HIPAA stands for the Health Insurance Portability and Accountability Act of 1996 which was enacted by Congress. Originally sponsored by Sen. Edward Kenney (D-Mass.) and Sen. Nancy Kassebaum (R-Kan.), the Act has two sections. Title I deals with protecting health insurance coverage for people who lose or change jobs. HIPAA Title II, also known as the Administrative Simplification (AS) provisions, requires the standardization of electronic health care transactions and national identifiers for providers, health insurance plans and employers.

The Administration Simplification provision also addresses the security and privacy of health data. The standards are designed for the improvement of the efficiency and effectiveness of the U.S. health care system by promoting the extensive use of electronic data interchange in the nation’s health care system.

In layman’s terms, it means HIPAA has two primary goals.

  • To make health insurance more accessible – mainly means restricting, and in some cases, eliminating the practice of excluding people from coverage because of pre-existing conditions.
  • To make health care more accountable in terms of cost. It aims to reduce fraud and increase efficiency and effectiveness through administrative simplification.

The Privacy Rule

The HIPAA Privacy Rule protects all identifiable information or personal health information (PHI) with regards to patient that is turned over to or maintained by a healthcare provider. This would include email, electronic, fax, paper, oral, and voice mail records, as well as phone conversations.

Simply put, HIPAA protects the information itself. It does not lose its protection whether it is stored in a computer or printed out in a paper.

Under the final rule:

  • Patients will have significant new rights to understand and control how their health information is used.
  • Health care providers and health plans will be required to give their patients a detailed written explanation of how their health information may be used and disclosed.
  • Patients will also have the right to see and get copies of their records.
  • Health care providers will be required to get permission from patients before sharing information for treatment, payment and health care operations.
  • Separate authorization must be given by patients for non-routine disclosures and non-health care purposes.
  • Patients have the right to request restrictions on the uses and disclosures of information pertaining to their health.
  • Patients will have the right to file a formal complaint against any provider or health plan, or with HHS, for violating the provisions of this rule or the policies and procedures of the covered entity.

With a few exceptions such as appropriate law enforcement needs, patient health information covered by the rule generally may not be used for purposes that are not health care-related without the explicit approval of the patient. Furthermore, disclosures of information will be limited to the minimum that is necessary to serve the purpose of disclosure. However, for treatment purposes where physicians, specialists and other health care providers will need access to the full disclosure of the patient’s records to enable them to provide quality health care, this provision does not apply.

The Security Rule

Portability is exactly what HIPAA is all about. It is how you and your family can have a continuing health care coverage no matter that you undergo job changes or even job losses. However, it does not mean a guarantee that you will have insurance or that you will keep insurance after switching jobs. But HIPAA provisions may help you keep health insurance coverage during transitions and help you get another health care coverage if you lose the coverage provided by your previous employer.



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