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17: Regulations
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Health Insurance Portability and Accountability Act of 1996
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In 1996, the US Congress passed the Health Insurance Portability and Accountability Act (HIPAA) The act includes two sections Title I provides health insurance coverage after employees have lost or changed jobs Title II deals with administrative actions intended to simplify and standardize health information The IT component of Title II deals with security and handling of health information in an electronic age When the topic of HIPAA arises, particularly among IT staff, the implications of this section are most prevalent The IT components of the act prescribe a standard methodology for security Further, HIPAA standardizes formats for health-related information The standards encompass methods that ensure patient confidentiality and data integrity for any information that can be associated with an individual patient The most commonly identified component of the act is a body of data collectively known as protected health information (PHI) or Electronic Protected Health Information (EPHI) which encompasses Individually Identifiable Health Information (IIHI) IIHI relates to an individual s medical condition, treatment, or payment for treatment Any entity that maintains and uses individually identifiable PHI is subject to the act The effective scope of HIPAA encompasses entities from hospitals, to insurers, to doctors (of all types), to laboratories, and to companies that operate or participate in health plans Organizations affected by HIPAA are referred to by the act as covered entities NOTE HIPAA is a very large, complex piece of legislation Two great places for information are the government website, wwwhhsgov/ocr/privacy, and the HIPAA Survival Guide located at wwwhipaasurvivalguidecom The latest edition of the HIPAA Survival Guide is sold for a nominal fee as a PDF This guide will save you from aging 30 years while digesting all-things-HIPAA
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Two rules were published in the Federal Register by the Department of Health and Human Services after HIPAA was passed The HIPAA Privacy Rule was published in December 2000, and the HIPAA Security Rule was published in February 2003 The HIPAA Privacy Rule is focused mostly on administrative controls designed to protect patient privacy, such as securing or masking medical charts, locking file cabinets, and establishing privacy policies The HIPAA Privacy Rule was enforced beginning in April 2003 The HIPAA Security Rule is focused on technical controls such as network perimeter protection, encryption, and workstation security The primary objective of the Security Rule is to protect EPHI when it is stored, maintained, or transmitted The HIPAA Security Rule is divided into high-level standards and implementation specifications that support each standard Implementation specifications are either required (mandatory)
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or addressable (required unless justified otherwise) Table 14-1 outlines the implementation specifications required by the HIPAA Security Rule The implementation specifications with (R) next to them are required; those with (A) are addressable Organizations were given until April 2005 to comply with the HIPAA Security Rule
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Standard Security Rule Reference Implementation Specification
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Security management process
164308(a)(1)
Risk Analysis (R) Risk Management (R) Sanction Policy (R) Information System Activity Review (R)
Assigned security responsibility Workforce security
164308(a)(2) 164308(a)(3)
Assigned Security Responsibility (R) Authorization and/or Supervision (A) Workforce Clearance Procedure Termination Procedures (A)
Information access management
164308(a)(4)
Isolating Health Care Clearinghouse Function (R) Access Authorization (A) Access Establishment and Modification (A)
Security awareness and training
164308(a)(5)
Security Reminders (A) Protection from Malicious Software (A) Log-in Monitoring (A) Password Management (A)
Security incident procedures Contingency plan
164308(a)(6) 164308(a)(7)
Response and Reporting (R) Data Backup Plan (R) Disaster Recovery Plan (R) Emergency Mode Operation Plan (R) Testing and Revision Procedure (A) Applications and Data Criticality Analysis (A)
Evaluation Business associate contracts and other arrangements
164308(a)(8) 164308(b)(1)
Evaluation (R) Written Contract or Other Arrangement (R)
Table 17-1 HIPAA Security Rule Requirements
17: Regulations
Standard Physical Safeguards Security Rule Reference Implementation Specification
Facility access controls
164310(a)(1)
Contingency Operations (A) Facility Security Plan (A) Access Control and Validation Procedures (A) Maintenance Records (A)
Workstation use Workstation security Device and media controls
164310(b) 164310(c) 164310(d)(1)
Workstation Use (R) Workstation Security (R) Disposal (R) Media Reuse (R) Accountability (A) Data Backup and Storage (A)
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