a notable exclusion of protected health information is quizlet; a notable exclusion of protected health information is quizlet. Individual and group plans that provide or pay the cost of medical care are covered entities.4 Health plans include health, dental, vision, and prescription drug insurers, health maintenance organizations ("HMOs"), Medicare, Medicaid, Medicare+Choice and Medicare supplement insurers, and long-term care insurers (excluding nursing home fixed-indemnity policies). A health plan must distribute its privacy practices notice to each of its enrollees by its Privacy Rule compliance date. 160.103.92 Fully insured health plans should use the amount of total premiums that they paid for health insurance benefits during the plan's last full fiscal year. 164.512(h).37 The Privacy Rule defines research as, "a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge." Health care operations are any of the following activities: (a) quality assessment and improvement activities, including case management and care coordination; (b) competency assurance activities, including provider or health plan performance evaluation, credentialing, and accreditation; (c) conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; (d) specified insurance functions, such as underwriting, risk rating, and reinsuring risk; (e) business planning, development, management, and administration; and (f) business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the covered entity.22. 164.524.56 45 C.F.R. There are exceptionsa 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. For a complete understanding of the conditions and requirements for these disclosures, please review the exact regulatory text at the . Covered entities may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.36, Research. 164.502(d)(2), 164.514(a) and (b).15 The following identifiers of the individual or of relatives, employers, or household members of the individual must be removed to achieve the "safe harbor" method of de-identification: (A) Names; (B) All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census (1) the geographic units formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000; (C) All elements of dates (except year) for dates directly related to the individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; (D) Telephone numbers; (E) Fax numbers; (F) Electronic mail addresses: (G) Social security numbers; (H) Medical record numbers; (I) Health plan beneficiary numbers; (J) Account numbers; (K) Certificate/license numbers; (L) Vehicle identifiers and serial numbers, including license plate numbers; (M) Device identifiers and serial numbers; (N) Web Universal Resource Locators (URLs); (O) Internet Protocol (IP) address numbers; (P) Biometric identifiers, including finger and voice prints; (Q) Full face photographic images and any comparable images; and any other unique identifying number, characteristic, or code, except as permitted for re-identification purposes provided certain conditions are met. A covered entity must mitigate, to the extent practicable, any harmful effect it learns was caused by use or disclosure of protected health information by its workforce or its business associates in violation of its privacy policies and procedures or the Privacy Rule.69. (i) A public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, including but not limited to, the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. Usamos cookies para asegurar que te damos la mejor experiencia en nuestra web. 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. A covered entity must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request.50 A covered entity must develop and implement policies and procedures to reasonably limit uses and disclosures to the minimum necessary. For Notification and Other Purposes. 802), or that is deemed a controlled substance by State law. Workers' Compensation. 164.53212 45 C.F.R. In addition, covered entities may use or disclose a limited data set (protected health information (PHI) that excludes certain identifiers) for research, public health, or health care operations purposes without obtaining consent. (6) Limited Data Set. (4) Incidental Use and Disclosure. 164.508(a)(2).49 45 C.F.R. Restriction Request. Health Care Providers. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided.33, Law Enforcement Purposes. Communications for case management or care coordination for the individual, or to direct or recommend alternative treatments, therapies, health care providers, or care settings to the individual. 164.502(g).85 45 C.F.R. situs link alternatif kamislot a notable exclusion of protected health information is: . The Privacy Rule requires a covered entity to treat a "personal representative" the same as the individual, with respect to uses and disclosures of the individual's protected health information, as well as the individual's rights under the Rule.84 A personal representative is a person legally authorized to make health care decisions on an individual's behalf or to act for a deceased individual or the estate. Covered entities must establish and implement policies and procedures (which may be standard protocols) for routine, recurring disclosures, or requests for disclosures, that limits the protected health information disclosed to that which is the minimum amount reasonably necessary to achieve the purpose of the disclosure. Marketing. Self-insured plans, both funded and unfunded, should use the total amount paid for health care claims by the employer, plan sponsor or benefit fund, as applicable to their circumstances, on behalf of the plan during the plan's last full fiscal year. Extended Health Care Plan The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.. Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time, other than . A health care provider may disclose protected health information about an individual as part of a claim for payment to a health plan. 45 C.F.R. Covered entities that fail to comply voluntarily with the standards may be subject to civil money penalties. A clinically-integrated setting where individuals typically receive health care from more. Consistent with the principles for achieving compliance provided in the Privacy Rule, OCR will seek the cooperation of covered entities and may provide technical assistance to help them comply voluntarily with the Privacy Rule. In the past, family doctors and other health care providers protected the confidentiality of those records by sealing them away in file cabinets and refusing to reveal them to anyone else. In addition, preemption of a contrary State law will not occur if HHS determines, in response to a request from a State or other entity or person, that the State law: Enforcement and Penalties for Noncompliance. A group health plan and the health insurer or HMO offered by the plan may disclose the following protected health information to the "plan sponsor"the employer, union, or other employee organization that sponsors and maintains the group health plan:83, Other Provisions: Personal Representatives and Minors. Retaliation and Waiver. 160.103.67 45 C.F.R. Materials in this section are updated as new information and vaccines become available. 164.508.45 A covered entity may condition the provision of health care solely to generate protected health information for disclosure to a third party on the individual giving authorization to disclose the information to the third party. Limiting Uses and Disclosures to the Minimum Necessary. 164.512(e).34 45 C.F.R. elgin mental health center forensic treatment program. Is necessary to ensure appropriate State regulation of insurance and health plans to the extent expressly authorized by statute or regulation. Common ownership exists if an entity possesses an ownership or equity interest of five percent or more in another entity; common control exists if an entity has the direct or indirect power significantly to influence or direct the actions or policies of another entity. Complaints. 164.512(j).41 45 C.F.R. 164.501.57 A covered entity may deny an individual access, provided that the individual is given a right to have such denials reviewed by a licensed health care professional (who is designated by the covered entity and who did not participate in the original decision to deny), when a licensed health care professional has determined, in the exercise of professional judgment, that: (a) the access requested is reasonably likely to endanger the life or physical safety of the individual or another person; (b) the protected health information makes reference to another person (unless such other person is a health care provider) and the access requested is reasonably likely to cause substantial harm to such other person; or (c) the request for access is made by the individual's personal representative and the provision of access to such personal representative is reasonably likely to cause substantial harm to the individual or another person. 164.534.91 45 C.F.R. ). Washington, D.C. 20201 A covered entity must have procedures for individuals to complain about its compliance with its privacy policies and procedures and the Privacy Rule.71 The covered entity must explain those procedures in its privacy practices notice.72. Frequently Asked Questions for Professionals- Please see the HIPAA FAQs for additional guidance on health information privacy topics. HHS (2) Treatment, Payment, Health Care Operations. 508(b)(4).46 45 CFR 164.532.47 "Psychotherapy notes" means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the of the individual's medical record. Minimum Necessary. The Privacy Rule permits covered entities to disclose protected health information, without authorization, to persons or entities activities including: Required by Law or Judicial and Administrative Proceedings Prevention or control of disease, injury, or disability Child or adult abuse, neglect, or domestic Violence 45 C.F.R. A limited data set is protected health information that excludes the 164.512(a).30 45 C.F.R. Civil Money Penalties. Compliance. 164.506(c)(5).82 45 C.F.R.