Nurse Reporter Spring 2009 - Wyoming State Board of Nursing

More documents

Recommendations

Info

An Overview of Permissive Disclosures Under HIPAA and 42 CFR Part 2 Travis J. Kirchhefer, J.D. Protecting the confidentiality of patient communications is not a new concept. For instance, in Wyoming physician-patient communications were protected by statute against disclosure in a court of law since 1886 (1886 Wyo. Sess. Laws 171). This makes federal regulations over health care information, passed in the 1970s and 1990s, incredibly recent. However, the two federal laws that address responsibility when handling the individually identifiable information of persons receiving health care services, are much more expansive. The first of these laws, [42 Code of Federal Regulations (CFR) Part 2], covers substance abuse information specifically; the second, HIPAA, covers individually identifiable health information broadly. To better make sense of these regulations, this article will briefly explore the authority behind them, and review the types of disclosures permitted by each of these laws in hopes of creating a better understanding of how these laws both protect and serve health care consumers in the United States. These regulations represent a commitment by the federal government to establish not only the responsible use of individual health information, but also to provide security for persons seeking treatment. The United States government’s regulation of the use of alcohol and drug abuse treatment information dates back to the early 1970s (Legal Action Center, 2006). The most recent incarnation of these laws is found at 42 United States Code (USC) § 290dd-2 (2006). This law establishes safeguards for substance abuse information in hopes of encouraging the use of substance abuse treatment and prevention programs (Legal Action Center, 2006). In 1996, the United States Congress passed the Health Information Portability and Accountability Act of 1996, Public Law 104-191. This time, Congress hoped to create incentives to using electronically portable health information by establishing protections for that information and establishing uniform standards for portability through electronic mediums (Health Information Portability and Accountability Act of 1996, Pub. L. 104-191, § 261, 110 Stat. 931, 1938 (1996)). The laws themselves are very general in nature and require the Secretary of the United States Department of Health and Human Services to establish federally enforceable rules that explicitly implement their provisions [42 USC § 1320d-1 through 3 (2006), and 42 USC §290dd- 2(g) (2006)]. These rules can be found at 42 CFR Part 2 and 45 CFR Parts 160, 162 and 164 (2008). These standards are known, respectively, as “Part 2” and “HIPAA” by today’s health care providers and consumers. HIPAA covers any individually identifiable information collected from or about an individual by a health care provider, health plan, or health care clearinghouse that “relates to the past, present ,or future physical or mental health or condition of an individual; the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual” (45 CFR § 160.103, 2008) Information is individually identifiable if it specifically identifies the individual or can reasonably be used to identify the individual (45 CFR § 160.103, 2008). The standards adopted under 42 CFR Part 2 are substantially similar; however, they relate specifically to information that establishes the “identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any drug abuse prevention function conducted, regulated or directly or indirectly assisted by any department or agency of the United States” [42 CFR § 2.1(a), 2008)]. It is important to note that while HIPAA does establish standards for the privacy (45 CFR Part 164, Subpart E, 2008) and security (45 CFR Part 164, Subpart C, 2008) of individually identifiable health information, this accountability is only one purpose of the legislation and implementing rule. HIPAA also allows for information to be responsibly made portable. For instance, it is important to remember that when an individual properly authorizes the use or disclosure of their information, HIPAA sets forth no roadblock to that use or disclosure [45 CFR § 164.508(b),2008]. Covered entities are also allowed to use protected health information for their own treatment, payment and operations and may disclose relevant information to other covered entities that need the information for these purposes [45 CFR § 164.506(c), 2008]. HIPAA also establishes standards that enable information to be deidentified, effectively removing the need for further compliance (45 CFR § 164.514, 2008). Finally, HIPAA sets forth limited instances when covered entities can choose to use or disclose protected health information without an authorization. A full list of these exceptions is found at 45 CFR § 164.512 and includes disclosures required by law [45 CFR § 164.512(a), 2008]; to report abuse or neglect [45 CFR § 164.512(c), 2008]; under court order [45 CFR §164.512(e), 2008]; for law enforcement purposes [45 CFR 164 §164.512(f), 2008]; and for research [45 CFR 164 §164.512(i), 2008]. While HIPAA applies to most of the nation’s health care providers, health plans and health care clearinghouses, Part 2 applies to substance abuse education, prevention, training, treatment, rehabilitation and research programs that are assisted by a department or agency of the United States [42 CFR § 2.1(a),2008]. Indeed, there is a great deal of overlap where HIPAA covered entities also fall under the provisions of Part 2. Part 2 providers should therefore be aware that to comply with both laws, the more stringent Part 2 will often control. Therefore, only disclosures allowed by both Part 2 and HIPAA can be made from Part 2 covered programs. A partial list of permitted disclosures is located at 42 CFR § 2.12(c). These include disclosures within the program [42 CFR § 2.12(c)(3), 2008], and the reporting of child abuse [42 CFR § 2.12(c)(6), 2008]. Additionally, Part 2 allows disclosures with a valid consent [42 CFR § 2.33, 2008], for research [42 CFR § 2.52, 2008], in a medical emergency [42 CFR § 2.51, 2008], for audit and evaluation [42 CFR § 2.53, 2008], and by court order [42 CFR § 2.61, 2008]. Disclosures by court order are limited to specific circumstances that must be set forth in the court’s order [42 CFR §§ 2.63 through 2.67, 2008]. This article establishes only a basic overview of the permissive disclosures established by HIPAA and Part 2. It is important to know that both of these regulations can be preempted by more stringent state law(s) [42 CFR § 2.20, and 45 CFR § 160.203, 2008]. Because of the many intricacies of these laws themselves and the potential state overlay, covered entities are encouraged to have a strong working relationship with their privacy experts and legal counsel to ensure full compliance. Travis Kirchhefer is an Assistant Attorney General for the State of Wyoming. REFERENCES 42 USC § 290dd-2 (2006) 42 USC § 1320(d) (2006) 42 CFR Part 2 (2008) 45 CFR Part 160 (2008) 45 CFR Part 164 (2008) Legal Action Center (2006). Confidentiality and Communication: A Guide to the Federal Drug and Alcohol Confidentiality Law and HIPAA (6th ed.). New York, NY: Legal Action Center of the City of New York, Inc. The Health Information Portability and Accountability Act of 1996, Pub L. No. 104-191 (codified at 42 USC § 1320(d), 42USC § 1395cc(a)(1), 42 USC § 242k(k) (2006)). 20 Wy o m i n g Nu r s e Re p o r t e r
We Treat You Like Family Lander offers a variety and abundance of outdoor recreational opportunities, cultural activities and affordable housing in a beautiful setting. With over 250 days of brilliant blue skies, your adventures are limitless. We are committed to five core values: High Quality Patient Care Excellent Workplace Supporting Physicians Providing community value Ensuring Fiscal responsibility In 2007 Lander Regional Hospital was awarded the prestigious LifePoint Hospitals – High Five Award for achieving outstanding results in our five core values. • Flexible Scheduling • Health Insurance, including dental & vision • Generous compensation Based on years of experience • Career Ladder that includes additional compensation for education, certifications, cross-training, quality, and mentorship This Big Horn Basin growing community’s climate is comfortable with little moisture. Located near Yellowstone National Park and surrounded by mountains, there is ample opportunity for outdoor recreation year around. Powell Valley Healthcare is a facility dedicated to providing an outstanding work environment for staff, and exceptional experiences for customers. Powell Valley Healthcare Employment Opportunities RNs and LPNs • Paid time off starting at 23 days • Life & Disability insurance • Differential for evenings & nights • Extended Illness Plan • Tuition & Student Loan Reimbursement • Retirement plan with employer matching contributions To interview us as your future employer, call: 1-800-428-1398, Ext. 134 Visit our web site at www.pvhc.org Equal Opportunity Employer $6,000 Sign-on/ Retention Bonus Opportunities include: - 12 hour night shifts in Med/Surg - 12 hour night shifts in Women’s Health Great Benefit Package! Contact: Human Resources Janet.Morgan@lpnt.net Lander Regional Hospital 1320 Bishop Randall Drive Lander, WY 82520 307-335-6580 Fax 307-335-6237 Visit www.landerhospital.com Wy o m i n g Nu r s e Re p o r t e r 21
Page 1: Nurse R E P O R T E R Wy o m i n g
Page 4 and 5: Continued from previous page promis
Page 6 and 7: Sc o p e o f Pr a c t i c e Issues
Page 8 and 9: Scope of Practice Decision Making M
Page 10 and 11: • Are there written policies and
Page 12 and 13: First Licensed Nurse in Wyoming Mar
Page 18 and 19: George Vandel, NCAC II, CAP The Wyo
Page 22 and 23: Patti Gardner, MSN, CNM, PMHNP-BC T
Page 24 and 25: Have you ever been lost in time whi
Page 26 and 27: Chapter 53. Senate File No. 37. 190
Page 28 and 29: Shirlie Carubie, RN 83 years old Sh
Page 30 and 31: THE WYOMING STATE BOARD OF NURSING
Page 32: Wy o m i n g St a t e Bo a r d o f

Nurse Reporter Spring 2009 - Wyoming State Board of Nursing

Create successful ePaper yourself

Delete template?

Save as template?