View source for Health Insurance Portability and Accountability Act

{{Short description|United States federal law concerning health information}}
{{Infobox U.S. legislation
| shorttitle        = Health Insurance Portability and Accountability Act of 1996
| othershorttitles  = Kassebaum–Kennedy Act, Kennedy–Kassebaum Act
| longtitle         = An Act To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.
| colloquialacronym = HIPAA (pronounced {{IPAc-en|ˈ|h|ɪ|p|ə}} {{respell|HIP|uh}})
| nickname          =
| enacted by        = 104th
| effective date    =
| public law url    =
| cite public law   = {{USPL|104|191}}
| cite statutes at large = {{USStat|110|1936}}
| acts amended    =
| acts repealed   =
| title amended   = <!--US code titles changed-->
| sections created = <!--{{USC}} can be used-->
| sections amended =
| leghisturl      = http://thomas.loc.gov/cgi-bin/bdquery/z?d104:HR03103:@@@S
| introducedin    = House
| introducedbill  = {{USBill|104|HR|3103}}
| introducedby    = [[William Reynolds Archer, Jr.|Bill Archer]] ([[Republican Party (United States)|R]]-[[Texas|TX]])
| introduceddate  = March 18, 1996
| committees      = [[United States House Committee on Ways and Means|House Ways and Means]]
| passedbody1     = House
| passeddate1     = March 28, 1996
| passedvote1     = [http://clerk.house.gov/evs/1996/roll106.xml 267–151]
| passedbody2     = Senate
| passedas2       = <!-- used if the second body changes the name of the legislation -->
| passeddate2     = April 23, 1996
| passedvote2     = [https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=104&session=2&vote=00078 100–0], in lieu of {{USBill|104|S|1028}}
| conferencedate  = July 31, 1996
| passedbody3     = House
| passeddate3     = August 1, 1996
| passedvote3     = [http://clerk.house.gov/evs/1996/roll393.xml 421–2]
| passedbody4     = Senate
| passeddate4     = August 2, 1996
| passedvote4     = [https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=104&session=2&vote=00264 98–0]
| signedpresident = [[Bill Clinton]]
| signeddate      = August 21, 1996
| amendments      =
| SCOTUS cases    =
}}

The '''Health Insurance Portability and Accountability Act of 1996''' ('''HIPAA''' or the '''[[Ted Kennedy|Kennedy]]–[[Nancy Kassebaum|Kassebaum]] Act'''<ref name="Atchinson/Fox">{{cite journal|last1=Atchinson|first1=Brian K.|last2=Fox|first2=Daniel M.|date=May–June 1997|title=The Politics Of The Health Insurance Portability And Accountability Act|journal=[[Health Affairs]]|volume=16|issue=3|pages=146–150|url=http://www.library.armstrong.edu/eres/docs/eres/MHSA8635-1_CROSBY/8635_week2_HIPAA_politics.pdf|doi=10.1377/hlthaff.16.3.146|pmid=9141331|url-status=dead|archive-url=https://web.archive.org/web/20140116195505/http://www.library.armstrong.edu/eres/docs/eres/MHSA8635-1_CROSBY/8635_week2_HIPAA_politics.pdf|archive-date=2014-01-16|access-date=2014-01-16}}</ref><ref name="WjE7g">{{cite web|url=http://www.gpo.gov/fdsys/pkg/BILLS-104s1028is/pdf/BILLS-104s1028is.pdf|title=104th Congress, 1st Session, S.1028|url-status=live|archive-url=https://web.archive.org/web/20120616142528/http://www.gpo.gov/fdsys/pkg/BILLS-104s1028is/pdf/BILLS-104s1028is.pdf|archive-date=2012-06-16}}</ref>) is a United States [[Act of Congress]] enacted by the [[104th United States Congress]] and signed into law by President [[Bill Clinton]] on August 21, 1996.<ref>{{Cite journal |title=Health insurance portability and accountability act of 1996 |journal=Public Law}}</ref> It aimed to alter the transfer of healthcare information, stipulated the guidelines by which [[personally identifiable information]] maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft,<ref>{{Citation |last1=Edemekong |first1=Peter F. |title=Health Insurance Portability and Accountability Act |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK500019/ |work=StatPearls |access-date=2023-06-15 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29763195 |last2=Annamaraju |first2=Pavan |last3=Haydel |first3=Micelle J.}}</ref> and addressed some limitations on [[Health insurance in the United States|healthcare insurance coverage]]. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The bill does not restrict patients from receiving information about themselves (with limited exceptions).<ref>{{Cite web|url=https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html|title = Your Medical Records|date = 19 November 2008}}</ref> Furthermore, it does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends or other individuals not employees of a covered entity.

The act consists of five titles:

# Title I protects [[health insurance in the United States|health insurance]] coverage for workers and their families when they change or lose their jobs.<ref name="XMVOH">{{Cite news|url=https://www.dol.gov/general/topic/health-plans/portability|title=Health Plans & Benefits: Portability of Health Coverage|date=2015-12-09|newspaper=United States Department of Labor|access-date=2016-11-05|url-status=live|archive-url=https://web.archive.org/web/20161220135517/https://www.dol.gov/general/topic/health-plans/portability|archive-date=2016-12-20}}</ref>
# Title II, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for [[Electronic health record|electronic health care]] transactions and national identifiers for providers, health insurance plans, and employers.<ref name="8iYhc">{{Cite web|url=https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html|title=Overview|date=2016-09-13|website=www.cms.gov|language=en-us|access-date=2016-11-05|url-status=live|archive-url=https://web.archive.org/web/20161102132054/https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html|archive-date=2016-11-02}}</ref>
# Title III sets guidelines for pre-tax medical spending accounts.
# Title IV sets guidelines for group health plans.
# Title V governs company-owned life insurance policies.

==Titles==
There are five sections to the act, known as titles.

===Title I: Health Care Access, Portability, and Renewability===
Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code. Furthermore, Title I addresses the issue of "job lock" which is the inability for an employee to leave their job because they would lose their health coverage.<ref>{{Cite journal|last1=Berger|first1=Mark C.|last2=Black|first2=Dan A.|last3=Scott|first3=Frank A.|date=2004|title=Is There Job Lock? Evidence from the Pre-HIPAA Era|url=https://www.jstor.org/stable/4135282|journal=Southern Economic Journal|volume=70|issue=4|pages=953–976|doi=10.2307/4135282|jstor=4135282|issn=0038-4038}}</ref> To combat the job lock issue, the Title protects health insurance coverage for workers and their families if they lose or change their jobs.<ref>{{Cite web|title=HIPAA Title Information|url=https://www.dhcs.ca.gov/formsandpubs/laws/hipaa/Pages/1.10HIPAATitleInformation.aspx|access-date=2021-10-31|website=www.dhcs.ca.gov|language=en}}</ref>

Title I requires the coverage of and also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits in relation to preexisting conditions for either 12 months following enrollment in the plan or 18 months in the case of late enrollment.<ref name="IyyXk">{{usc-clause|29|1181|(a)(2)}}</ref> Title I allows individuals to reduce the exclusion period by the amount of time that they have had "creditable coverage" before enrolling in the plan and after any "significant breaks" in coverage.<ref name="ZBui3">{{usc-clause|29|1181|(a)(3)}}</ref> "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.<ref name="SNKGE">{{usc-clause|29|1181|(c)(1)}}</ref> A "significant break" in coverage is defined as any 63-day period without any creditable coverage.<ref name="zC46r">{{usc-clause|29|1181|(c)(2)(A)}}</ref> Along with an exception, it allows employers to tie premiums or co-payments to tobacco use, or body mass index.

Title I mandates that insurance providers must issue policies without exclusions to individuals leaving group health plans, provided they have maintained continuous, credible coverage. (see above) exceeding 18 months, and<ref name="HMoEZ">(Sub B Sec 111)</ref> renew individual policies for as long as they are offered or provide alternatives to discontinued plans for as long as the insurer stays in the market without exclusion regardless of health condition.

Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans like dental or vision plans offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits.

An alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans, such as dental to apply towards exclusion periods of the new plan that does include those coverages.

Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, must have occurred while the beneficiary was covered under this exact same health insurance contract"). Such clauses must not be acted upon by the health plan. Also, they must be re-written so they can comply with HIPAA.<ref name="6NTTk">{{Cite journal|date=2014|title=HIPAA for Healthcare Workers: The Privacy Rule|url=http://dx.doi.org/10.4135/9781529727890|doi=10.4135/9781529727890}}</ref>

===Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform===
{{more citations needed section|date=April 2010}}

Title II of HIPAA establishes policies and procedures for maintaining the privacy and the security of individually identifiable health information, outlines numerous offenses relating to health care, and establishes civil and criminal penalties for violations. It also creates several programs to control fraud and abuse within the health-care system.<ref name="LB0fN">{{usc|42|1320a-7c|}}</ref><ref name="Iu5AU">{{usc|42|1395ddd}}</ref><ref name="668st">{{usc|42|1395b-5}}</ref><ref name="auto">{{Cite web|url=https://www.law.cornell.edu/uscode/text/42/1395ddd|title=42 U.S. Code § 1395ddd - Medicare Integrity Program|website=LII / Legal Information Institute|language=en|access-date=2018-03-21|url-status=live|archive-url=https://web.archive.org/web/20180321192516/https://www.law.cornell.edu/uscode/text/42/1395ddd|archive-date=2018-03-21}}</ref> However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the [[United States Department of Health and Human Services|Department of Health and Human Services]] (HHS) to increase the efficiency of the health-care system by creating standards for the use and dissemination of health-care information.<ref name="auto" />

These rules apply to "covered entities", as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses (such as billing services and community health information systems), and health care providers that transmit health care data in a way regulated by HIPAA.<ref name="CodeFedReg|45|160|103">{{CodeFedReg|45|160|103}}</ref>

Per the requirements of Title II, the HHS has promulgated five rules regarding Administrative Simplification: the Privacy Rule,  the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.<ref>{{cite web | url=https://www.hhs.gov/hipaa/for-professionals/other-administration-simplification-rules/index.html | title=Other Administrative Simplification Rules | date=4 December 2015 }}</ref>

====Privacy Rule====

The HIPAA Privacy Rule is composed of national regulations for the use and disclosure of [[Protected health information|Protected Health Information]] (PHI) in healthcare treatment, payment and operations by "covered entities" (generally, health care clearinghouses, employer-sponsored health plans, health insurers, and medical service providers that engage in certain transactions).<ref name="d07T8">Terry, Ken [http://www.physicianspractice.com/articles/patient-privacy-—-new-threats "Patient Privacy - The New Threats"] {{webarchive|url=https://web.archive.org/web/20151120220654/http://www.physicianspractice.com/articles/patient-privacy-%E2%80%94-new-threats|date=2015-11-20}} ''Physicians Practice'' journal, volume 19, number 3, year 2009, access date July 2, 2009</ref>

The Privacy Rule came into effect on April 14, 2003, with a one-year extension for certain "small plans". By regulation, the HHS extended the HIPAA privacy rule to independent contractors of covered entities who fit within the definition of "business associates".<ref name="1YiYW">See [http://www.medlawplus.com/library/legal/hipaaprivacyreg.htm 45 CFR Sections 160.102 and 160.103] {{webarchive|url=https://web.archive.org/web/20120112115921/http://www.medlawplus.com/library/legal/hipaaprivacyreg.htm |date=2012-01-12}}.</ref> PHI is any information that is held by a covered entity regarding health status, provision of health care, or health care payment that can be linked to any individual.<ref name="CodeFedReg|45|160|103" /> This is interpreted rather broadly and includes any part of an individual's [[medical record]] or payment history. Covered entities must disclose PHI to the individual within 30 days upon request.<ref name="tY5YO">{{CodeFedReg|45|164|524|(b)}}</ref> They must also disclose PHI when required to do so by law such as reporting suspected [[child abuse]] to state child welfare agencies.<ref name="gTkXU">{{CodeFedReg|45|164|512}}</ref>

Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; or to identify or locate a suspect, a fugitive, a material witness, or a missing person.<ref name="CYZ6i">{{cite web|url=https://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html|title=Summary of the HIPAA Privacy Rule|first=Office for Civil Rights|last=(OCR)|date=7 May 2008|url-status=live|archive-url=https://web.archive.org/web/20151206123936/http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html|archive-date=6 December 2015}}</ref>

A covered entity may disclose PHI to certain parties to facilitate treatment, payment, or health care operations without a patient's express written authorization.<ref name="JVxqn">{{CodeFedReg|45|164|524|(a)(1)(ii)}}</ref> Any other disclosures of PHI require the covered entity to obtain written authorization from the individual for disclosure.<ref name="Gm6fK">{{CodeFedReg|45|164|502|(a)(1)(iv)}}</ref> In any case, when a covered entity discloses any PHI, it must make a reasonable effort to disclose only the minimum necessary information required to achieve its purpose.<ref name="tcjyp">{{CodeFedReg|45|164|502|(b)}}</ref>

The Privacy Rule gives individuals the right to request a covered entity to correct any inaccurate PHI.<ref name="WfTcp">{{CodeFedReg|45|164|526}}</ref> Also, it requires covered entities to take some reasonable steps on ensuring the confidentiality of communications with individuals.<ref name="d9pOh">{{CodeFedReg|45|164|522|(b)}}</ref> For example, an individual can ask to be called at their work number instead of home or cell phone numbers.

The Privacy Rule requires covered entities to notify individuals of uses of their PHI.<ref name="WSWLy">{{Cite journal|last=Rowe|first=Linda|date=2005|title=What Judicial Officers Need to Know about the HIPAA Privacy Rule|journal=NASPA Journal|volume=42|issue=4|pages=498–512|doi=10.2202/0027-6014.1537|id={{ProQuest|62084860}}}}</ref> Covered entities must also keep track of disclosures of PHI and document privacy policies and procedures.<ref name="C18uY">{{CodeFedReg|45|164|528}}</ref> They must appoint a Privacy Official and a contact person<ref name="FaGgD">{{CodeFedReg|45|164|530|(a)}}</ref> responsible for receiving complaints and train all members of their workforce in procedures regarding PHI.<ref name="RPFBq">{{CodeFedReg|45|164|530|(b)}}</ref>

An individual who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).<ref name="t5GiT">{{cite web|url=https://archive.hhs.gov/ocr/hipaahowto.pdf|title=How to File A Health Information Privacy Complaint with the Office for Civil Rights|url-status=dead|archive-url=https://web.archive.org/web/20161221034754/http://archive.hhs.gov/ocr/hipaahowto.pdf|archive-date=2016-12-21|access-date=2017-10-07}}</ref><ref name="MDsuD">{{CodeFedReg|45|160|306}}</ref> In 2006 the ''Wall Street Journal'' reported that the OCR had a long backlog and ignores most complaints. "Complaints of privacy violations have been piling up at the Department of Health and Human Services. Between April of 2003 and November 2006, the agency fielded 23,886 complaints related to medical-privacy rules, but it has not yet taken any enforcement actions against hospitals, doctors, insurers or anyone else for rule violations. A spokesman for the agency says it has closed three-quarters of the complaints, typically because it found no violation or after it provided informal guidance to the parties involved."<ref name="mCOnA">[https://www.wsj.com/articles/SB116709136139859229 "Spread of records stirs fears of privacy erosion"] {{webarchive|url=https://web.archive.org/web/20170710060546/https://www.wsj.com/articles/SB116709136139859229 |date=2017-07-10}}, December 23, 2006, by Theo Francis, ''The Wall Street Journal''</ref> However, in July 2011, the [[University of California, Los Angeles]] agreed to pay $865,500 in a settlement regarding potential HIPAA violations. An HHS Office for Civil Rights investigation showed that from 2005 to 2008, unauthorized employees repeatedly and without legitimate cause looked at the electronic protected health information of numerous UCLAHS patients.<ref name="O5U00">{{cite news|url=https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/examples/UCLA-health-system/index.html|title=University of California settles HIPAA Privacy and Security case involving UCLA Health System facilities|publisher=Department of Health and Human Services|url-status=live|archive-url=https://web.archive.org/web/20171012043924/https://www.hhs.gov/HIPAA/for-professionals/compliance-enforcement/examples/UCLA-health-system/index.html|archive-date=2017-10-12}}</ref>

It is a misconception that the Privacy Rule creates a right for any individual to refuse to disclose any health information (such as chronic conditions or immunization records) if requested by an employer or business. HIPAA Privacy Rule requirements merely place restrictions on disclosure by covered entities and their business associates without the consent of the individual whose records are being requested; they do not place any restrictions upon requesting health information directly from the subject of that information.<ref>{{Cite news|last=Kavi|first=Aishvarya|date=2021-07-22|title=How the HIPAA Law Works and Why People Get It Wrong|language=en-US|work=The New York Times|url=https://www.nytimes.com/article/hipaa-law.html|access-date=2021-07-23|issn=0362-4331}}</ref><ref>{{Cite news|last=Chiu|first=Allyson|date=2021-05-22|title=Explaining HIPAA: No, it doesn't ban questions about your vaccination status|url=https://www.washingtonpost.com/lifestyle/wellness/hipaa-vaccine-covid-privacy-violation/2021/05/22/f5f145ec-b9ad-11eb-a6b1-81296da0339b_story.html|access-date=2021-07-23|newspaper=Washington Post}}</ref><ref>{{Cite web|date=2021-07-21|title=Lawmaker Marjorie Taylor Greene, in Ten Words or Less, Gets HIPAA All Wrong|url=https://lawandcrime.com/legal-analysis/lawmaker-marjorie-taylor-greene-in-ten-words-or-less-gets-hipaa-all-wrong/|access-date=2021-07-23|website=Law & Crime|language=en}}</ref>

=====2013 Final Omnibus Rule update=====
In January 2013, HIPAA was updated via the Final Omnibus Rule.<ref name="tVWwA">{{cite web|url=https://www.hhs.gov/ocr/privacy/hipaa/administrative/omnibus/index.html|title=Omnibus HIPAA Rulemaking|first=Office for Civil Rights|last=(OCR)|date=30 October 2015}}</ref> The updates included changes to the Security Rule and Breach Notification portions of the HITECH Act. The most significant changes related to the expansion of requirements to include business associates, where only covered entities had originally been held to uphold these sections of the law.{{citation needed|date=November 2023}}

In addition, the definition of "significant harm" to an individual in the analysis of a breach was updated to provide more scrutiny to covered entities with the intent of disclosing breaches that previously were unreported. Previously, an organization needed proof that harm had occurred whereas now organizations must prove that harm had not occurred.

Protection of PHI was changed from indefinite to 50 years after death. More severe penalties for violation of PHI privacy requirements were also approved.<ref name="yjddM">[https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/health-information-of-deceased-individuals/index.html Health Information of Deceased Individuals] {{webarchive|url=https://web.archive.org/web/20171019060457/https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/health-information-of-deceased-individuals/index.html |date=2017-10-19}} 2013</ref>

The HIPAA Privacy rule may be waived during disasters. Limited waivers have been issued in cases such as [[Hurricane Harvey]] in 2017.<ref>{{Cite web |last=Cohen |first=Jessica Kim |date=2017-08-30 |title=HHS releases limited HIPAA waiver during Hurricane Harvey: 5 things to know |url=https://www.beckershospitalreview.com/healthcare-information-technology/hhs-releases-limited-hipaa-waiver-during-hurricane-harvey-5-things-to-know.html |access-date=2024-03-19 |website=www.beckershospitalreview.com |language=en-gb}}</ref>

======HITECH Act: privacy requirements======
See the [[Health Information Technology for Economic and Clinical Health Act#Subtitle D – Privacy|Privacy section]] of the [[Health Information Technology for Economic and Clinical Health Act]] ([[HITECH Act]]).

===== Right to access one's PHI =====
The Privacy Rule requires medical providers to give individuals access to their PHI.<ref name="8PmDn">{{Cite news|url=https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html|title=Individuals' Right under HIPAA to Access their Health Information|date=2016-01-05|work=HHS.gov|access-date=2017-12-10|language=en|url-status=live|archive-url=https://web.archive.org/web/20171202065556/https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html|archive-date=2017-12-02}}</ref> After an individual requests information in writing (typically using the provider's form for this purpose), a provider has up to 30 days to provide a copy of the information to the individual. An individual may request the information in electronic form or hard-copy, and the provider is obligated to attempt to conform to the requested format. For providers using an electronic health record ([[Electronic health record|EHR]]) system that is certified using CEHRT (Certified Electronic Health Record Technology) criteria, individuals must be allowed to obtain the PHI in electronic form. Providers are encouraged to provide the information expediently, especially in the case of electronic record requests.

Individuals have the broad right to access their health-related information, including medical records, notes, images, lab results, and insurance and billing information.<ref>{{Cite web|last=Rights (OCR)|first=Office for Civil|date=2016-06-24|title=2042-What personal health information do individuals have a right under HIPAA to access from their health care providers and health plans?|url=https://www.hhs.gov/hipaa/for-professionals/faq/2042/what-personal-health-information-do-individuals/index.html|access-date=2021-09-01|website=HHS.gov|language=en}}</ref> Explicitly excluded are the private psychotherapy notes of a provider, and information gathered by a provider to defend against a lawsuit.<ref>{{cite web |title=Individuals' Right under HIPAA to Access their Health Information 45 CFR § 164.524 |date=5 January 2016 |url=https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html |publisher=U.S. Department of Health & Human Services |access-date=10 April 2021}}</ref>

Providers can charge a reasonable amount that relates to their cost of providing the copy, however, no charge is allowable when providing data electronically from a certified [[Electronic health record|EHR]] using the "view, download, and transfer" feature which is required for certification. When delivered to the individual in electronic form, the individual may authorize delivery using either encrypted or unencrypted email, delivery using media (USB drive, CD, etc., which may involve a charge), direct messaging (a secure email technology in common use in the healthcare industry), or possibly other methods. When using unencrypted email, the individual must understand and accept the risks to privacy using this technology (the information may be intercepted and examined by others). Regardless of delivery technology, a provider must continue to fully secure the PHI while in their system and can deny the delivery method if it poses additional risk to PHI while in their system.<ref>{{Cite web|last=Rights (OCR)|first=Office for Civil|date=2009-11-20|title=Summary of the HIPAA Security Rule|url=https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html|access-date=2021-03-17|website=HHS.gov|language=en}}</ref>

An individual may also request (in writing) that their PHI is delivered to a designated third party such as a family care provider.

An individual may also request (in writing) that the provider send PHI to a designated service used to collect or manage their records, such as a Personal Health Record application. For example, a patient can request in writing that her ob-gyn provider digitally transmit records of her latest prenatal visit to a pregnancy self-care app that she has on her mobile phone.

=====Disclosure to relatives=====
According to their interpretations of HIPAA, hospitals will not reveal information over the phone to relatives of admitted patients. This has, in some instances, impeded the location of missing persons. After the [[Asiana Airlines Flight 214]] San Francisco crash, some hospitals were reluctant to disclose the identities of passengers that they were treating, making it difficult for Asiana and the relatives to locate them.<ref name="Fusd2">{{cite web|url=http://www.cnn.com/2014/02/25/travel/asiana-plane-crash-fine/index.html|title=Asiana fined $500,000 for failing to help families - CNN|first= Mike M. |last=Ahlers|date=25 February 2014|publisher=CNN|url-status=live|archive-url=https://web.archive.org/web/20140227183919/http://www.cnn.com/2014/02/25/travel/asiana-plane-crash-fine/index.html|archive-date=2014-02-27}}</ref> In one instance, a man in Washington state was unable to obtain information about his injured mother.<ref name="HfxQ0">{{cite web |url=http://www.firstamendmentcenter.org/hipaas-unintended-consequences-generate-discussion |title=First Amendment Center &#124; Freedom Forum Institute |access-date=2016-04-19 |url-status=live |archive-url=https://web.archive.org/web/20160605025424/http://www.firstamendmentcenter.org/hipaas-unintended-consequences-generate-discussion |archive-date=2016-06-05}}</ref>

Janlori Goldman, director of the advocacy group [https://cdt.org/insights/health-privacy-101/ Health Privacy Project], said that some hospitals are being "overcautious" and misapplying the law, the Times reports. Suburban Hospital in Bethesda, Md., has interpreted a federal regulation that requires hospitals to allow patients to opt out of being included in the hospital directory as meaning that patients want to be kept out of the directory unless they specifically say otherwise. As a result, if a patient is unconscious or otherwise unable to choose to be included in the directory, relatives and friends might not be able to find them, Goldman said.<ref name="vyxKm">{{cite web|url=http://californiahealthline.org/morning-breakout/new-york-times-examines-unintended-consequences-of-hipaa-privacy-rule/|title=New York Times Examines 'Unintended Consequences' of HIPAA Privacy Rule|date=3 June 2003|url-status=live|archive-url=https://web.archive.org/web/20160506165655/http://californiahealthline.org/morning-breakout/new-york-times-examines-unintended-consequences-of-hipaa-privacy-rule/|archive-date=6 May 2016}}</ref>

====Transactions and Code Sets Rule====
HIPAA was intended to make the health care system in the United States more efficient by standardizing health care transactions. HIPAA added a new Part C titled "Administrative Simplification" to Title XI of the Social Security Act.<ref name="Up437">{{Cite web|last=U.S. Social Security Administration|title=TITLE XI—General Provisions, Peer Review, and Administrative Simplification|url=https://www.ssa.gov/OP_Home/ssact/title11/1100.htm|access-date=2020-07-18|website=www.ssa.gov}}</ref> This is supposed to simplify healthcare transactions by requiring all health plans to engage in health care transactions in a standardized way.

The HIPAA/EDI ([[electronic data interchange]]) provision was scheduled to take effect from October 16, 2003, with a one-year extension for certain "small plans". However, due to widespread confusion and difficulty in implementing the rule, Centers for Medicare & Medicaid Services (CMS) granted a one-year extension to all parties.<ref>{{Cite journal |url=https://academic.oup.com/ajhp/article/59/5/402/5157991 |access-date=2023-12-16 |doi=10.1093/ajhp/59.5.402 |title=HIPAA compliance date for electronic transactions extended |date=2002 |last1=Traynor |first1=Kate |journal=American Journal of Health-System Pharmacy |volume=59 |issue=5 |page=402 |pmid=11887402 }}</ref> On January 1, 2012, newer versions, [[ASC X12]] 005010 and NCPDP D.0 become effective, replacing the previous ASC X12 004010 and NCPDP 5.1 mandate.<ref name="9srzm">{{cite web|url=https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Code-Sets/index.html|title=Overview|date=26 July 2017|website=www.cms.gov|url-status=live|archive-url=https://web.archive.org/web/20171018132622/https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Code-Sets/index.html|archive-date=18 October 2017}}</ref> The ASC X12 005010 version provides a mechanism allowing the use of [[ICD-10-CM]] as well as other improvements.

Under HIPAA, HIPAA-covered health plans are now required to use standardized HIPAA electronic transactions. See, 42 USC § 1320d-2 and 45 CFR Part 162. Information about this can be found in the final rule for HIPAA electronic transaction standards (74 Fed. Reg. 3296, published in the Federal Register on January 16, 2009), and on the CMS website.<ref name="iXRVb">{{cite web|url=https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp|title=Overview|date=28 March 2016|website=www.cms.gov|url-status=live|archive-url=https://web.archive.org/web/20120212052227/http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp|archive-date=12 February 2012}}</ref>

The '''EDI Health Care Claim Transaction Set''' (837) is used to submit health care claim billing information, encounter information, or both, except for retail pharmacy claims (see EDI Retail Pharmacy Claim Transaction). It can be sent from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment.

For example, a state mental health agency may mandate all healthcare claims, Providers and health plans who trade professional (medical) health care claims electronically must use the 837 Health Care Claim: Professional standard to send in claims. As there are many different business applications for the Health Care claim, there can be slight derivations to cover off claims involving unique claims such as for institutions, professionals, chiropractors, dentists, etc.

'''EDI Retail Pharmacy Claim Transaction ([[NCPDP]] Telecommunications''' is used to submit retail pharmacy claims to payers by health care professionals who dispense medications, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit claims for retail pharmacy services and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of retail pharmacy services within the pharmacy health care/insurance industry segment.

The '''EDI Health Care Claim Payment/Advice Transaction Set''' (835) can be used to make a payment, send an Explanation of Benefits (EOB), send an Explanation of Payments (EOP) [[remittance advice]], or make a payment and send an EOP remittance advice only from a health insurer to a health care provider either directly or via a financial institution.

The '''[[ANSI 834 Enrollment Implementation Format|EDI Benefit Enrollment and Maintenance Set]]''' (834) can be used by employers, unions, government agencies, associations or insurance agencies to enroll members to a payer. The payer is a healthcare organization that pays claims, administers insurance or benefit or product. Examples of payers include an insurance company, healthcare professional (HMO), preferred provider organization (PPO), government agency (Medicaid, Medicare etc.) or any organization that may be contracted by one of these former groups.

'''EDI Payroll Deducted''', and another group, '''Premium Payment for Insurance Products''' (820), is a transaction set for making a premium payment for insurance products. It can be used to order a financial institution to make a payment to a payee.

'''EDI Health Care Eligibility/Benefit Inquiry''' (270) is used to inquire about the health care benefits and eligibility associated with a subscriber or dependent.

'''EDI Health Care Eligibility/Benefit Response''' (271) is used to respond to a request inquiry about the health care benefits and eligibility associated with a subscriber or dependent.

'''EDI Health Care Claim Status Request''' (276) is a transaction set that can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim.

'''EDI Health Care Claim Status Notification''' (277) is a transaction set that can be used by a healthcare payer or authorized agent to notify a provider, recipient or authorized agent regarding the status of a health care claim or encounter, or to request additional information from the provider regarding a health care claim or encounter. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, is not used for account payment posting. The notification is at a summary or service line detail level. The notification may be solicited or unsolicited.

'''EDI Health Care Service Review Information''' (278) is a transaction set that can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of the request for review, certification, notification or reporting the outcome of a health care services review.

'''EDI Functional Acknowledgement Transaction Set''' (997) is a transaction set that can be used to define the control structures for a set of acknowledgments to indicate the results of the syntactical analysis of the electronically encoded documents. Although it's not specifically named in the HIPAA Legislation or Final Rule, it's necessary for X12 transaction set processing. The encoded documents are the transaction sets, which are grouped in functional groups, used in defining transactions for business data interchange. This standard doesn't cover the semantic meaning of the information encoded in the transaction sets.

=====Brief 5010 Transactions and Code Sets Rules Update Summary=====
# Transaction Set (997) will be replaced by Transaction Set (999) "acknowledgment report".
# The size of many fields {segment elements} will be expanded, causing a need for all IT providers to expand corresponding fields, element, files, GUI, paper media, and databases.
# Some segments have been removed from existing Transaction Sets.
# Many segments have been added to existing Transaction Sets allowing greater tracking and reporting of cost and patient encounters.
# Capacity to use both "International Classification of Diseases" versions 9 (ICD-9) and 10 (ICD-10-CM) has been added.<ref name="QhGXQ">CSM.gov "Medicare & Medicaid Services" "Standards for Electronic Transactions-New Versions, New Standard and New Code Set – Final Rules"</ref><ref name="KUKiA">"The Looming Problem in Healthcare EDI: ICD-10 and HIPAA 5010 migration" October 10, 2009 – Shahid N. Shah</ref>

====Security Rule====
The Final Rule on Security Standards was issued on February 20, 2003. The Security Rule complements the Privacy Rule. While the Privacy Rule pertains to all Protected Health Information (PHI) including paper and electronic, the Security Rule deals specifically with Electronic Protected Health Information (EPHI). It lays out three types of security safeguards required for compliance: administrative, physical, and technical.<ref name="H5vrg">{{cite web|title=HIPAA security rule & risk analysis |date=14 December 2023 |publisher=American Medical Association|url=https://www.ama-assn.org/practice-management/hipaa/hipaa-security-rule-risk-analysis}}</ref> For each of these types, the Rule identifies various security standards, and for each standard, it names both required and addressable implementation specifications. Required specifications must be adopted and administered as dictated by the Rule. Addressable specifications are more flexible. Individual covered entities can evaluate their own situation and determine the best way to implement addressable specifications. Some privacy advocates have argued that this "flexibility" may provide too much latitude to covered entities.<ref name="u9GsH">{{cite journal|ssrn=1547425|first=Tim|last=Wafa|title=How the Lack of Prescriptive Technical Granularity in HIPAA Has Compromised Patient Privacy|journal=Northern Illinois University Law Review|volume=30|issue=3|date=Summer 2010}}</ref> Software tools have been developed to assist covered entities in the risk analysis and remediation tracking. The standards and specifications are as follows:
* Administrative Safeguards – policies and procedures designed to clearly show how the entity will comply with the act
** Covered entities (entities that must comply with HIPAA requirements) must adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.
** The policies and procedures must reference management oversight and organizational buy-in to compliance with the documented security controls.
** Procedures should clearly identify employees or classes of employees who have access to electronic protected health information (EPHI). Access to EPHI must be restricted to only those employees who have a need for it to complete their job function.
** The procedures must address access authorization, establishment, modification, and termination.
** Entities must show that an appropriate ongoing training program regarding the handling of PHI is provided to employees performing health plan administrative functions.
** Covered entities that out-source some of their business processes to a third party must ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor will meet the same data protection requirements that apply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls are in place.
** A contingency plan should be in place for responding to emergencies. Covered entities are responsible for backing up their data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures.
** Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based.
** Procedures should document instructions for addressing and responding to security breaches that are identified either during the audit or the normal course of operations.
* Physical Safeguards – controlling physical access to protect against inappropriate access to protected data
** Controls must govern the introduction and removal of hardware and software from the network. (When equipment is retired it must be disposed of properly to ensure that PHI is not compromised.)
** Access to equipment containing health information should be carefully controlled and monitored.
** Access to hardware and software must be limited to properly authorized individuals.
** Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
** Policies are required to address proper workstation use. Workstations should be removed from high traffic areas and monitor screens should not be in direct view of the public.
** If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
* Technical Safeguards – controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.
** Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
** Each covered entity is responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.
** Data corroboration, including the use of a checksum, double-keying, message authentication, and digital signature may be used to ensure data integrity.
** Covered entities must also authenticate entities with which they communicate. Authentication consists of corroborating that an entity is who it claims to be. Examples of corroboration include password systems, two or three-way handshakes, telephone callback, and token systems.
** Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
** In addition to policies and procedures and access records, information technology documentation should also include a written record of all configuration settings on the components of the network because these components are complex, configurable, and always changing.
** Documented risk analysis and risk management programs are required. Covered entities must carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act's security requirements are a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)

====Unique Identifiers Rule (National Provider Identifier)====
HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans must use only the National Provider Identifier (NPI) to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008.
Effective from May 2006 (May 2007 for small health plans), all covered entities using electronic communications (e.g., physicians, hospitals, health insurance companies, and so forth) must use a single new NPI. The NPI replaces all other identifiers used by health plans, Medicare, Medicaid, and other government programs.<ref name="n5I5D">[http://www.healthinsurance.org/glossary/health-insurance-portability-and-accountability-act-of-1996-hipaa/ Health Insurance Portability and Accountability Act of 1996 (HIPAA).] {{webarchive|url=https://web.archive.org/web/20140108150217/http://www.healthinsurance.org/glossary/health-insurance-portability-and-accountability-act-of-1996-HIPAA/ |date=2014-01-08}} Steve Anderson: HealthInsurance.org.</ref> However, the NPI does not replace a provider's DEA number, state license number, or tax identification number. The NPI is 10 digits (may be alphanumeric), with the last digit being a checksum. The NPI cannot contain any embedded intelligence; in other words, the NPI is simply a number that does not itself have any additional meaning. The NPI is unique and national, never re-used, and except for institutions, a provider usually can have only one. An institution may obtain multiple NPIs for different "sub-parts" such as a free-standing cancer center or rehab facility.

====Enforcement Rule====
On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule sets civil money penalties for violating HIPAA rules and establishes procedures for investigations and hearings for HIPAA violations. For many years there were few prosecutions for violations.<ref name="XLsYb">[https://www.washingtonpost.com/wp-dyn/content/article/2006/06/04/AR2006060400672.html Medical Privacy Law Nets No Fines.] {{webarchive|url=https://web.archive.org/web/20171013152820/http://www.washingtonpost.com/wp-dyn/content/article/2006/06/04/AR2006060400672.html |date=2017-10-13}} Rob Stein: ''The Washington Post''.</ref>

{{blockquote|This may have changed with the fining of $50,000 to the Hospice of North Idaho (HONI) as the first entity to be fined for a potential HIPAA Security Rule breach affecting fewer than 500 people. Rachel Seeger, a spokeswoman for HHS, stated, "HONI did not conduct an accurate and thorough risk analysis to the confidentiality of ePHI [electronic Protected Health Information] as part of its security management process from 2005 through Jan. 17, 2012." This investigation was initiated with the theft from an employees vehicle of an unencrypted laptop containing 441 patient records.<ref name="0En06">{{cite web |url=http://www.scmagazine.com/feds-step-up-hipaa-enforcement-with-hospice-settlement/article/274916/ |title=Feds step up HIPAA enforcement with hospice settlement - SC Magazine |date=7 January 2013 |access-date=2013-01-09 |url-status=live |archive-url=https://web.archive.org/web/20130109205644/http://www.scmagazine.com/feds-step-up-hipaa-enforcement-with-hospice-settlement/article/274916/ |archive-date=2013-01-09}} Feds step up HIPAA enforcement with hospice settlement</ref>|author=|title=|source=}}

{{Wikisource|American Recovery and Reinvestment Act of 2009/Division A/Title XIII/Subtitle D}}

As of March 2013, the [[United States Department of Health and Human Services]] (HHS) has investigated over 19,306 cases that have been resolved by requiring changes in privacy practice or by corrective action. If noncompliance is determined by HHS, entities must apply corrective measures. Complaints have been investigated against many different types of businesses such as national pharmacy chains, major health care centers, insurance groups, hospital chains and other small providers. There were 9,146 cases where the HHS investigation found that HIPAA was followed correctly. There were 44,118 cases that HHS did not find eligible cause for enforcement; for example, a violation that started before HIPAA started; cases withdrawn by the pursuer; or an activity that does not actually violate the Rules.

===Title III: Tax-related health provisions governing medical savings accounts===
Title III standardizes the amount that may be saved per person in a [[Medical savings account (United States)|pre-tax medical savings account]]. Beginning in 1997, a medical savings account ("MSA") became available to employees covered under an employer-sponsored high deductible plan, these being small employer and self-employed individuals.

===Title IV: Application and enforcement of group health insurance requirements===
Title IV specifies conditions for group health plans regarding coverage of persons with preexisting conditions, and modifies continuation of coverage requirements. It also clarifies continuation coverage requirements and includes [[Consolidated Omnibus Budget Reconciliation Act of 1985|COBRA]] clarification.

===Title V: Revenue offset governing tax deductions for employers===
Title V includes provisions related to company-owned life insurance for employers providing company-owned life insurance premiums, prohibiting the tax-deduction of interest on life insurance loans, company endowments, or contracts related to the company. It also repeals the financial institution rule to interest allocation rules. Finally, it amends provisions of law relating to [[list of former United States citizens who relinquished their nationality|people who give up United States citizenship]] or permanent residence, expanding the [[expatriation tax]] to be assessed against those deemed to be giving up their U.S. status for tax reasons, and making ex-citizens' names part of the [[public record]] through the creation of the [[Quarterly Publication of Individuals Who Have Chosen to Expatriate]].<ref name="7Qmkv">{{cite journal|ssrn=552730|first=Michael S.|last=Kirsch|title=Alternative Sanctions and the Federal Tax Law: Symbols, Shaming, and Social Norm Management as a Substitute for Effective Tax Policy|journal=Iowa Law Review|volume=89|issue=863|year=2004}}</ref>

==Effects on research and clinical care==
The enactment of the Privacy and Security Rules has caused major changes in the way physicians and medical centers operate. The complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. An August 2006 article in the journal ''Annals of Internal Medicine'' detailed some such concerns over the implementation and effects of HIPAA.<ref name="annals">{{cite journal|author=Wilson J|title=Health Insurance Portability and Accountability Act Privacy rule causes ongoing concerns among clinicians and researchers|journal=Ann Intern Med|volume=145|issue=4|pages=313–6|year=2006|pmid=16908928|doi=10.7326/0003-4819-145-4-200608150-00019|s2cid=32140125 }}</ref>

===Effects on research===
HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting them for follow-up. A study from the [[University of Michigan]] demonstrated that implementation of the HIPAA Privacy rule resulted in a drop from 96% to 34% in the proportion of follow-up surveys completed by study patients being followed after a [[myocardial infarction|heart attack]].<ref name="s2fYj">{{cite journal|vauthors=Armstrong D, Kline-Rogers E, Jani S, Goldman E, Fang J, Mukherjee D, Nallamothu B, Eagle K |title=Potential impact of the HIPAA privacy rule on data collection in a registry of patients with acute coronary syndrome|journal=Arch Intern Med|volume=165|issue=10|pages=1125–9|year=2005|pmid=15911725|doi=10.1001/archinte.165.10.1125|doi-access=}}</ref> Another study, detailing the effects of HIPAA on recruitment for a study on cancer prevention, demonstrated that HIPAA-mandated changes led to a 73% decrease in patient accrual, a tripling of time spent recruiting patients, and a tripling of mean recruitment costs.<ref name="W1Awg">{{cite journal|vauthors=Wolf M, Bennett C |title=Local perspective of the impact of the HIPAA privacy rule on research|journal=Cancer|volume=106|issue=2|pages=474–9|year=2006|pmid=16342254|doi=10.1002/cncr.21599|doi-access=free}}</ref>

Under HIPAA, [[informed consent]] forms for research studies must document how protected health information will be kept private, potentially increasing barriers to participation.<ref name="annals" />

These data suggest that HIPAA privacy rules may have negative effects on the cost and quality of [[medical research]]. Dr. Kim Eagle, professor of [[internal medicine]] at the University of Michigan, was quoted in the ''Annals'' article as saying, "Privacy is important, but research is also important for improving care. We hope that we will figure this out and do it right."<ref name="annals" />

===Effects on clinical care===
The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their legal privacy responsibilities and often responded with an overly guarded approach to disclosing information ... than necessary to ensure compliance with the Privacy rule".<ref name="annals" /> Reports of this uncertainty continue.<ref name="gEGT2">{{cite news | last=Gross | first=Jane | title=Keeping Patients' Details Private, Even From Kin | work=[[The New York Times]] | date=July 3, 2007 | url=https://www.nytimes.com/2007/07/03/health/policy/03hipaa.html | access-date=August 11, 2019 | archive-url=https://web.archive.org/web/20170812142925/http://www.nytimes.com/2007/07/03/health/policy/03hipaa.html?ex=1341115200&en=19160c75b9633d68&ei=5090&partner=rssuserland&emc=rss |archive-date=August 12, 2017 |url-status=live |df=mdy-all}}</ref>

Standardizing the handling and sharing of health information under HIPAA has contributed to a decrease in medical errors. Accurate and timely access to patient information ensures that healthcare providers make informed decisions, reducing the risk of errors related to incomplete or incorrect data. This standardization supports safer clinical practices and better patient outcomes. <ref>{{Cite web |date=January 2016 |title=Clinician's Guide To HIPAA Privacy |url=The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their legal privacy responsibilities and often responded with an overly guarded approach to disclosing information ... than necessary to ensure compliance with the Privacy rule".[65] Reports of this uncertainty continue.[68] |website=nursing yale}}</ref> Furthermore, HIPAA grants patients the right to access their own health information, request amendments to their records, and obtain an accounting of disclosures.<ref>{{Cite web |date=January 2016 |title=Clinician's Guide To HIPAA Privacy |url=https://nursing.yale.edu/sites/default/files/files/HIPAA%20Cinician%20Guide%2001_2016.pdf |website=nursing yale}}</ref> This empowers patients to be more involved in their healthcare decisions and ensures transparency in the handling of their information. 

===Costs of implementation===
In the period immediately before the enactment of the HIPAA Privacy and Security Acts, medical centers and medical practices were charged with complying with the new requirements. Many practices and centers turned to private consultants for compliance assistance.{{Citation needed|date=March 2024}}

===Education and training===
Education and training of healthcare providers is a requirement for correct implementation of both the HIPAA Privacy Rule and Security Rule.<ref>{{cite web | url=https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.530#p-164.530(b) | title=Federal Register :: Request Access }}</ref><ref>{{cite web | url=https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-C/section-164.308#p-164.308(a)(5)(i) | title=Federal Register :: Request Access }}</ref>

Healthcare providers must receive initial training on HIPAA policies and procedures, including the Privacy Rule and the Security Rule. This training covers how to handle protected health information (PHI), patient rights, and the minimum necessary standard.  Providers learn about the types of information that are protected under HIPAA, such as medical records, billing information and any other health information.<ref>{{Cite web |date=February 2023 |title=HIPAA Basics for Providers: Privacy, security & Breach Notification Rules |url=https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HIPAAPrivacyandSecurity.pdf |website=Outreach and Education}}</ref> They are also taught about patients' rights under HIPAA, such as the right to access their health records and request correction. <ref>{{Cite web |title=HIPAA Basics for Providers: Privacy, security & Breach Notification Rules |url=https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HIPAAPrivacyandSecurity.pdf |website=Outreach and Education}}</ref> Regular fresher training is recommended to keep healthcare providers up to date with any changes in HIPAA regulations and best practices. This includes updates on new policies, procedures, and any material changes to existing practices. 

{{anchor|HIPPA}}{{anchor|HIPAA acronym}}

== Misspelling as ''HIPPA'' ==
{{quote box|width=30%|"People make up what that acronym stands for."|author=Deven McGraw, former [[United States Department of Health and Human Services|HHS]] deputy director|source=as quoted in ''[[Vox (website)|Vox]]''<ref name=morrison/>}}
Although the acronym ''HIPAA'' matches the title of the 1996 Public Law 104-191, ''Health Insurance Portability and Accountability Act'', HIPAA is sometimes incorrectly referred to as ''HIPPA'', variously said to refer to the "Health Information Privacy and Portability Act",<ref name="COURT.HIPPA">{{cite web |url=https://www.gpo.gov/fdsys/pkg/USCOURTS-caed-1_07-cv-01814/pdf/USCOURTS-caed-1_07-cv-01814-13.pdf |quote=violation of the Health Information Privacy and Portability Act. ("HIPPA") |title=United States District Court |date=September 16, 2010}}</ref><ref name="bBi5I">{{cite journal |title=The Effects of Promoting Patient Access to Medical Records: A Review |journal=Journal of the American Medical Informatics Association |volume=10 |issue=2 |pages=129–138 |quote=The Health Insurance Privacy and Portability Act (HIPPA) stipulates that ... |date=2003 |author=S. E. Ross|pmc=150366 |pmid=12595402 |doi=10.1197/jamia.M1147}}</ref> "Health Information Privacy Protection Act",<ref name=morrison>{{cite news |last1=Morrison |first1=Sara |title=HIPAA, the health privacy law that's more limited than you think, explained |url=https://www.vox.com/recode/22363011/hipaa-not-hippa-explained-health-privacy |access-date=31 October 2023 |work=Vox |date=20 April 2021 |language=en}}</ref> or "Health Insurance Privacy and Protection Act".<ref>{{cite news |title=No, asking if you are vaccinated is not a HIPAA violation |url=https://www.wtsp.com/article/news/health/what-is-a-hipaa-violation/67-2fb60a88-f052-4ea8-8b84-f33b9c879219 |access-date=31 October 2023 |work=wtsp.com |date= September 13, 2021}}</ref> The ''HIPPA'' misspelling has been observed among [[COVID-19 scammers]].<ref>{{cite news |last1=LaFraniere |first1=Sharon |last2=Hamby |first2=Chris |title=Another Thing to Fear Out There: Coronavirus Scammers |url=https://www.nytimes.com/2020/04/05/us/politics/coronavirus-scams-fraud-price-gouging.html |access-date=31 October 2023 |work=The New York Times |date=5 April 2020 |url-access=limited}}</ref>

==Violations==
[[File:Hipaa Violations by Type - Pie Chart.png|thumb|alt=HIPAA Chart illustrating HIPAA violations by Type|A breakdown of the HIPAA violations that resulted in the illegal exposure of personal information.]]

According to the US Department of Health and Human Services Office for Civil Rights, between April 2003 and January 2013, it received 91,000 complaints of HIPAA violations, in which 22,000 led to enforcement actions of varying kinds (from settlements to fines) and 521 led to referrals to the US Department of Justice as criminal actions.<ref name="mF2Hl">{{cite web|url=https://www.hhs.gov/ocr/privacy/hipaa/enforcement/highlights/index.html|title=Enforcement Highlights|website=OCR Home, Health Information Privacy, Enforcement Activities & Results, Enforcement Highlights|publisher=U.S. Department of Health & Human Services|access-date=3 March 2014|url-status=live|archive-url=https://web.archive.org/web/20140305213251/http://www.hhs.gov/ocr/privacy/hipaa/enforcement/highlights/index.html|archive-date=5 March 2014}}</ref> Examples of significant breaches of protected information and other HIPAA violations include:
* The largest loss of data that affected 4.9 million people by Tricare Management of Virginia in 2011<ref name="OLON5">{{cite web|url=https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf|title=Breaches Affecting 500 or more Individuals|website=OCR Home, Health Information Privacy, HIPAA Administrative Simplification Statute and Rules, Breach Notification Rule|publisher=U.S. Department of Health & Human Services|access-date=3 March 2014|url-status=live|archive-url=https://web.archive.org/web/20150315010807/https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf|archive-date=15 March 2015}}</ref>
* The largest fines of $5.5 million levied against Memorial Healthcare Systems in 2017 for accessing confidential information of 115,143 patients and of $4.3 million levied against Cignet Health of Maryland in 2010 for ignoring patients' requests to obtain copies of their own records and repeated ignoring of federal officials' inquiries<ref name="Gp2Kt">{{cite web|url=https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/examples/cignet-health/index.html|title=Civil Money Penalty|date=October 2010|website=HHS Official Site|publisher=U.S. Department of Health & Human Services |access-date=8 October 2017 |url-status=live |archive-url=https://web.archive.org/web/20171008030619/https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/examples/cignet-health/index.html |archive-date=8 October 2017}}</ref>
* The first criminal indictment was lodged in 2011 against a Virginia physician who shared information with a patient's employer "under the false pretenses that the patient was a serious and imminent threat to the safety of the public, when in fact he knew that the patient was not such a threat."{{citation needed|date=November 2023}}

According to Koczkodaj et al., 2018,<ref name="UibEC">{{Cite journal |last1=Koczkodaj |first1=Waldemar W. |last2=Mazurek |first2=Mirosław |last3=Strzałka |first3=Dominik |last4=Wolny-Dominiak |first4=Alicja |last5=Woodbury-Smith |first5=Marc |date=2019-01-01 |title=Electronic Health Record Breaches as Social Indicators |url=https://doi.org/10.1007/s11205-018-1837-z |journal=Social Indicators Research |language=en |volume=141 |issue=2 |pages=861–871 |doi=10.1007/s11205-018-1837-z |s2cid=255006896 |issn=1573-0921}}</ref> the total number of individuals affected since October 2009 is 173,398,820.

The differences between civil and criminal penalties are summarized in the following table:
{|class="wikitable"
|-
!Type of Violation!! CIVIL Penalty (min) !! CIVIL Penalty (max)
|-
| Individual did not know (and by exercising reasonable diligence would not have known) that he/she violated HIPAA || $100 per violation, with an annual maximum of $25,000 for repeat violations || $50,000 per violation, with an annual maximum of $1.5 million
|-
| HIPAA violation due to reasonable cause and not due to willful neglect || $1,000 per violation, with an annual maximum of $100,000 for repeat violations || $50,000 per violation, with an annual maximum of $1.5 million
|-
| HIPAA violation due to willful neglect but violation is corrected within the required time period || $10,000 per violation, with an annual maximum of $250,000 for repeat violations || $50,000 per violation, with an annual maximum of $1.5 million
|-
| HIPAA violation is due to willful neglect and is not corrected || $50,000 per violation, with an annual maximum of $1,000,000 || $50,000 per violation, with an annual maximum of $1.5 million
|-
!Type of Violation!! CRIMINAL Penalty
|-
| Covered entities and specified individuals who "knowingly" obtain or disclose individually identifiable health information|| A fine of up to $50,000
Imprisonment up to 1 year
|-
| Offenses committed under false pretenses || A fine of up to $100,000
Imprisonment up to 5 years
|-
| Offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or malicious harm || A fine of up to $250,000
Imprisonment up to 10 years
|}

==Legislative information==
In 1994, President Clinton expressed his goals to improve the healthcare system. However, his reforms did not succeed, most likely due to lack of support.<ref name=":0">{{Cite web|title=Health Insurance Portability and Accountability Act - LIMSWiki|url=https://www.limswiki.org/index.php/Health_Insurance_Portability_and_Accountability_Act#cite_note-CQHIPAAHist-2|access-date=2021-10-10|website=www.limswiki.org|language=en}}</ref> The Congressional Quarterly Almanac of 1996 explains how two senators, [[Nancy Kassebaum]] (R-KS) and [[Ted Kennedy]] (D-MA) came together and created a bill called the Health Insurance Reform Act of 1995 or more commonly known as the Kassebaum-Kennedy Bill.<ref>{{Cite journal|last=Cade|first=Dozier C.|title=Book Review: Congressional Quarterly Almanac: 81st Congress, 2nd Session. Vol. VI.|url=http://dx.doi.org/10.1177/107769905102800313|journal=Journalism Quarterly|year=1951|volume=28|issue=3|pages=389–390|doi=10.1177/107769905102800313|s2cid=164443756|issn=0022-5533}}</ref> This bill was stalled despite making it out of the Senate. In the 1996 State of the Union address, Clinton pressed the issue, and it resulted in bipartisan cooperation.<ref name=":0" /> After much debate and negotiation, there was a shift in momentum once a compromise between Kennedy and [[United States House Committee on Ways and Means|Ways and Means Committee]] Chairman [[Bill Archer]] was accepted, after alterations were made of the original Kassebaum-Kennedy Bill.<ref>{{Cite web|title=The Health Insurance Portability and Accountability Act (HIPAA) {{!}} Colleaga|url=https://www.colleaga.org/article/health-insurance-portability-and-accountability-act-hipaa|access-date=2021-10-10|website=www.colleaga.org|archive-date=2021-10-10|archive-url=https://web.archive.org/web/20211010203324/https://www.colleaga.org/article/health-insurance-portability-and-accountability-act-hipaa|url-status=dead}}</ref> Soon after this, the bill was signed into law by President Clinton and was named the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

* {{USPL|104|191}}, {{USStat|110|1936}}
* {{USBill|104|hr|3103}}; H. Rept. 104–469, part 1; H. Rept. 104-736
* {{USBill|104|s|1028}}; {{USBill|104|s|1698}}; S. Rept. 104-156
* [[United States Department of Health and Human Services|HHS]] Security Standards, {{USCFR|45|160}}, {{USCFR|45|162}}, and {{USCFR|45|164}}
* HHS Standards for Privacy of Individually Identifiable Health Information, {{USCFR|45|160}} and {{USCFR|45|164}}

==References==
{{reflist|1=30em}}

==External links==
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* [http://www.ohii.ca.gov/calohi/PrivacySecurity/HIPAA.aspx California Office of HIPAA Implementation] {{Webarchive|url=https://web.archive.org/web/20121101095424/http://www.ohii.ca.gov/calohi/PrivacySecurity/HIPAA.aspx |date=2012-11-01 }} (CalOHI)
* [https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html "HIPAA"], Centers for Medicare and Medicaid Services (CMS)
* [https://digital.library.unt.edu/govdocs/crs/search/?q=hipaa&t=fulltext Congressional Research Service (CRS) reports regarding HIPAA], University of North Texas Libraries
* [http://www.gpo.gov/fdsys/search/pagedetails.action?granuleId=CRPT-104hrpt736&packageId=CRPT-104hrpt736 Full text of the Health Insurance Portability and Accountability Act (PDF/TXT)] U.S. Government Printing Office
* [https://www.hhs.gov/ocr/hipaa/ Office for Civil Rights page on HIPAA]

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{{DEFAULTSORT:Health Insurance Portability And Accountability Act}}
[[Category:Acts of the 104th United States Congress]]
[[Category:Data erasure]]
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