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L    ThePrivacyRule(45CFRPart160andSubpartsAandEofPart164)providesthefirst $  comprehensiveFederalprotectionfortheprivacyofhealthinformation.Allsegmentsofthe   healthcareindustryhaveexpressedsupportfortheobjectiveofenhancedpatientprivacyinthe   healthcaresystem.ThePrivacyRule,asmodified,iscarefullybalancedtoprovidestrong   privacyprotectionsthatdonotinterferewithpatientaccessto,orthequalityof,healthcare   delivery. ~  XXXX  Theguidancethatfollowsismeanttocommunicateasclearlyaspossibletheprivacy V policiescontainedinthePrivacyRule.ForaparticularsegmentinthePrivacyRule,the B guidancewillprovideabriefexplanationofthesegmentandhowtheRuleworks,followedbya .p linktothe FrequentlyAskedQuestionsaboutthatprovision.YoucanseeallofthePrivacy \ Rule FrequentlyAskedQuestionsifyou#XXXX#XXXX4Z O  5  c  XXCLICKHERE  cn  6"6  7 d#XX#XX;#XX ##XXXX#XXXXoryoucangoto H #XXXX # 4]$O  5  c  XXXXhttp://answers.hhs.gov/cgibin/hhs.cfg/php/enduser/std_alp.php c   #XXXX #6T h   7$~ XXXXX ,thenselect"PrivacyofHealth 4 Information/HIPAA"fromtheCategory_dropdown_ԀlistandclicktheSearchbutton.The   guidancedoesnotaddressalloftherelevantprovisionsintheRule,althoughweanticipate   addingsegmentsinthefutureaswedevelopguidanceonmorePrivacyRulestandards.Wewill  alsobeaddingtothe FrequentlyAskedQuestionsonanongoingbasisasnewquestionsarise.   _HHS_Ԁplanstoworkexpeditiouslytoaddresstheseadditionalquestionstofacilitateunderstanding ! oftheRuleandtoencouragevoluntarycompliancewithitsrequirements.However,forafull z" understandingofonesrightsandresponsibilitiesundertheRule,itisimportanttoconsultthe f# Ruleitself.E #XXXX # R$  ThePrivacyRuleStandardsAddressed  *&l! GeneralOverview (D # IncidentalUsesandDisclosures(45CFR164.502(a)) (0!$ MinimumNecessary(45CFR164.502(b),164.514(d)) )"% PersonalRepresentatives(45CFR164.502(g)) *#& BusinessAssociates(45CFR164.502(e),164.504(e),164.532(d)and(e)) +#' _UsesandDisclosuresforTreatment,Payment,andHealthCareOperations(45CFR164.506)  Marketing(45_CFR_Ԁ164.501,164.508(a))  PublicHealth(45_CFR_Ԁ164.512(b))   Research(45_CFR_Ԁ164.501,164.508,164.512(_i_),164.514(e),164.528,164.532)   WorkersCompensationLaws(45_CFR_Ԁ164.512(l)) n  Notice(45_CFR_Ԁ164.520) Z  GovernmentAccess(45_CFR_ԀPart160,SubpartC,164.512(f)) F  Miscellaneous_FAQs_  2t @   GENERALOVERVIEWOFSTANDARDSFORPRIVACY  OFINDIVIDUALLYIDENTIFIABLEHEALTHINFORMATION   [45CFRPart160andSubpartsAandEofPart164]   D  ThefollowingoverviewprovidesanswerstogeneralquestionsregardingtheStandards n  forPrivacyofIndividuallyIdentifiableHealthInformation(thePrivacyRule),promulgatedby Z  theDepartmentofHealthandHumanServices(_HHS_). F    Toimprovetheefficiencyandeffectivenessofthehealthcaresystem,theHealth ` InsurancePortabilityandAccountabilityAct(HIPAA)of1996,PublicLaw104191,included  L   AdministrativeSimplificationprovisionsthatrequiredHHStoadoptnationalstandardsfor 8  electronichealthcaretransactions.Atthesametime,Congressrecognizedthatadvancesin $  electronictechnologycoulderodetheprivacyofhealthinformation.Consequently,Congress   incorporatedintoHIPAAprovisionsthatmandatedtheadoptionofFederalprivacyprotections   forindividuallyidentifiablehealthinformation.     InresponsetotheHIPAAmandate,_HHS_Ԁpublishedafinalregulationintheformofthe ~ PrivacyRuleinDecember2000,whichbecameeffectiveonApril14,2001.ThisRuleset j nationalstandardsfortheprotectionofhealthinformation,asappliedtothethreetypesof V coveredentities:healthplans,healthcareclearinghouses,andhealthcareproviderswhoconduct B certainhealthcaretransactionselectronically.BythecompliancedateofApril14,2003(April .p 14,2004,forsmallhealthplans),coveredentitiesmustimplementstandardstoprotectandguard \ againstthemisuseofindividuallyidentifiablehealthinformation.Failuretotimelyimplement H thesestandardsmay,undercertaincircumstances,triggertheimpositionofcivilorcriminal 4 penalties.     SecretaryTommyThompsoncalledforanadditionalopportunityforpubliccommenton  thePrivacyRuletoensurethatthePrivacyRuleachievesitsintendedpurposewithoutadversely   affectingthequalityof,orcreatingnewbarriersto,patientcare.Aftercarefulconsiderationof ! thesecomments,inMarch2002_HHS_ԀpublishedproposedmodificationstotheRule,toimprove z" _workability_Ԁandavoidunintendedconsequencesthatcouldhaveimpededpatientaccessto f# deliveryofqualityhealthcare.Followinganotherroundofpubliccomment,inAugust2002,the R$ DepartmentadoptedasafinalRulethemodificationsnecessarytoensurethatthePrivacyRule >%  workedasintended. *&l!   ThePrivacyRuleestablishes,forthefirsttime,afoundationofFederalprotectionsforthe (D # privacyofprotectedhealthinformation.TheRuledoesnotreplaceFederal,State,orotherlaw (0!$ thatgrantsindividualsevengreaterprivacyprotections,andcoveredentitiesarefreetoretainor )"% adoptmoreprotectivepoliciesorpractices. *#&  +#'  XXXX  4+ j O  5  c      RFAQsonPrivacyRule:GeneralTopicsc6$  6#O#  7 n$ #XXXX##   ____#   INCIDENTAL_ԀUSESAND_DISCLOSURES   ____[45CFR164.502(a)(1)(iii)]_  _%__ Background __   _  _Many_Ԁcustomaryhealthcarecommunicationsandpracticesplayanimportantoreven Z  essentialroleinensuringthatindividualsreceivepromptandeffectivehealthcare._Due_Ԁtothe F  natureofthesecommunicationsandpractices,aswellasthevariousenvironmentsinwhich 2t individualsreceivehealthcareorotherservicesfromcoveredentities,thepotentialexistsforan ` individualshealthinformationtobedisclosed_incidentally._ԀForexample,ahospitalvisitormay  L  overhearaprovidersconfidentialconversationwithanotherproviderorapatient,ormay 8  glimpseapatientsinformationona_signinsheetornursingstationwhiteboard._ԀThe_HIPAA $  Privacy_ԀRuleisnotintendedtoimpedethesecustomaryandessentialcommunicationsand   practicesand,thus,doesnotrequirethatallriskofincidentaluseordisclosurebeeliminatedto   satisfyitsstandards.Rather,thePrivacyRulepermitscertainincidentalusesanddisclosuresof   protectedhealthinformationtooccurwhenthecoveredentityhasinplacereasonablesafeguards   andminimumnecessarypoliciesandprocedurestoprotectanindividualsprivacy. ~ _ How_ԀtheRuleWorks  V   GeneralProvision.ThePrivacyRulepermitscertainincidentalusesanddisclosuresthat .p occurasabyproductof_another_Ԁ_permissibleorrequireduse_Ԁor_disclosure__________,aslongas____thecovered \ entityhasappliedreasonablesafeguardsandimplementedtheminimumnecessarystandard, H whereapplicable,withrespecttotheprimaryuseordisclosure.See45CFR164.502(a)(1)(iii)__._ 4 Anincidentaluseordisclosureisasecondaryuseordisclosurethatcannotreasonablybe   _prevented,_Ԁ___is_Ԁlimitedin_nature,andthatoccursasaresultofanotheruseordisclosurethatis   permittedbytheRule._Ԁ_However,an_Ԁincidentaluseordisclosure_isnotpermittedifitisa________by  _productof_anunderlying_Ԁuseordisclosure_which____violates_Ԁ___the_ԀPrivacy_Rule._     ReasonableSafeguards.Acoveredentitymusthaveinplaceappropriateadministrative, z" technical,andphysicalsafeguardsthatprotectagainstusesanddisclosuresnotpermittedbythe f# PrivacyRule,aswellasthatlimitincidentalusesordisclosures.See45CFR164.530(c).Itis R$ notexpectedthat_acoveredentitys__safeguards_Ԁguaranteetheprivacyofprotectedhealth >%  informationfromanyandallpotentialrisks._Reasonablesafeguardswillvaryfromcovered *&l! entitytocoveredentitydependingonfactors,suchasthesizeofthecoveredentityandthenature 'X" ofitsbusiness.In_Ԁ_implementing______________reasonable_Ԁsafeguards,_coveredentitiesshouldanalyzetheir (D # ownneedsandcircumstances,suchasthenatureoftheprotectedhealthinformationitholds,and (0!$ assessthepotentialriskstopatientsprivacy.Coveredentitiesshouldalsotakeintoaccount__the_ )"% potentialeffectsonpatient_care__and_Ԁ_mayconsiderotherissues,suchas_Ԁthefinancialand *#& administrative_burden_Ԁof_implementingparticular____safeguards. +#' ____ԇ  __Manyhealthcareprovidersandprofessionalshavelongmadeitapracticetoensure  reasonablesafeguardsforindividualshealthinformation!forinstance:  {c  0  {c="0` (#(#  Byspeakingquietlywhendiscussingapatientsconditionwithfamilymembersin   awaitingroomorotherpublicarea;{c==݌n ` (#` (# Ќ  0   (#(# {c  0  {c>"0` (#(#  Byavoidingusingpatientsnamesinpublichallwaysandelevators,andposting F  signstoremindemployeestoprotectpatientconfidentiality;{c>?݌2t` (#` (# Ќ  0   (#(# {c  0  {cO@"0` (#(#  Byisolatingorlockingfilecabinetsorrecordsrooms;or{cO@v@݌ L ` (#` (# Ќ  0   (#(# {c  0  {cLA"0` (#(#  Byprovidingadditionalsecurity,suchaspasswords,oncomputersmaintaining $  personalinformation.{cLAsA݌ ` (#` (# Ќ  0   (#(#   Protectionofpatientconfidentialityisanimportantpracticeformanyhealthcareand   healthinformationmanagementprofessionals;coveredentitiescanbuilduponthosecodesof   conducttodevelopthereasonablesafeguardsrequiredbythePrivacyRule._ ~   MinimumNecessary.Coveredentitiesalsomustimplementreasonableminimum V necessarypoliciesandproceduresthat_limithowmuchprotectedhealthinformationisused, B disclosed,andrequestedforcertainpurposes.Theseminimumnecessarypoliciesandprocedures .p alsoreasonablymustlimit_Ԁwhowithintheentityhasaccesstoprotectedhealth_information,_Ԁand \ underwhat_conditions,_Ԁbasedon___job_Ԁresponsibilitiesandthenatureofthe_business________._ԀThe H minimumnecessarystandarddoesnotapplytodisclosures,includingoraldisclosures,among 4 healthcareprovidersfortreatmentpurposes.___Forexample,aphysicianisnotrequiredtoapply   theminimumnecessarystandardwhendiscussingapatientsmedicalchartinformationwitha   specialistatanotherhospital.See_Ԁ45_CFR_Ԁ164.502(b)and164.514(d),andthe_factsheetand  frequentlyaskedquestionsonthiswebsiteabout______the_Ԁminimumnecessary_standard,_Ԁformore   information. !   Anincidentaluseordisclosurethatoccursasaresultofafailuretoapplyreasonable f# safeguardsortheminimumnecessarystandard,whererequired,isnotpermittedunderthe R$ Privacy_Rule. >%  __  Forexample: 'X" 0  {c  {c%L"0` (#(#  Theminimumnecessarystandardrequiresthatacoveredentitylimitwhowithin (0!$ theentityhasaccesstoprotectedhealthinformation,basedonwhoneedsaccess )"% toperformtheirjobduties.Ifahospitalemployeeisallowedtohaveroutine, *#& unimpededaccesstopatientsmedicalrecords,wheresuchaccessisnotnecessary +#' forthehospitalemployeetodohisjob,thehospitalisnotapplyingtheminimum  necessarystandard.Therefore,anyincidentaluseordisclosurethatresultsfrom  thispractice,suchasanotherworkeroverhearingthehospitalemployees   conversationaboutapatientscondition,wouldbeanunlawfuluseordisclosure   underthePrivacyRule.{c%L@L݌n ` (#` (# Ќ  0  ]% (#(# ____ __  4/  O  5  c      XXXX_FAQs_ԀonIncidentalUsesandDisclosurescP  #XXXX7Q#6PP  7 P  F  P  MINIMUMNECESSARY __  ____[45_CFR_Ԁ164.502(b),164.514(d)]_   R_ Background __ n  ____  Theminimumnecessarystandard,akeyprotectionofthe_HIPAA_ԀPrivacyRule,__isderived F  fromconfidentialitycodesandpracticesincommonusetoday.Itisbasedonsoundcurrent 2t practicethatprotectedhealthinformationshouldnotbeusedordisclosedwhenitisnot ` necessarytosatisfyaparticularpurposeorcarryoutafunction.Theminimumnecessary  L  standardrequirescoveredentitiestoevaluatetheirpracticesandenhancesafeguardsasneededto 8  limitunnecessaryorinappropriateaccesstoanddisclosureofprotectedhealthinformation.The $  PrivacyRulesrequirementsforminimumnecessaryaredesignedtobesufficientlyflexibleto   accommodatethevariouscircumstancesofanycoveredentity.   __________ How_ԀtheRuleWorks    ___  ThePrivacyRulegenerallyrequirescoveredentitiestotakereasonablestepstolimitthe j useordisclosureof,andrequestsfor,protectedhealthinformationtotheminimumnecessaryto V accomplishtheintendedpurpose.Theminimumnecessarystandarddoesnotapplytothe B following: .p {c  0  {crZ"0` (#(#  Disclosurestoorrequestsbyahealthcareproviderfortreatmentpurposes.{crZZ݌H` (#` (# Ќ  0   (#(# {c  0  {c["0` (#(#  Disclosurestotheindividualwhoisthesubjectoftheinformation.{c[[݌ ` (#` (# Ќ  0   (#(# {c  0  {c\"0` (#(#  Usesordisclosuresmadepursuanttoanindividualsauthorization.{c\\݌` (#` (# Ќ  0   (#(# {c  0  {c]"0` (#(#  UsesordisclosuresrequiredforcompliancewiththeHealthInsurancePortability ! andAccountabilityAct(_HIPAA_)AdministrativeSimplificationRules.{c]]݌z"` (#` (# Ќ  0   (#(# {c  0  {c_"0` (#(#  DisclosurestotheDepartmentofHealthandHumanServices(_HHS_)when R$ disclosureofinformationisrequiredunderthePrivacyRuleforenforcement >%  purposes.{c_D_݌*&l!` (#` (# Ќ  0   (#(# {c  0  {c`"0` (#(#  Usesordisclosuresthatarerequiredbyotherlaw.{c``݌(D #` (#` (# Ќ    Theimplementationspecificationsforthisprovisionrequireacoveredentitytodevelop )"% andimplementpoliciesandproceduresappropriateforitsownorganization,reflectingthe *#& entitysbusinesspracticesandworkforce.Whileguidancecannotanticipateeveryquestionor +#' factualapplicationoftheminimumnecessarystandardtoeachspecificindustrycontext,whereit  wouldbegenerallyhelpfulwewillseektoprovideadditionalclarificationonthisissueinthe  future.Inaddition,theDepartmentwillcontinuetomonitorthe_workability_Ԁoftheminimum   necessarystandardandconsiderproposingrevisions,whereappropriate,toensurethattheRule   doesnothindertimelyaccesstoqualityhealthcare. n    UsesandDisclosuresof,andRequestsfor,ProtectedHealthInformation.Forusesof F  protectedhealthinformation,thecoveredentityspoliciesandproceduresmustidentifythe 2t personsorclassesofpersonswithinthecoveredentitywhoneedaccesstotheinformationto ` carryouttheirjobduties,thecategoriesortypesofprotectedhealthinformationneeded,and  L  conditionsappropriatetosuchaccess.Forexample,hospitalsmayimplementpoliciesthat 8  permitdoctors,nurses,orothersinvolvedintreatmenttohaveaccesstotheentiremedical $  record,asneeded.Casebycasereviewofeachuseisnotrequired.Wheretheentiremedical   recordisnecessary,thecoveredentityspoliciesandproceduresmuststatesoexplicitlyand   includeajustification.     Forroutineorrecurringrequestsanddisclosures,thepoliciesandproceduresmaybe ~ standardprotocolsandmustlimittheprotectedhealthinformationdisclosedorrequestedtothat j whichistheminimumnecessaryforthatparticulartypeofdisclosureorrequest.Individual V reviewofeachdisclosureorrequestisnotrequired. B   Fornonroutinedisclosuresandrequests,coveredentitiesmustdevelopreasonable \ criteriafordeterminingandlimitingthedisclosureorrequesttoonlytheminimumamountof H protectedhealthinformationnecessarytoaccomplishthepurposeofanonroutinedisclosureor 4 request.Nonroutinedisclosuresandrequestsmustbereviewedonanindividualbasisin   accordancewiththesecriteriaandlimitedaccordingly.     Ofcourse,whereprotectedhealthinformationisdisclosedto,orrequestedby,healthcare   providersfortreatmentpurposes,theminimumnecessarystandarddoesnotapply. !   ReasonableReliance.Incertaincircumstances,thePrivacyRulepermitsacoveredentity f# torelyonthejudgmentofthepartyrequestingthedisclosureastotheminimumamountof R$ informationthatisneeded.Suchreliancemustbereasonableundertheparticularcircumstances >%  oftherequest.Thisrelianceispermittedwhentherequestismadeby: *&l! {c  0  {c_o"0` (#(#  Apublicofficialoragencywhostatesthattheinformationrequestedisthe (D # minimumnecessaryforapurposepermittedunder45_CFR_ԁ164.512oftheRule, (0!$ suchasforpublichealthpurposes(45_CFR_Ԁ164.512(b)).{c_oo݌)"%` (#` (# Ќ  0   (#(# {c  0  {cZq"0` (#(#  Anothercoveredentity.{cZqq݌+#'` (#` (# Ќ  0   (#(# {c  0  {c4r"0` (#(#  Aprofessionalwhoisaworkforcememberorbusinessassociateofthecovered  entityholdingtheinformationandwhostatesthattheinformationrequestedisthe   minimumnecessaryforthestatedpurpose.{c4r[r݌ ` (#` (# Ќ  0   (#(# {c  0  {cs"0` (#(#  AresearcherwithappropriatedocumentationfromanInstitutionalReviewBoard Z  (_IRB_)orPrivacyBoard.{cst݌F ` (#` (# Ќ    TheRuledoesnotrequiresuchreliance,however,andthecoveredentityalwaysretains ` discretiontomakeitsownminimumnecessarydeterminationfordisclosurestowhichthe  L  standardapplies.__ 8   JR  45 O  5  c      XXXX_FAQs_ԀonMinimumNecessary cv$  #XXXXw#6svv$  7 vfw    fv   PERSONALREPRESENTATIVES   [45_CFR_Ԁ164.502(g)]  zx Background      The_HIPAA_ԀPrivacyRuleestablishesafoundationofFederallyprotectedrightswhich f  permitindividualstocontrolcertainusesanddisclosuresoftheirprotectedhealthinformation. R  Alongwiththeserights,thePrivacyRuleprovidesindividualswiththeabilitytoaccessand >t amendthisinformation,andtherighttoanaccountingofcertaindisclosures.TheDepartment *` recognizesthattheremaybetimeswhenindividualsarelegallyorotherwiseincapableof L  exercisingtheirrights,orsimplychoosetodesignateanothertoactontheirbehalfwithrespectto 8  theserights.UndertheRule,apersonauthorized(underStateorotherapplicablelaw,e.g.,tribal $  ormilitarylaw)toactonbehalfoftheindividualinmakinghealthcarerelateddecisionsisthe   individuals personalrepresentative.Section164.502(g)provideswhen,andtowhatextent,   thepersonalrepresentativemustbetreatedastheindividualforpurposesoftheRule.Inaddition   totheseformaldesignationsofapersonalrepresentative,theRuleat45_CFR_Ԁ164.510(b)   addressessituationsinwhichpersonsareinvolvedintheindividualshealthcarebutarenot  expresslyauthorizedtoactontheindividualsbehalf. v  HowtheRuleWorks  N   GeneralProvisions.Exceptasotherwiseprovidedin45_CFR_Ԁ164.502(g),thePrivacy &\ Rulerequirescoveredentitiestotreatanindividualspersonalrepresentativeastheindividual H withrespecttousesanddisclosuresoftheindividualsprotectedhealthinformation,aswellas 4 theindividualsrightsundertheRule.     Thepersonalrepresentativestandsintheshoesoftheindividualandhastheabilitytoact  fortheindividualandexercisetheindividualsrights.Forinstance,coveredentitiesmust   providetheindividualspersonalrepresentativewithanaccountingofdisclosuresinaccordance ! with45_CFR_Ԁ164.528,aswellasprovidethepersonalrepresentativeaccesstotheindividuals " protectedhealthinformationinaccordancewith45_CFR_Ԁ164.524totheextentsuchinformation r# isrelevanttosuchrepresentation .Inadditiontoexercisingtheindividualsrightsunderthe ^$ Rule,apersonalrepresentativemayalsoauthorizedisclosuresoftheindividualsprotectedhealth J%  information. 6&l!   Ingeneral,thescopeofthepersonalrepresentativesauthoritytoactfortheindividual (D # underthePrivacyRulederivesfromhisorherauthorityunderapplicablelawtomakehealthcare (0!$ decisionsfortheindividual.Wherethepersonhasbroadauthoritytoactonthebehalfofaliving )"% individualinmakingdecisionsrelatedtohealthcare,suchasaparentwithrespecttoaminor *#& childoralegalguardianofamentallyincompetentadult,thecoveredentitymusttreatthe +#' personalrepresentativeastheindividualforallpurposesundertheRule,unlessanexception  applies.(Seebelowwithrespecttoabuse,neglectorendangermentsituations,andthe  applicationofStatelawinthecontextofparentsandminors).Wheretheauthoritytoactforthe   individualislimitedorspecifictoparticularhealthcaredecisions,thepersonalrepresentativeis   tobetreatedastheindividualonlywithrespecttoprotectedhealthinformationthatisrelevantto z  therepresentation.Forexample,apersonwithanindividualslimitedhealthcarepowerof f  attorneyregardingonlyaspecifictreatment,suchasuseofartificiallifesupport,isthat R  individualspersonalrepresentativeonlywithrespecttoprotectedhealthinformationthatrelates >t tothathealthcaredecision.Thecoveredentityshouldnottreatthatpersonastheindividualfor *` otherpurposes,suchastosignanauthorizationforthedisclosureofprotectedhealthinformation L  formarketingpurposes.Finally,wherethepersonhasauthoritytoactonthebehalfofa 8  deceasedindividualorhisestate,whichdoesnothavetoincludetheauthoritytomakedecisions $  relatedtohealthcare,thecoveredentitymusttreatthepersonalrepresentativeastheindividual   forallpurposesundertheRule.Stateorotherlawshouldbeconsultedtodeterminetheauthority   ofthepersonalrepresentativetoreceiveoraccesstheindividualsprotectedhealthinformation.     WhoMustBeRecognizedastheIndividualsPersonalRepresentative.Thefollowing  chartdisplayswhomustberecognizedasthepersonalrepresentativeforacategoryof v individuals: b   IftheIndividualIs:0  0h(#(#0h(#h(#ThePersonalRepresentativeIs::p(#(#   AnAdultor0 0 (# (#0h(#(#0h(#h(#ApersonwithlegalauthoritytomakehealthH(#(#   AnEmancipatedMinor0 h 0h(#h(#caredecisionsonbehalfoftheindividual4(#(#    `     h   Examples:0 p Healthcarepowerofattorney p(#p(#    `     h      p Courtappointedlegalguardian     `     h      p Generalpowerofattorney     AnUnemancipatedMinor0 h 0h(#h(#Aparent,guardian,orotherpersonactinginloco " parentiswithlegalauthoritytomakehealthcare r# decisionsonbehalfoftheminorchild^$(#(#    `     h   Exceptions:0 p Seeparentsandminorsdiscussion 6&l! below."'X"p(#p(#   Deceased0 0 (# (#0h(#(#0h(#h(#Apersonwithlegalauthoritytoactonbehalfofthe (0!$ decedentortheestate(notrestrictedtohealthcare )"% decisions)*#&(#(#  +#'    `     h   Examples:0 p Executoroftheestatep(#p(#    `     h      p Nextofkinorotherfamilymember     `     h      p Durablepowerofattorney     ParentsandUnemancipatedMinors.ThePrivacyRuledeferstoStateorotherapplicable z  lawsthataddresstheabilityofaparent,guardian,orotherpersonactinginlocoparentis f  (collectively, parent)toobtainhealthinformationaboutaminorchild.Inmostcasesunderthe R  Rule,theparentisthepersonalrepresentativeoftheminorchildandcanexercisetheminors >t rightswithrespecttoprotectedhealthinformation,becausetheparentusuallyhastheauthorityto *` makehealthcaredecisionsabouthisorherminorchild.Regardlessofwhetheraparentisthe L  personalrepresentative,thePrivacyRulepermitsacoveredentitytodisclosetoaparent,or 8  providetheparentwithaccessto,aminorchildsprotectedhealthinformationwhenandtothe $  extentitisexpresslypermittedorrequiredbyStateorotherlaws(includingrelevantcaselaw).   Likewise,thePrivacyRuleprohibitsacoveredentityfromdisclosingaminorchildsprotected   healthinformationtoaparent,orprovidingaparentwithaccessto,suchinformationwhenand   totheextentitisexpresslyprohibitedunderStateorotherlaws(includingrelevantcaselaw).   Thus,Stateandotherapplicablelawgovernswhensuchlawexplicitlyrequires,permits,or  prohibitsthedisclosureof,oraccessto,thehealthinformationaboutaminorchild. v   ThePrivacyRulespecifiesthreecircumstancesinwhichtheparentisnotthe personal N representativewithrespecttocertainhealthinformationabouthisorherminorchild.These :p exceptionsgenerallytracktheabilityofcertainminorstoobtainspecifiedhealthcarewithout &\ parentalconsentunderStateorotherlaws,orstandardsofprofessionalpractice.Inthese H situations,theparentdoesnotcontroltheminorshealthcaredecisions,andthusundertheRule, 4 doesnotcontroltheprotectedhealthinformationrelatedtothatcare.Thethreeexceptional   circumstanceswhenaparentisnottheminorspersonalrepresentativeare:   {c    {cF"0 `   WhenStateorotherlawdoesnotrequiretheconsentofaparentorother   personbeforeaminorcanobtainaparticularhealthcareservice,andthe ! minorconsentstothehealthcareservice;{cFm݌"` (#` (# Ќ     `  Example:0  AStatelawprovidesanadolescenttherighttoobtainmental b$ healthtreatmentwithouttheconsentofhisorherparent,andthe N%  adolescentconsentstosuchtreatmentwithouttheparentsconsent.:&p!(#(# {c  0  {c"0` (#(#  Whenacourtdeterminesorotherlawauthorizessomeoneotherthanthe (H # parenttomaketreatmentdecisionsforaminor ;{c5݌)8!$` (#` (# Ќ  0   ` Example:0(#(#Acourtmaygrantauthoritytomakehealthcaredecisionsforthe *#& minortoanadultotherthantheparent,totheminor,orthe_court +$' maymakethedecision(s)itself.(#(# {c    {cw"0 `   Whenaparentagreestoaconfidentialrelationshipbetweentheminorand   thephysician .{cw݌ ` (#` (# Ќ     `    ` Example:0  Aphysicianaskstheparentofa16yearoldifthephysiciancan n  talkwiththechildconfidentiallyaboutamedicalconditionandthe Z  parentagrees.F|(#(#   Evenintheseexceptionalcircumstances,wheretheparentisnotthe personal T  representativeoftheminor,thePrivacyRuledeferstoStateorotherlawsthatrequire,permit,  @  orprohibitthecoveredentitytodisclosetoaparent,orprovidetheparentaccessto,aminor ,  childsprotectedhealthinformation.Further,inthesesituations,ifStateorotherlawissilentor   unclearconcerningparentalaccesstotheminorsprotectedhealthinformation,acoveredentity   hasdiscretiontoprovideordenyaparentwithaccesstotheminorshealthinformation,ifdoing   soisconsistentwithStateorotherapplicablelaw,andprovidedthedecisionismadebya   licensedhealthcareprofessionalintheexerciseofprofessionaljudgment.d  d  Abuse,Neglect,andEndangermentSituations.Whenaphysicianorothercoveredentity j reasonablybelievesthatanindividual,includinganunemancipatedminor,hasbeenormaybe V subjectedtodomesticviolence,abuseorneglectbythepersonalrepresentative,orthattreatinga Bx personasanindividualspersonalrepresentativecouldendangertheindividual,thecovered .d entitymaychoosenottotreatthatpersonastheindividualspersonalrepresentative,ifinthe P exerciseofprofessionaljudgment,doingsowouldnotbeinthebestinterestsoftheindividual. < Forexample,ifaphysicianreasonablybelievesthatdisclosinginformationaboutanincompetent ( elderlyindividualtotheindividualspersonalrepresentativewouldendangerthatindividual,the  PrivacyRulepermitsthephysiciantodeclinetomakesuchdisclosure.   4x46 O  5  c      XXXX  _FAQs_ԀonPersonalReps/Parentsand_Minorscϰctic_  _#XXXX#6ctic_  7 MŰ  ! _______8  BUSINESS_Ԁ_ASSOCIATES   ____[45_CFR_Ԁ164.502(e),164.504(e),164.532(d)and(e)]_  ___ Background  `     h    _  Bylaw,the__HIPAA_ԀPrivacy_ԀRuleappliesonlytocovered_entities!__health_Ԁplans,health f  careclearinghouses,andcertainhealthcareproviders.However,mosthealthcareprovidersand R  healthplansdonotcarryoutalloftheirhealthcareactivitiesandfunctionsbythemselves. >t Instead,theyoftenusetheservicesofavarietyofotherpersonsorbusinesses._The_ԀPrivacyRule *` allows_coveredproviders_Ԁand_healthplans_Ԁ_todisclose____Ԁprotected_Ԁhealthinformationtothese L   business_associatesiftheprov______________ider__s_Ԁor_plans_Ԁ_obtain_______Ԁsatisfactoryassurancesthatthebusiness 8  associatewillusetheinformationonlyforthepurposesforwhich_itwas____engaged_Ԁbythecovered $  _entity,_Ԁ_will_Ԁsafeguardtheinformationfrom_misuse,andwillhelpthecoveredentitycomplywith   someofthecoveredentitysdutiesunderthePrivacyRule._Ԁ_ԀCoveredentitiesmaydisclose   p____rotected_Ԁhealthinformation_______to_Ԁ_____anentityinitsroleasabusiness_Ԁassociateonlytohelpthe   coveredentitycarryoutitshealthcarefunctions!notfor_thebusinessassociatesindependent_   use_orpurposes____,exceptasneededforthepropermanagementandadministrationofthebusiness  associate._ v _ How_ԀtheRuleWorks  N _  GeneralProvision.ThePrivacyRulerequiresthatacoveredentityobtainsatisfactory &\ assurancesfromitsbusinessassociatethatthebusinessassociatewillappropriatelysafeguardthe H protectedhealthinformationitreceivesorcreatesonbehalfofthecoveredentity.The 4 satisfactoryassurancesmustbeinwriting,whetherintheformofacontractorotheragreement   betweenthecoveredentityandthebusinessassociate.   ___  What_Is_Ԁa_ Business_Ԁ_Associate?_ԀA businessassociateisapersonorentitythat   performscertainfunctionsoractivities_thatinvolvetheuseordisclosureofprotectedhealth ! information_Ԁonbehalfof,orprovidesservicesto,acovered_entity__._ " _  _{c  {c"0 `   Amemberofthecoveredentitysworkforceisnotabusiness_associate.{c݌^$` (#` (# Ќ    0  {c  {c"0` (#(#  Acoveredhealthcareprovider,healthplan,orhealthcareclearinghousecanbea 6&l! businessassociateofanothercoveredentity.{c݌"'X"` (#` (# Ќ    ThePrivacyRulelistssomeofthefunctionsoractivities,aswellastheparticular (0!$ services,thatmakeapersonorentityabusinessassociate,iftheactivityorserviceinvolvesthe )"% useordisclosureofprotectedhealthinformation.Thetypesoffunctionsoractivitiesthatmay *#& makeapersonorentityabusinessassociateincludepaymentorhealthcareoperationsactivities, +#' aswellasotherfunctionsoractivitiesregulatedbytheAdministrativeSimplificationRules.  {c  0  {cz"0` (#(#  Businessassociatefunctionsandactivitiesinclude:claimsprocessingor   administration;_Ԁdataanalysis,processingoradministration;utilizationreview;   qualityassurance;billing;benefitmanagement;practicemanagement;and z  repricing.{cz݌f ` (#` (# Ќ    {c  0  {ch"0` (#(#  Businessassociateservicesare:legal;actuarial;accounting;consulting;data >t aggregation;management;administrative;accreditation;andfinancial.{ch݌*`` (#` (# Ќ    Seethedefinitionof businessassociateat45_CFR_Ԁ160.103. 8    ExamplesofBusinessAssociates.   0  {c  {c"0` (#(#  Athirdpartyadministratorthatassistsahealthplanwithclaims_processing._{c݌ ` (#` (# Ќ  0  {c  {c"0` (#(#  _ACPA_firmwhoseaccountingservicestoahealthcareproviderinvolveaccessto  protectedhealthinformation.{c݌v` (#` (# Ќ  {c  0  {c"0` (#(#  Anattorneywhoselegalservicestoahealthplaninvolveaccesstoprotected N healthinformation.{c݌:p` (#` (# Ќ  {c  0  {c"0` (#(#  Aconsultantthatperformsutilizationreviewsforahospital.{c݌H` (#` (# Ќ  {c  0  {c"0` (#(#  Ahealthcareclearinghousethattranslatesaclaimfromanonstandardformat   intoastandardtransactiononbehalfofahealthcareproviderandforwardsthe   processedtransactiontoapayer.{c݌` (#` (# Ќ  {c  0  {cX"0` (#(#  Anindependentmedical_transcriptionist_Ԁthatprovidestranscriptionservicestoa ! physician.{cX݌"` (#` (# Ќ  {c  0  {c"0` (#(#  Apharmacybenefitsmanagerthatmanagesahealthplanspharmacistnetwork.{c݌^$` (#` (# Ќ    BusinessAssociateContracts._Ԁ_______Acoveredentitys__contract_Ԁorother_writtenarrangement_ 6&l! _withitsbusinessassociatemust_Ԁcontaintheelementsspecifiedat45CFR164.504(e).For "'X" example,thecontract_must: (D # _0  {c  {c"0` (#(#  _Describe___Ԁthepermittedandrequiredusesofprotectedhealthinformationbythe )"% business_associate;{c݌*#&` (#` (# Ќ  0  +#'(#(# 0  {c  {cH"0` (#(#  Providethatthebusinessassociatewillnotuseorfurtherdisclosetheprotected  healthinformationotherthanaspermittedorrequiredbythecontractoras  requiredbylaw;and{cHc݌ ` (#` (# Ќ  0   (#(# 0  {c  {c"0` (#(#  Requirethebusinessassociatetouseappropriatesafeguardstopreventauseor z  disclosureoftheprotectedhealthinformationotherthanasprovidedforbythe f  contract.{c݌R ` (#` (# Ќ  0   (#(#   Whereacoveredentityknowsofamaterialbreachorviolationbythebusinessassociate *` ofthecontractoragreement,thecoveredentityisrequiredtotakereasonablestepstocurethe L  breachorendtheviolation,andifsuchstepsareunsuccessful,toterminatethecontractor 8  arrangement.Ifterminationofthecontractoragreementisnotfeasible,acoveredentityis $  requiredtoreporttheproblemtotheDepartmentofHealthandHumanServices(_HHS_)Office   forCivilRights(OCR).     Samplebusinessassociatecontractlanguageisavailable__on_Ԁ_the_HHS_ԀOCR_Ԁ_Privacyof   Health_ԀInformation___website_Ԁat_4eg4O  5  http://www.hhs.gov/ocr/hipaa/contractprov.html6rOrds  7egP.    TransitionProvisionsforExistingContracts.Coveredentities(otherthansmallhealth b plans)thathaveanexistingcontract(orotherwrittenagreement)withabusinessassociateprior N toOctober15,2002,arepermittedtocontinuetooperateunderthatcontractforuptoone :p additionalyearbeyondtheApril14,2003compliancedate,providedthatthecontractisnot &\ renewedormodifiedpriortoApril14,2003.Thistransitionperiodappliesonlytowritten H contractsorotherwrittenarrangements.Oralcontractsorotherarrangementsarenoteligiblefor 4 thetransitionperiod.Coveredentitieswithcontractsthatqualifyarepermittedtocontinueto   operateunderthosecontractswiththeirbusinessassociatesuntilApril14,2004,oruntilthe   contractisrenewedormodified,whicheverissooner,regardlessofwhetherthecontractmeets  theRulesapplicablecontractrequirementsat45_CFR_Ԁ164.502(e)and164.504(e).Acovered   entitymustotherwisecomplywiththePrivacyRule,suchasmakingonlypermissibledisclosures ! tothebusinessassociateandpermittingindividualstoexercisetheirrightsundertheRule. "   See45_CFR_Ԁ164.532(d)and(e). ^$   ExceptionstotheBusinessAssociateStandard.ThePrivacyRuleincludesthefollowing 6&l! exceptionstothebusinessassociatestandard.See45_CFR_Ԁ164.502(e).Inthesesituations,a "'X" coveredentityisnotrequiredtohaveabusinessassociatecontractorotherwrittenagreementin (D # placebeforeprotectedhealthinformationmaybedisclosedtothepersonorentity. (0!$   {c  {cP"0 `   Disclosuresbyacoveredentitytoahealthcareproviderfortreatmentofthe *#& individual.{cPk݌+#'` (#` (# Ќ    0  0` (#(#Forexample:` (#` (#  RSTUVWXY(y3"3"     ` 3&23  0   Ahospitalisnotrequiredtohaveabusinessassociatecontractwiththe   specialisttowhomitrefersapatientandtransmitsthepatientsmedical z  chartfortreatmentpurposes.3&k݌f  (# (# Ќ  ! ! RSTUVWXY(yyRSTUVWXY"3"  0  0` (#(#3s23  0 ` (#` (#  Aphysicianisnotrequiredtohaveabusinessassociatecontractwitha R  laboratoryasaconditionofdisclosingprotectedhealthinformationforthe >t treatmentofanindividual.3s݌*` (# (# Ќ  "3"  0  0` (#(#3*23  0 ` (#` (#  Ahospitallaboratoryisnotrequiredtohaveabusinessassociatecontract L  todiscloseprotectedhealthinformationtoareferencelaboratoryfor 8  treatmentoftheindividual.3*w݌$  (# (# Ќ  {c  0  {c"0` (#(#  Disclosurestoahealthplansponsor,suchasanemployer,byagrouphealthplan,   orbythehealthinsuranceissuerorHMOthatprovidesthehealthinsurance   benefitsorcoverageforthegrouphealthplan,providedthatthegrouphealth   plansdocumentshavebeenamendedtolimitthedisclosuresoroneofthe  exceptionsat45_CFR_Ԁ164.504(f)havebeenmet.{c݌v` (#` (# Ќ  {c  0  {cZ"0` (#(#  Thecollectionandsharingofprotectedhealthinformationbyahealthplanthatis N apublicbenefitsprogram,suchasMedicare,andanagencyotherthantheagency :p administeringthehealthplan,suchastheSocialSecurityAdministration,that &\ collectsprotectedhealthinformationtodetermineeligibilityorenrollment,or H determineseligibilityorenrollment,forthegovernmentprogram,wherethejoint 4 activitiesareauthorizedbylaw.{cZ݌ ` (#` (# Ќ  0   (#(#   OtherSituationsinWhichaBusinessAssociateContractIsNOTRequired.  0   (#(# {c  0  {c"0` (#(#  Whenahealthcareproviderdisclosesprotectedhealthinformationtoahealth ! planforpaymentpurposes,orwhenthehealthcareprovidersimplyacceptsa " discountedratetoparticipateinthehealthplansnetwork.Aproviderthat r# submitsaclaimtoahealthplanandahealthplanthatassessesandpaystheclaim ^$ areeachactingonitsownbehalfasacoveredentity,andnotasthe business J%  associateoftheother.{c݌6&l!` (#` (# Ќ  0   (#(# {c  0  {c"0` (#(#  Withpersonsororganizations(e.g.,janitorialserviceorelectrician)whose (D # functionsorservicesdonotinvolvetheuseordisclosureofprotectedhealth (0!$ information,andwhereanyaccesstoprotectedhealthinformationbysuch )"% personswouldbeincidental,ifatall.{c݌*#&` (#` (# Ќ   +#' {c  0  {c"0` (#(#  Withapersonororganizationthatactsmerelyasaconduitforprotectedhealth  information,forexample,theUSPostalService,certainprivatecouriers,andtheir  electronicequivalents.{c݌ ` (#` (# Ќ  0  {c  {c4"0`