HIPAA
Providing accurate
information on HIPAA Compliance is one of the areas Diversified
Benefit
Services excels
in. We are industry leaders in providing low cost
solutions to all of your
regulatory responsibilities. Both fully-insured and
self-insured plans have responsibilities
under HIPAA.
HIPAA's Impact on Employees
Under HIPAA, there are
two components of an employer the group health plan and the plan
sponsor. The group health plan is
directly regulated by HIPAA regulations. Employers, as plan
sponsors, will indirectly be subject to portions of HIPAA law.
HIPAA regulations may vary for your company depending on which
component wishes to receive PHI. The following scenarios
apply to Self-Insured plans receiving Summary Health Information
(SHI) and Protected Health Information (PHI).
The following guidelines are provided as
an information service only. This is not intended to serve
as legal counsel. Use the information below as a quick reference
only. To ensure your health plans are in compliance, call us
(DBS).
Group Health
Plans (Employees who administer on behalf of employer)
-
Refrain from interfering with employees exercising their
rights under the Privacy Rule
(e.g., requesting access to or a copy of their health
information, filing a privacy complaint).
-
Refrain from requiring any person to waive rights under the
Privacy Rule as a condition
of receiving payment, enrolling in a health plan or being
eligible for benefits.
-
Designate a Privacy Official who is responsible for the
development and implementation
of the group health plans policies and procedures; and who
is responsible for receiving complaints filed under the
Privacy Rule.
-
Establish policies and procedures
concerning PHI that comply with the Privacy Rule.
Train all members of the workforce on
the group health plans PHI policies and procedures.
Establish appropriate administrative, technical, and
physical safeguards to protect the
privacy of PHI from intentional or unintentional use or
disclosure.
Provide a process for individuals to make complaints
concerning the group health plans
policies and procedures, or its compliance with its policies
and procedures.
Establish and apply appropriate disciplinary measures
against members of its workforce
for violations of the group health plans policies and
procedures.
Provide Notice of Privacy Practices to
members of the group health plan.
Send agreements to business associates to ensure HIPAA
compliance dealing with PHI.
Plan Sponsors (Employers)
- Prior to any release of PHI to a plan sponsor, the plan
sponsor must provide certification
to the group health plan that
the plan documents have been amended to incorporate the
following provisions:
- Only disclose PHI as permitted by the plan documents or
as required by law;
- Not use or disclose the PHI for employment-related
actions or decisions, or in connection
with any other benefit or
employee benefit plan of the sponsor;
- Ensure "adequate separation" of records and employees is
established and maintained
between the group health plan
and the plan sponsor;
- Ensure agents and subcontractors (e.g., benefits
consultants) agree to abide by the same
restrictions and conditions as
the plan sponsor in regard tot he use of PHI received from
the group health plan;
- Report any improper use or disclosure of PHI to the
group health plan;
- Allow individuals to inspect and obtain copies of PHI
about themselves;
- Allow individuals to request to amend PHI about
themselves;
- Provide individuals with an accounting of disclosures of
PHI made within the six years prior
to the request for such
accounting;
- Return or destroy PHI provided by the group health plan
that is still maintained by the plan
sponsor when no longer needed
for purpose the disclosure was made. If not feasible,
then
limit the use and disclosure
to those purposes; and
- Make its internal practices, books and records relating
to the use and disclosure of PHI
available to the Department of
Health and Human Services (HHS) for purposes of auditing the
group health plans compliance with the Privacy Rule.
Providing unparalleled Low Cost
HIPAA Solutions and Value to our clientele is our main goal
here. We look forward to working with you on all your needs and
questions. In short, we are here to help! Contact us today for
more information on these and other topics as they relate to
HIPAA.
