Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Congress passed HIPAA to provide consumers with greater access to health care insurance, to protect the privacy of health care data, and to promote more standardization and efficiency in the health care industry. Portability in HIPAA includes patient protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances.
Federal Privacy Law HIPAA
The Final Rule
greatly enhances a patient’s privacy protections, provides individuals new rights to their health information, and strengthens the government’s ability to enforce the law. Some of the provisions include:
- Clarifying when breaches of unsecured health information must be reported to the federal government.
- Strengthening the requirement between physicians and their business associates such as health plans and other entities who receive patient information.
- Allowing cash paying patients to instruct their physician not to share information about their treatment with health plans.
HIPAA Administrative Simplification Provisions
The Administrative Simplification provisions of HIPAA streamline the administration of health care with requirements for privacy, electronic transactions and code sets, security, and national provider identifiers. These provisions apply to all covered entities.
- The PRIVACY requirements govern disclosure of patient protected health information (PHI), while protecting patient rights. The Office of Civil Rights (OCR) enforces the HIPAA Privacy Rule.
- The ELECTRONIC TRANSACTIONS AND CODE SETS requirements involve the transfer of health care information and the adoption of standard formats for processing claims and payments.
- The SECURITY regulations involve the adoption of administrative, technical, and physical safeguards required to prevent unauthorized access to PHI. The Office
of Civil Rights enforces the HIPAA Security Rule.
- HHS has health information privacy guidance materials for Covered Entities.
- The HIPAA Privacy and Security Audit Program requires HHS to provide for periodic audits to ensure covered entities and business associates are complying with the HIPAA Privacy and Security Rules and Breach Notification standards.
- Combined regulation text of all HIPAA Administrative Simplification Regulations found at 45 CFR 160, 162, and 164. Privacy Rule is located at 45 CFR Part 160 and Subparts A and E of Part 164. The Security Rule is located at 45 CFR Part 160 and Subparts A and C of Part 164.
Cybersecurity and Risk Assessments - Informational page regarding cybersecurity and risk assessments as well as vendors and tools.
HB 300 (2011) and its 2013 amendment amended the Texas Health and Safety Code §181 and contains privacy requirements that are more stringent than the federal privacy requirements of HIPAA. This law imposes requirements regarding training, electronic health records access, sales of protected health information, notice and authorization for electronic disclosures, enforcement and disciplinary actions, and audits of covered entities. This law was effective on Sept. 1, 2012. In the legislative session of 2013, the law was further amended to change some the requirements and timetables for training.
HB 4390 (2019) amended Section 521.053 of the Texas Business & Commerce Code, effective Jan. 1, 2020, and is more restrictive than Federal HIPAA laws. HB 4390 amends the code by defining a deadline by which businesses must provide notice to affected individuals, requiring notice be provided without unreasonable delay, but no later than 60 days after discovering a breach has occurred. Businesses are also required to provide notice to the Texas attorney general within the same 60 days after a breach is discovered if the breach involves the sensitive personal information (SPI) of 250 or more Texas residents.
- Texas Medical Association (TMA) and Texas Medical Liability Trust (TMLT)
- HIPAA Resource Center - The TMA HIPAA Resource Center offers practical guidance for the physician's office.
- Online HIPAA Management Tool - A cloud based interactive tool that helps physician practices reach and maintain HIPAA compliance. Based on an online assessment completed by the practice, the tool will conduct a comprehensive risk assessment and create customized policies and procedures tailored to the practice.
- TMLT provides answers to risk management FAQs involving medical privacy and security.
- HIPAA Resources
- Office of Civil Rights (OCR) and Enforcement
- State and Federal Health Privacy Laws and Resources
The HIPAA Privacy Rules outline methods and approaches to de-identify PHI.
The 2009 federal economic stimulus bill, American Recovery and Reinvestment Act (ARRA), substantially broadens the scope and impact of HIPAA security and privacy rules. These mandates are included in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of ARRA. A requirement of the stimulus bill regarding electronic protected health information (ePHI) is to notify patients and the US Dept of Health & Human Services (HHS) of "unsecured" PHI leaks and breaches. Under the stimulus bill, several HIPAA security provisions apply to business associates in the same manner as those that apply to covered entities.
- The HIPAA Privacy and Security Audit Program requires HHS to provide for periodic audits to ensure covered entities and business associates are complying with the HIPAA Privacy and Security Rules and Breach Notification standards. Also see a TMA article in Texas Medicine, July 2012, on the the federal government's enforcement of data security and privacy standards.
- For additional information on electronic health/medical records, see our EHR web page.