focus on forms american medical association
TRANSCRIPT
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Focus on Forms
American Medical Association
Jacqueline M. Darrah, M.A., J.D.
Mary Kuffner, J.D.
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Preemption
• HIPAA “trumps” if state law is “contrary”
• State law “trumps” if it is “more stringent”
• Generally, state law “wins” if more restrictive or gives patients additional rights
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Forms Are “More Stringent”
• With respect to form or substance
• Narrow the scope or duration
• Increase the privacy protections afforded
• Reduce coercive effect
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Recordkeeping Is “More Stringent”
• Retention or reporting of more detailed information
• Retention or reporting for a longer duration
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General Standard
• With respect to any other matter
• Provides greater privacy protection for the individual
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Other Exceptions to HIPAA Preemption
• Determination by the Secretary of HHS in specific categories
• State law provides for reporting and public health activities
• State law requires health plan reporting, auditing, licensing
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Use of the Consent Form
• Required for health care providers
• May condition treatment on provision of consent
• May not be combined with Notice of Privacy Practices
• May be combined with other types of legal permission
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Use of the Consent Form
• Before uses or disclosures of protected health information for treatment, payment and/or health care operations
• Exceptions:– Emergency
– Indirect treatment relationship
– Inmates
– Required by law
– Communication barriers
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Use of the Consent Form
• Documented policies and procedures
• Retain copy for six years
• Effective only for the covered entity that obtained the consent except for joint consent
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Use of the Consent Form
• Defective consents:– Lacks a required element– Revoked
• Conflicting legal permission– Disclose in accordance with more restrictive
consent or authorization– May resolve conflicts
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Consent Form
• Plain language
• Informs the patient that protected health information may be used or disclosed for treatment, payment and health care operations
• Refers to the Notice of Privacy Practices
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Consent Form
• Patient rights– Review the Notice of Privacy Practices before
signing– To request restrictions– To revoke consent
• Signed and dated
• Reserve right to change Notice of Privacy Practices
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Use of Authorization Forms
• When consent or another exception does not apply
• Type of authorizations form depends on purpose:– Use or disclosure of PHI by your practice– Disclosure of PHI by another practice or entity to
your practice– Use or disclosure of PHI for research that
includes treatment
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Use of Authorization Forms
• May not condition treatment, payment or enrollment on provision of authorization except:– Research that includes treatment
– Purpose of treatment is to create information for others
– To determine payment of claims (not psych. notes)
– Eligibility/enrollment determinations (not psych. notes)
– Underwriting/risk rating (not psych. notes)
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Use of Authorization Forms
• May not combine authorizations except:– May combine authorizations for use or
disclosure of psychotherapy notes only with similar authorization
– May combine other authorizations (not psychotherapy notes) unless one conditions treatment on an authorization for research
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Use of Authorization Forms
– May combine authorization for research that includes treatment with:
• Consent to participate in the research,
• Consent to use or disclose PHI for related treatment, payment and health care operations,
• Notice of Privacy practices
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Use of Authorization Forms
• Documented policies and procedures
• Retain copy for six years
• Effective only for the covered entity that obtained the authorization
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Authorization Forms
• All forms must include the following:– Name of authorized persons or practices – Description of information – Expiration date or event– Patient’s right to revoke, exceptions, and
procedure– Statement about potential for redisclosure– Signed and dated– Authority of personal representative (if applies)
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Authorization Forms
• Must be valid
• Defective authorizations:– Expiration date or event has passed
– Form is not filled out completely
– The practice knows the patient has revoked
– Lacks a required element
– Is inappropriately combined with another consent or authorization
– Contains any material information known by the practice to be false
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Authorization Form A
• For use or disclosure, or both
• Description of each purpose
• Informs patient of rights:– to inspect or copy the information to be used or
disclosed– to refuse to sign– whether the information will result in
remuneration to the physician from a third party
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Authorization Form A (Cont.)
• Statement that the practice will not condition treatment, payment, enrollment or eligibility of benefits (if applies) on the provision of the authorization [unless an exception applies]
• The patient must receive a copy of the form
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Authorization Form B
• For disclosure of PHI from another covered entity to the practice to carry out treatment, payment or health care operations
• Description of each purpose
• Informs patient of right to refuse to sign
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Authorization Form B (Cont.)
• Statement that the practice will not condition treatment, payment, enrollment or eligibility of benefits (if applies) on the provision of the authorization [unless an exception applies]
• The patient must receive a copy of the form
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Authorization Form C
• For uses/disclosures of PHI created for research that includes treatment (unless otherwise permitted under Privacy Rule)
• Description of each purpose, and:– How PHI will be used or disclosed for treatment,
payment or operations– Any PHI that will not be used as permitted under
the Privacy Rule
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Authorization Form C (Cont.)
• Informs patient of rights:– to inspect or copy the information to be used or
disclosed– to refuse to sign– whether the information will result in
remuneration to the physician from a third party
• Refers to consent or Notice of Privacy Practices (if not combined with authorization)
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Authorization Form C (Cont.)
• Statement that the practice will not condition treatment, payment, enrollment or eligibility of benefits (if applies) on the provision of the authorization [optional]
• The patient must receive a copy of the form
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Notice of Privacy Practices (“NPP”)
• Right to adequate notice
• Uses and disclosures of PHI
• Individual’s rights
• Covered Entity’s legal duties
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Use of NPP
• Direct treatment relationship
• Available on request
• No later than the date of first service delivery
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Use of NPP
• Available at office for patient to take with them
• Post in reasonable location in office
• Make revised notices readily available
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Use of NPP
• If maintain web site with information about services
• Display notice on the website prominently
• Make available on the website
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Use of NPP
• NPP may be provided by e-mail
• If the individual has agreed receive by e-mail and has not withdrawn
• If e-mail fails, paper copy must be provided
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Use of NPP
• E-mail NPP must be delivered within same timeframe as paper
• If service is electronic, then must deliver NPP automatically and contemporaneously with first request for service
• Recipient may still receive paper copy of NPP
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Content of NPP
• Plain language
• Specific header
• Uses and disclosures
• Separate statements - appointments and fundraising
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Content of NPP
• Individual’s rights
• Covered Entities’ duties
• Reserve right to change NPP
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Content of NPP
• Complaint Process
• Identify Privacy Contact
• Effective Date
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Content of NPP
• Optional elements - limited uses and disclosures
• Revisions to the NPP if material change in privacy practices
• Do not implement change until NPP is revised (unless required by law)
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Joint Notice
• Participation in Organized Health Care Arrangement
• Previously discussed requirements apply
• Entities included, delivery sites, and statement about TPO
• Joint notice is effective for all
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Documentation Requirements
• Maintain policies and procedures
• Maintain paper or electronic copy
• Maintain for 6 years