Health Information Portability & Accountability Act

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 Links

9. Patient has right to see, get a copy of, and amend recordORS 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 REPRESENTATIVES 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_us/admin_offices/hipaa_privacy/medical-record-amendment.pdf • http://www.bmc.org/Documents/bmc-RequestCorrection-MedicalRecord.pdf • 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/articles • Power Points, Outline and details of presentation • 4 Steps to HIPAA Compliance • This presentation & Links • Oregon HIPAA Forum • http://www.oregonhipaaforum.org • Oregon Health Authority • http://public.health.oregon.gov/DISEASESCONDITIONS/COMMUNICABLEDISEASE/LOCALHEALTHDEPARTMENTS/Pages/hipaa.aspx • Office for Civil Rights • http://www.hhs.gov/ocr/hipaa • Dept. Health & Human Services • http://www.hhs.gov/hipaafaq/use/index.html • Psychiatric, Alcohol and Drug • http://www.law.cornell.edu/uscode/text/42/290dd-2