Health Information Portability & Accountability Act Presented by Jennifer Coughlin Eugene, Oregon April 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  Treatment  Payment  Operations  Patient Requests

Do I Need To Comply With HIPAA?  Use computers to send health information for administrative, financial purposes  Ie, filing claims for insurance  ORS (2)(c)

HIPAA COMPLIANT FORMS: ORS Go to for Presentation and Linkswww.brotherslaw.com/articles

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

PERSONAL REPRESENT ATIVES Court-Appointed Personal Representatives Proof of appointment and identification If not an appointed personal representative, hierarchy of others can request

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  s/admin_offices/hipaa_privacy/medical-record- amendment.pdf s/admin_offices/hipaa_privacy/medical-record- amendment.pdf  MedicalRecord.pdf MedicalRecord.pdf 

Allowable Charges for Records ORS $30 10 or fewer pages $.50/page $.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 to ORS  42 USC 290: Methods of Disclosure

RESOURCES FOR HIPAA COMPLIANCE  Brothers, Hawn & Coughlin,  Power Points, Outline and details of presentation  4 Steps to HIPAA Compliance  This presentation & Links  Oregon HIPAA Forum   Oregon Health Authority  UNICABLEDISEASE/LOCALHEALTHDEPARTMENTS/Pages/hipaa.a spx UNICABLEDISEASE/LOCALHEALTHDEPARTMENTS/Pages/hipaa.a spx  Office for Civil Rights   Dept. Health & Human Services   Psychiatric, Alcohol and Drug 