apply to the entity with respect to the health plan line of business.
Health Care Providers. Every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity. These transactions include claims, benefit eligibility inquiries, referral Effective Communication Through Person Centered Care requests, or other transactions for Effective Communication Through Person Centered Care HHS has established standards under the HIPAA Transactions Rule. The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf. Health Care Clearinghouses. Health care clearinghouses are entities that process nonstandard information they receive from another entity into a standard i. Business Associate Defined. In general, a business associate is a person or organization, other than a member of a covered entity's workforce, that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of individually identifiable health information.
Business associate functions or activities on behalf of a covered entity include claims processing, data analysis, utilization review, and billing. However, persons or organizations are not considered business associates if their functions or services do not involve the use or disclosure of protected health information, and where any access to protected health information by such persons would be incidental, if at all.
A covered entity can be the business associate of another covered entity. Business Associate Contract. When a covered entity uses a contractor or other non-workforce member to perform "business associate" services or activities, the Rule requires that the covered entity include certain protections for the information in a business associate agreement in certain Effective governmental entities may use alternative means to achieve the same protections. In the business associate contract, a covered entity must impose specified written safeguards on the individually identifiable health information used or disclosed by its business associates.]
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