Using the attachments below , read the three different definitions of “health information,” found on pages 14, 15, and 16. Then read the scenario and answer the question below.
Scenario: Paramedic Erika Toledo took a photo at a traffic collision and posted it on his Facebook page. She was very careful not to show the patient’s face, but the license plate of the patient’s vehicle is clearly visible.
Do you believe Erika violated HIPAA? If so, which section of HIPAA regarding the definition of “health information” would you use to explain to Erika that what she did was wrong?
In our current technological age where everybody has a camera on their phone, whenever there is a medical emergency in public you will see multiple people filming the incident. Although HIPAA does not restrict private individuals, why would be the benefits and disadvantages of doing that? Name and explain one disadvantage and one advantage.
HIPAA Administrative Simplification Regulation Text March 2013 (4) A group health plan and one (iii) In employment records held State refers to one of the or more other group health plans by a covered entity in its role as following: each of which are maintained by employer; and the same plan sponsor; or (1 ) For a health plan established (iv) Regarding a person who has or regulated by Federal law, (5) The group health plans been deceased for more than 50 State has the meaning set forth described in paragraph (4) of years. in the applicable section of the this definition and health United States Code for such insurance issuers or HMOs with Respondent means a covered health plan. respect to such group health entity or business associate upon plans, but only with respect to which the Secretary has (2) For all other purposes, State protected health information imposed, or proposes to impose, means any of the several States, created or received by such a civil money penalty. the District of Columbia, the health insurance issuers or Commonwealth of Puerto Rico, HMOs that relates to individuals Secretary means the Secretary the Virgin Islands, Guam, who are or have been participants or beneficiaries in of Health and Human Services American Samoa, and the any of such group health plans. or any other officer or employee Commonwealth of the Northern of HHS to whom the authority Mariana Islands. involved has been delegated. Person means a natural person, Subcontractor means a person to trust or estate, partnership, Small health plan means a whom a business associate corporation, professional health plan with annual receipts delegates a function, activity, or association or corporation, or of $5 million or less service, other than in the other entity, public or private. capacity of a member of the Standard means a rule, workforce of such business Protected health information condition, or requirement: associate. means individually identifiable health information: (1) Describing the following Trading partner agreement (1 ) Except as provided in information for products, means an agreement related to systems, services, or practices: the exchange of information in paragraph (2) of this definition, electronic transactions, whether that is: the agreement is distinct or part (i) Classification of components; of a larger agreement, between (i) Transmitted by electronic each party to the agreement. media; (ii) Specification of materials, For example, a trading partner performance, or operations; or agreement may specify, among (ii) Maintained in electronic other things, the duties and media; or (iii) Delincation of procedures; responsibilities of each party to or the agreement in conducting a standard transaction. (iii) Transmitted or maintained in any other form or medium, (2) With respect to the privacy of protected health information. Transaction means the transmission of information (2) Protected health information Standard setting organization between two parties to carry out excludes individually identifiable health information: (SSO) means an organization financial or administrative accredited by the American activities related to health care. (i) In education records covered National Standards Institute that It includes the following types by the Family Educational develops and maintains of information transmissions: standards for information Rights and Privacy Act, as (1 ) Health care claims or amended, 20 U.S.C. 1232g: transactions or data elements, or any other standard t equivalent encounter necessary for, or will facilitate information. (ii) In records described at 20 the implementation of, this part. U.S.C. 1232g(a)(4)(B)(iv); 16
HIPAA Administrative Simplification Regulation Text March 2013 (xvii) Any other individual or employer, or health care one covered entity participates group plan, or combination of clearinghouse; and and in which the participating individual or group plans, that covered entities: provides or pays for the cost of (2) Relates to the past, present, medical care (as defined in or future physical or mental (i) Hold themselves out to the section 2791(a)(2) of the PHS health or condition of an public as participating in a joint Act, 42 U.S.C. 300gg-91(a)(2)). individual; the provision of arrangement; and health care to an individual; or (2) Health plan excludes: the past, present, or future (ii) Participate in joint activities payment for the provision of that include at least one of the (i) Any policy, plan, or program health care to an individual; and following: to the extent that it provides, or pays for the cost of, excepted (i) That identifies the individual; (A) Utilization review, in which benefits that are listed in section health care decisions by 2791(c)(1) of the PHS Act, 42 participating covered entities are U.S.C. 300gg-91 (c)(1); and (ii) With respect to which there reviewed by other participating is a reasonable basis to believe covered entities or by a third (ii) A government-funded the information can be used to party on their behalf; program (other than one listed in identify the individual. paragraph (1)(i)-(xvi) of this (B) Quality assessment and definition): Manifestation or manifested improvement activities, in which means, with respect to a discase, treatment provided by (A) Whose principal purpose is disorder, or pathological participating covered entities is other than providing, or paying condition, that an individual has assessed by other participating the cost of, health care; or been or could reasonably be covered entities or by a third diagnosed with the disease, party on their behalf; or (B) Whose principal activity is: disorder, or pathological condition by a health care (C) Payment activities, if the (1) The direct provision of professional with appropriate financial risk for delivering health care to persons; or training and expertise in the health care is shared, in part or field of medicine involved. For in whole, by participating (2) The making of grants to fund purposes of this subchapter, a covered entities through the disease, disorder, or pathological the direct provision of health joint arrangement and if condition is not manifested if the care to persons. protected health information diagnosis is based principally on created or received by a covered genetic information. Implementation specification entity is reviewed by other participating covered entities or means specific requirements or Modify or modification refers to by a third party on their behalf instructions for implementing a a change adopted by the standard. Secretary, through regulation, to for the purpose of administering the sharing of financial risk. a standard or an implementation Individual means the person specification. who is the subject of protected (3) A group health plan and a health insurance issuer or HMO health information. Organized health care arrangement means: with respect to such group health plan, but only with Individually identifiable health respect to protected health information is information that (1) A clinically integrated care information created or received is a subset of health information, setting in which individuals by such health insurance issuer including demographic typically receive health care or HMO that relates to information collected from an from more than one health care individuals who are or who have individual, and: provider, been participants or beneficiaries in such group (1 ) Is created or received by a (2) An organized system of health plan; health care provider, health plan, health care in which more than 15
HIPAA Administrative Simplification Regulation Text March 2013 elements or a standard business of insurance in a State (vii) An issuer of a Medicare transaction. and is subject to State law that supplemental policy (as defined regulates insurance. Such term in section 1882(g)(1) of the Act, (2) Receives a standard does not include a group health 42 U.S.C. 1395ss(@)(1)). transaction from another entity plan. and processes or facilitates the (vili) An issuer of a long-term processing of health information Health maintenance care policy, excluding a nursing into nonstandard format or organization (HMO) (as defined home fixed indemnity policy. nonstandard data content for the in section 2791(b)(3) of the PHS receiving entity. Act, 42 U.S.C. 300gg-91(b)(3) (ix) An employee welfare and used in the definition of benefit plan or any other Health care provider means a health plan in this section) arrangement that is established provider of services (as defined means a federally qualified or maintained for the purpose of in section 1861(u) of the Act, 42 HMO, an org offering or providing health U.S.C. 1395x(u)), a provider of recognized as an HMO under benefits to the employees of two medical or health services (as State law, or a similar or more employers. defined in section 1861(s) of the organization regulated for Act, 42 U.S.C. 1395x(s)), and solvency under State law in the any other person or organization same manner and to the same (x) The health care program for extent as such an HMO. uniformed services under title who furnishes, bills, or is paid 10 of the United States Code. for health care in the normal course of business. Health plan means an individual or group plan that provides, or (xi) The veterans health care pays the cost of, medical care program under 38 U.S.C. Health information means any (as defined in section 2791 (a)(2) chapter 17. information, including genetic information, whether oral or of the PHS Act, 42 U.S.C. 300gg-91(a)(2)). (xii) The Indian Health Service recorded in any form or medium, that: program under the Indian Health (1) Health plan includes the Care Improvement Act, 25 U.S.C. 1601, et seq. (1) Is created or received by a following, singly or in health care provider, health plan, combination: (xiii) The Federal Employees public health authority, employer, life insurer, school or Health Benefits Program under (i) A group health plan, as university, or health care defined in this section. 5 U.S.C. 8902, et seq. clearinghouse; and (ii) A health insurance issuer, as (xiv) An approved State child (2) Relates to the past, present, defined in this section. health plan under title XXI of or future physical or mental the Act, providing benefits for health or condition of an child health assistance that meet (iii) An HMO, as defined in this individual; the provision of the requirements of section 2103 section. health care to an individual; or of the Act, 42 U.S.C. 1397, er the past, present, or future seq. (iv) Part A or Part B of the payment for the provision of health care to an individual. Medicare program under title (xv) The Medicare Advantage XVIII of the Act. program under Part C of title Health insurance issuer (as XVIII of the Act, 42 U.S.C. defined in section 2791(b)(2) of (v) The Medicaid program under 1395w-21 through 1395w-28. the PHS Act, 42 U.S.C. 300gg- title XIX of the Act, 42 U.S.C. 91(b)(2) and used in the 1396, et seq. (xvi) A high risk pool that is a definition of health plan in this mechanism established under section) means an insurance (vi) The Voluntary Prescription State law to provide health company, insurance service, or Drug Benefit Program under insurance coverage or insurance organization Part D of title XVIII of the Act, comparable coverage to eligible (including an HMO) that is 42 U.S.C. 1395w-101 through individuals. licensed to engage in the 1395w-152. 14
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