 Health Insurance and Accountability Act Cornelius Villalon Jr.

H.I.P.A.A

On August 21, 1996 H.I.P.A.A

On August 21, 1996 by the United States Congress and signed by President Bill Clinton

Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Title III: Tax-related Health Provisions Governing Medical Savings Accounts Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Title III: Tax-related Health Provisions Governing Medical Savings Accounts Title IV: Application and Enforcement of Group Health Insurance Requirements Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Title III: Tax-related Health Provisions Governing Medical Savings Accounts Title IV: Application and Enforcement of Group Health Insurance Requirements Title V: Revenue Offset Governing Tax Deductions Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Health Insurance Portability and Accountability Act

Title I: Health Care Access, Portability and Renewability Health Insurance Portability and Accountability Act Insurance portability when a worker changes or loses his job.

Scope and Limitations Title I: Health Care Access, Portability and Renewability Scope Limits the ability of a new employer plan to exclude coverage for preexisting conditions Provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events Prohibits discrimination against employees and their independent family members based on any health factors Guarantees that certain individuals will have access to, and can renew, individual health insurance policies

Scope and Limitations Title I: Health Care Access, Portability and Renewability Scope Limits the ability of a new employer plan to exclude coverage for preexisting conditions Provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events Prohibits discrimination against employees and their independent family members based on any health factors Guarantees that certain individuals will have access to, and can renew, individual health insurance policies Limitations Does not require employers to offer health coverage Does not guarantee that any conditions you now have (or have had in the past) are covered by your new employer’s health plan Does not prohibit employer from imposing a preexisting condition exclusion period if you have been treated for a condition for the past 6 months

Health Insurance Portability and Accountability Act

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions Improved accountability

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions Improved accountability Adopt national standards of electronic health care transactions, code sets, unique identifiers and security.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions o Privacy Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions o Privacy Rule o Transaction and Set Code Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions o Privacy Rule o Transaction and Set Code Rule o Security Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions o Privacy Rule o Transaction and Set Code Rule o Security Rule o Unique Identifiers Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Health Insurance Portability and Accountability Act Administrative Simplification Provisions o Privacy Rule o Transaction and Set Code Rule o Security Rule o Unique Identifiers Rule o Enforcement Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Privacy Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Privacy Rule Regulates the use and disclosure of Protected Health Information (PHI) held by “covered entities”.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Privacy Rule Protected Health Information (PHI) - any information held by a covered entity which concerns health status, provision of health care, payment for health care that can be linked to an individual.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Privacy Rule Covered Entities - health care clearinghouses, employer sponsored health plans, health insurers and medical service providers that engage in certain transactions.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Unintended Consequences

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Unintended Consequences Hospitals can not reveal any information on people that may have been admitted under emergency conditions

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Transaction and Code Set Rules

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Transaction and Code Set Rules Medical providers had to file their electronic claims using HIPAA Standards to be paid

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Transaction and Code Set Rules Medical providers had to file their electronic claims using HIPAA Standards to be paid HIPAA-covered health plans are required to use standardized HIPAA electronic transactions

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Transaction and Code Set Rules Medical providers had to file their electronic claims using HIPAA Standards to be paid Compliance with the Electronic Data Interchange (EDI) HIPAA-covered health plans are required to use standardized HIPAA electronic transactions

Electronic Data Interchange (EDI) An electronic communication system that provides standards for exchanging data via any electronic means.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Security Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Security Rule Deals specifically with Electronic Protected Health Information (EPHI)

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Security Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Security Rule Administrative safeguards

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Security Rule Administrative safeguards Physical safeguards

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Security Rule Administrative safeguards Physical safeguards Technical safeguards

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Final Omnibus Rule Update of 2013

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Final Omnibus Rule Update of 2013 Updates to the Security Rule and Breach Notification of the HITECH Act.

Health Information Technology for Economic and Clinical Health (HITECH) Act Promotion and expansion of the adoption of health information technology.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Final Omnibus Rule Update of 2013 Updates to the Security Rule and Breach Notification of the HITECH Act.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Final Omnibus Rule Update of 2013 Updates to the Security Rule and Breach Notification of the HITECH Act. Inclusion of business associates in the “covered entities”.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Final Omnibus Rule Update of 2013 Updates to the Security Rule and Breach Notification of the HITECH Act. Inclusion of business associates in the “covered entities”. Prove that harm had not occurred

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Final Omnibus Rule Update of 2013 Updates to the Security Rule and Breach Notification of the HITECH Act. Inclusion of business associates in the “covered entities”. Prove that harm had not occurred PHI is protected until 50 years after death

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Unique Identifiers Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Unique Identifiers Rule Use a National Provider Identifier (NPI) number to identify covered health care providers

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Unique Identifiers Rule Use a National Provider Identifier (NPI) number to identify covered health care providers 10 alphanumeric digits

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Enforcement Rule

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Enforcement Rule Sets civil money penalties for violating HIPAA rules and establishes procedures for investigation and hearings for HIPAA violations.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Enforcement Rule of 2006 Frequent Issues Misuse and disclosure of PHI No protection in place of health information Patient unable to access their health information Using or disclosing more than the minimum necessary to protect health information No safe guards of electronic protected health information

Violation of HIPPA Health Insurance Portability and Accountability Act Civil Penalties Criminal Penalties

Violation of HIPPA Health Insurance Portability and Accountability Act Civil Penalties Individual did not know (and by exercising reasonable diligence would not have known) that he violated HIPAA HIPAA violation due to reasonable cause and not due to willful neglect HIPAA violation due to willful neglect but violation is corrected within the required time period HIPAA violation due to willful neglect and is not corrected

Violation of HIPPA Health Insurance Portability and Accountability Act Criminal Penalties Covered entities and specific individuals who “knowingly” obtain or disclose individual identifiable health information Offenses committed under false pretense Offenses committed with the intent to sell, transfer or use individually identifiable health information for commercial advantage, personal gain or malicious harm.

Effects on Research Health Insurance Portability and Accountability Act

Effects on Research Health Insurance Portability and Accountability Act Decrease follow-up evaluation

Effects on Research Health Insurance Portability and Accountability Act Decrease follow-up evaluation Complicated informed consent

Effects on Clinical Practice Health Insurance Portability and Accountability Act Withholding of information Impede communication/ miscommunication

Summary Health Insurance Portability and Accountability Act Insurance Portability Four health information standards: o Standardized formats for all computer-to- computer information o Standard “identifiers” for health providers and health plans o Information system security standards o Privacy standards

References: Health Insurance Portability and Accountability Act American Medical Association. (n.d.). HIPAA Violations and Enforcement. Retrieved May 14, 2014, from American Medical Association: resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance- portability-accountability-act/hipaa-violations-enforcement.page Texas Department of State Health Services. (2010, November 10). HIPAA at DSHS. Retrieved May 14, 2014, from Texas Department of State Health Services: US Department of Health and Human Services. (n.d.). Health Information Privacy. Retrieved May 14, 2014, from US Department of Health and Human Services: Wikipedia. (2014, May 10). Health Insurance Portability and Accountability Act. Retrieved May 14, 2014, from Wikipedia The Free Encyclopedia:

 Health Insurance and Accountability Act Cornelius Villalon Jr.