Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Confidentiality, security, and privacy are in most cases used to mean the same thing, although they differ. The concepts relate to the personal information protection in health care agencies. The law in the United States protects patient data and health records from illegal or malicious access. However, health care providers face challenges in balancing between privacy, security, and confidentiality of health information and the need to provide quality care to patients. While ethical standards provide a guideline to health care providers to observe privacy, security, and confidentiality of health information, legal frameworks, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), offer better standards to ensure the safety of patient records.
HIPAA is a federal law in the United States enacted by the 104th Congress. President Bill Clinton signed the bill on August 21, 1996 (Nosowsky & Giordano, 2006). According to the act, the Secretary of the U.S. Department of Health and Human Services (HHS) should come up with regulatory measures to ensure the protection of patient records. The law introduces health care professionals to the responsible use of information, including concepts such as meaningful use (Lutkevich, 2021). Consequently, they protect electronic health records from illegal usage.
The Purpose of HIPAA
The law was meant to modernize the movement of health information, stipulating how covered entities maintain personally identifiable information. The law would protect such entities from illegal access to information and fraud or theft (Nosowsky & Giordano, 2006). The law ensures that covered entities protect the security, privacy, and confidentiality of patient information (Kenney, 2020). Furthermore, the law addresses the limitations on insurance coverage to Americans. The act also creates the need for national standards for ensuring that those dealing with sensitive patient information protect it from unlawful disclosure. Whenever they intend to disclose the information, they should seek the patient’s consent.
The History of HIPAA
The law has been in force since August 21, 1996, when it was signed into law. Before the law was created, the country lacked any generally accepted security standards or general requirements that protected information in healthcare organizations (Atchinson & Fox, 1997). The challenge became worse with the development of information technology, making it possible for healthcare organizations to create and distribute a high quantity of patient health records. The growth in information technology also improved the potential for third parties and unauthorized persons to access patient information. Consequently, the government recognized creating an effective policy to protect patient records’ confidentiality, privacy, and security, leading to HIPAA development.
The law was responsible for significant changes in the health care system, although the changes did not happen overnight. When the Act was enacted for the first time, it necessitated creating standards to protect individually identifiable health information by the Secretary of Health and Human Services (HSS). In 1999, the government published the original set of “Code Set” standards. The initial proposal for the establishment of the Privacy Rule was made in 2000. The law also evolved considerably since the earliest incarnation (Atchinson & Fox, 1997). The language changed to accommodate development in technology, while the legal scope extended to cover Business Associates. Hence, the law changed to cover the disclosure or use of Protected Health Information (PHI).
The U.S. Department of Health & Human Services’ Office for Civil Rights (OCR) polices the HIPAA regulations and investigates reported complaints regarding potential law violations. State Attorneys General also has the mandate to act against Covered Entities and Business Associates that violate the law. The OCR and State Attorneys General can impose financial penalties on violators of HIPAA regulations.
HIPAA has five Titles:
Title I: Offers protection to health insurance coverage for employees and their dependents that lose or change their jobs. Furthermore, it creates limitations to new health plans and prevent them from discriminating against patients with preexisting conditions.
Title II: Offers protection against Abuse and Medical Liability Reform and Health Care Fraud. The title also calls for the establishment of standards for electronic health care transactions.
Title III: Creates controls relating to pre-tax medical expenditure records. In case of alternations in health insurance policy and medical cover deductions, the title spells out the conditions.
Title IV: Creates guidelines for group health plans and offers changes for health coverage.
Title V: Controls company-owned life insurance policies. The title also provides for the treatment of people without United States Citizenship.
The Secretary of the U.S. Department of Health and Human Services (HHS) created the Privacy Rule to deal with the disclosure and use of individuals’ health information (“protected health information”) (Cohen & Mello, 2018). The Rule introduces “covered entities,” individuals, and agencies subject to the Privacy Rule. The Rule also includes standards for personal rights to comprehend and control the use of the information by the owner. The Rule aims to ensure that personal health information is adequately protected while ensuring effective movement to support quality care to patients and protect the public’s health and wellbeing of the people. Thus, the Rule provides a balance between proper use of patient information while protecting patients’ privacy.
Apart from the Privacy Rule, the law has Security Rule to safeguard protected health information (PHI). The provision offers protection to a subset of information that the Privacy Rule covers. The subset relates to activities of covered entities regarding the creation, receipt, maintenance, and transmission of electronic health records (CDC, 2018). Covered entities should ensure the integrity, confidentiality, and availability of the information and emphasize professional ethics and best judgment to comply with the Rule.
One of the groups of covered entities is healthcare providers, regardless of their size, who create electronic records in their interactions with patients (CDC, 2018). They involve actions like insurance claims, authorized referrals, and questions about qualifications for benefits.
The second group include health plans. These are the organizations involved in providing health insurance or paying for care delivery. They comprise of agencies that offer medical insurance to patients, such for dental, vision, or drugs. Some of the organizations are Medicare supplement insurers, Medicare, Medicaid, and HMOs (CDC, 2018). Others include insurance plans provided by the government or religious bodies, covers provided by employers, or multi employer covers.
The third agencies are healthcare clearinghouses. They are agencies involved in processing non-standard information that they receive other covered entities (CDC, 2018). Thus, they receive the information when required to process a health plan or healthcare provider in most cases.
The fourth groups are business associates. They are individuals or companies that disclose or use patient information when interacting with a covered entity. They engage in actions like analyzing data, processing claims, billing, or reviewing utilization.
Conclusion and Reflection
The non-intuitive name of the law, the “Health Insurance Portability and Accountability Act” (HIPAA), marks an understanding of the immediate impact on the health care system. However, apart from ethical guidelines, the law has a significant impact on how health care providers treat patient health information. As an allied health student, one has a huge responsibility to understand and apply the law to protect patient data and prevent any legal ramifications for violation. Overall, the general working knowledge of HIPAA practices is necessary to maintain a legal focus when working with patient records.