1. Health Information Portability & Accountability Act Presented by Jennifer Coughlin www.brotherslaw.com Eugene, Oregon April 10, 2013

2. 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

3. 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

4. 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

5. 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

6. PATHWAYS TO DISCLOSURE OF PROTECTED HEALTH INFORMATION  Treatment  Payment  Operations  Patient Requests

7. 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)

8. 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_auth Go to www.brotherslaw.com/articles for Presentation and Linkswww.brotherslaw.com/articles

9. 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

10. 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

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

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

13. 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?

14. 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

15. 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_u s/admin_offices/hipaa_privacy/medical-record- amendment.pdf http://www.utsouthwestern.edu/edumedia/edufiles/about_u s/admin_offices/hipaa_privacy/medical-record- amendment.pdf  http://www.bmc.org/Documents/bmc-RequestCorrection- MedicalRecord.pdf http://www.bmc.org/Documents/bmc-RequestCorrection- MedicalRecord.pdf  www.brotherslaw.com/articles www.brotherslaw.com/articles

16. 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?

17. 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

18. SPECIALIZED TOPIC RECORDS

19. 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

20. RESOURCES FOR HIPAA COMPLIANCE  Brothers, Hawn & Coughlin, www.brotherslaw.com/articleswww.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 http://www.oregonhipaaforum.org  Oregon Health Authority  http://public.health.oregon.gov/DISEASESCONDITIONS/COMM UNICABLEDISEASE/LOCALHEALTHDEPARTMENTS/Pages/hipaa.a spx http://public.health.oregon.gov/DISEASESCONDITIONS/COMM UNICABLEDISEASE/LOCALHEALTHDEPARTMENTS/Pages/hipaa.a spx  Office for Civil Rights  http://www.hhs.gov/ocr/hipaa http://www.hhs.gov/ocr/hipaa  Dept. Health & Human Services  http://www.hhs.gov/hipaafaq/use/index.html http://www.hhs.gov/hipaafaq/use/index.html  Psychiatric, Alcohol and Drug  http://www.law.cornell.edu/uscode/text/42/290dd-2 http://www.law.cornell.edu/uscode/text/42/290dd-2