Difference between revisions of "LII:HIPAA Compliance - LII 007 04. Use and Disclosure"

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If a CE accepts an amendment request, it must make reasonable efforts to provide the amendment to persons that the individual has identified as needing it, as well as to persons that the CE knows might rely on the information to the individual’s detriment. If the request is denied, CEs must provide the individual with a written denial and allow the individual to submit a statement of disagreement for inclusion in the record. The Rule specifies processes for requesting and responding to a request for amendment. Additionally, if a CE receives notice to amend from another CE, it must amend PHI in its designated record set upon receipt.
If a CE accepts an amendment request, it must make reasonable efforts to provide the amendment to persons that the individual has identified as needing it, as well as to persons that the CE knows might rely on the information to the individual’s detriment. If the request is denied, CEs must provide the individual with a written denial and allow the individual to submit a statement of disagreement for inclusion in the record. The Rule specifies processes for requesting and responding to a request for amendment. Additionally, if a CE receives notice to amend from another CE, it must amend PHI in its designated record set upon receipt.
====Disclosure Accounting====
Under HIPAA, individuals have a right to an accounting of the disclosures of their PHI by a CE or the CE’s business associates. The maximum disclosure accounting period is the six years immediately preceding the accounting request. However, a CE is not obligated to account for any disclosure made before its Privacy Rule compliance date.
The Privacy Rule does not require accounting for disclosures: (a) for treatment, payment, or health care operations; (b) to the individual or the individual’s personal representative; (c) for notification of or to persons involved in an individual’s health care or payment for health care, for disaster relief, or for facility directories; (d) pursuant to an authorization; (e) of a limited data set; (f) for national security or intelligence purposes; (g) to correctional institutions or law enforcement officials for certain purposes regarding inmates or individuals in lawful custody; or (h) incident to otherwise permitted or required uses or disclosures. Accounting for disclosures to health oversight agencies and law enforcement officials must be temporarily suspended on their written representation that an accounting would likely impede their activities.
Restriction Request. Individuals have the right to request that a covered entity restrict use or disclosure of protected health information for treatment, payment or health care operations, disclosure to persons involved in the individual’s health care or payment for health care, or disclosure to notify family members or others about the individual’s general condition, location, or death.61 A covered entity is under no obligation to agree to requests for restrictions. A covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.62
Confidential Communications Requirements. Health plans and covered health care providers must permit individuals to request an alternative means or location for receiving communications of protected health information by means other than those that the covered entity typically employs.63 For example, an individual may request that the provider communicate with the individual through a designated address or phone number. Similarly, an individual may request that the provider send communications in a closed envelope rather than a post card.
Health plans must accommodate reasonable requests if the individual indicates that the disclosure of all or part of the protected health information could endanger the individual. The health plan may not question the individual’s statement of
endangerment. Any covered entity may condition compliance with a confidential communication request on the individual specifying an alternative address or method of contact and explaining how any payment will be handled.
   
   
===Personal Representatives and Minors===
===Personal Representatives and Minors===

Revision as of 19:52, 10 June 2016

Now that we understand a) what HIPAA is, b) who it applies to and c) what information is protected, it's time to look at exactly how PHI can and cannot be used.

Permitted Uses and Disclosures

A covered entity ("CE") is permitted - but not required - to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations:

  1. To the Individual who is the subject of the information - unless required for access or accounting of disclosures
  2. Treatment, Payment, and Healthcare Operations
  3. Opportunity to Agree or Object
  4. Incident to an otherwise permitted use and disclosure
  5. Public Interest and Benefit Activities
  6. Limited Data Set for the purposes of research, public health or healthcare operations. Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make.[1]

Treatment, Payment, Healthcare Operations

A CE may use and disclose PHI for its own use in treatment, payment, and healthcare operations activities. A covered entity also may disclose protected health information for the treatment activities of any healthcare provider, the payment activities of another covered entity and of any healthcare provider, or the healthcare operations of another covered entity involving either quality or competency assurance activities or fraud and abuse detection and compliance activities, if both covered entities have or had a relationship with the individual and the protected health information pertains to the relationship. See additional guidance on Treatment, Payment, & Healthcare Operations.


  • Treatment is the provision, coordination, or management of healthcare and related services for an individual by one or more healthcare providers, including consultation between providers regarding a patient and referral of a patient by one provider to another.


  • Payment encompasses activities of a health plan to obtain premiums, determine or fulfill responsibilities for coverage and provision of benefits, and furnish or obtain reimbursement for healthcare delivered to an individual and activities of a healthcare provider to obtain payment or be reimbursed for the provision of healthcare to an individual.


  • Healthcare operations are any of the following activities: (a) quality assessment and improvement activities, including case management and care coordination; (b) competency assurance activities, including provider or health plan performance evaluation, credentialing, and accreditation; (c) conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; (d) specified insurance functions, such as underwriting, risk rating, and reinsuring risk; (e) business planning, development, management, and administration; and (f) business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the covered entity.

Most uses and disclosures of psychotherapy notes for treatment, payment, and healthcare operations purposes require an authorization as described below. Obtaining “consent” (written permission from individuals to use and disclose their protected health information for treatment, payment, and healthcare operations) is optional under the Privacy Rule for all covered entities.24 The content of a consent form, and the process for obtaining consent, are at the discretion of the covered entity electing to seek consent.

Uses and Disclosures with Opportunity to Agree or Object

Informal permission may be obtained by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object. Where the individual is incapacitated, in an emergency situation, or not available, covered entities generally may make such uses and disclosures, if in the exercise of their professional judgment, the use or disclosure is determined to be in the best interests of the individual.

  • Facility Directories It is a common practice in many healthcare facilities, such as hospitals, to maintain a directory of patient contact information. A covered healthcare provider may rely on an individual’s informal permission to list in its facility directory the individual’s name, general condition, religious affiliation, and location in the provider’s facility. The provider may then disclose the individual’s condition and location in the facility to anyone asking for the individual by name, and also may disclose religious affiliation to clergy. Members of the clergy are not required to ask for the individual by name when inquiring about patient religious affiliation.
  • For Notification and Other Purposes A covered entity also may rely on an individual’s informal permission to disclose to the individual’s family, relatives, or friends, or to other persons whom the individual identifies, protected health information directly relevant to that person’s involvement in the individual’s care or payment for care. 26 This provision, for example, allows a pharmacist to dispense filled prescriptions to a person acting on behalf of the patient. Similarly, a covered entity may rely on an individual’s informal permission to use or disclose protected health information for the purpose of notifying (including identifying or locating) family members, personal representatives, or others responsible for the individual’s care of the individual’s location, general condition, or death. In addition, protected health information may be disclosed for notification purposes to public or private entities authorized by law or charter to assist in disaster relief efforts.

Incidental Use and Disclosure

The Privacy Rule does not require that every risk of an incidental use or disclosure of protected health information be eliminated. A use or disclosure of this information that occurs as a result of, or as “incident to,” an otherwise permitted use or disclosure is permitted as long as the covered entity has adopted reasonable safeguards as required by the Privacy Rule, and the information being shared was limited to the “minimum necessary,” as required by the Privacy Rule.

Public Interest and Benefit Activities

The Privacy Rule permits use and disclosure of protected health information, without an individual’s authorization or permission, for 12 national priority purposes. These disclosures are permitted, although not required, by the Rule in recognition of the important uses made of health information outside of the healthcare context. Specific conditions or limitations apply to each public interest purpose, striking the balance between the individual privacy interest and the public interest need for this information.

  • Required by Law Covered entities may use and disclose protected health information without individual authorization as required by law (including by statute, regulation, or court orders).
  • Public Health Activities Covered entities may disclose protected health information to: (1) public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect; (2) entities subject to FDA regulation regarding FDA regulated products or activities for purposes such as adverse event reporting, tracking of products, product recalls, and post-marketing surveillance; (3) individuals who may have contracted or been exposed to a communicable disease when notification is authorized by law; and (4) employers, regarding employees, when requested by employers, for information concerning a work-related illness or injury or workplace related medical surveillance, because such information is needed by the employer to comply with the Occupational Safety and Health Administration (OHSA), the Mine Safety and Health Administration (MHSA), or similar state law. See additional guidance on Public Health Activities and CDC's web pages on Public Health and HIPAA Guidance.
  • Victims of Abuse, Neglect or Domestic Violence In certain circumstances, covered entities may disclose protected health information to appropriate government authorities regarding victims of abuse, neglect, or domestic violence.
  • Health Oversight Activities Covered entities may disclose protected health information to health oversight agencies (as defined in the Rule) for purposes of legally authorized health oversight activities, such as audits and investigations necessary for oversight of the healthcare system and government benefit programs.
  • Judicial and Administrative Proceedings Covered entities may disclose protected health information in a judicial or administrative proceeding if the request for the information is through an order from a court or administrative tribunal. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided.
  • Law Enforcement Purposes Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions:
  1. As required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests
  2. To identify or locate a suspect, fugitive, material witness, or missing person
  3. In response to a law enforcement official’s request for information about a victim or suspected victim of a crime
  4. To alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death
  5. When a covered entity believes that protected health information is evidence of a crime that occurred on its premises
  6. By a covered healthcare provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime
  • Decedents Covered entities may disclose protected health information to funeral directors as needed, and to coroners or medical examiners to identify a deceased person, determine the cause of death, and perform other functions authorized by law.
  • Cadaveric Organ, Eye, or Tissue Donation CEs may use or disclose PHI to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue
  • Research “Research” is defined as any systematic investigation designed to develop or contribute to generalizable knowledge.

The Privacy Rule permits a covered entity to use and disclose protected health information for research purposes, without an individual’s authorization, provided the covered entity obtains either:

  1. Documentation that an alteration or waiver of individuals’ authorization for the use or disclosure of PHI about them for research purposes has been approved by an Institutional Review Board or Privacy Board
  2. Representations from the researcher that the use or disclosure of the PHI:
    1. Is solely to prepare a research protocol or for similar purpose preparatory to research
    2. That the researcher will not remove any PHI from the covered entity, and
    3. The PHI for which access is sought is necessary for the research

...OR

  1. Representations from the researcher that the use or disclosure sought is solely for research on the PHI of decedents, that the PHI sought is necessary for the research, and, at the request of the CE, documentation of the death of the individuals about whom information is sought.

A CE also may use or disclose, without an individuals’ authorization, a limited data set of PHI for research purposes (see discussion below).

  • Serious Threat to Health or Safety Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat). Covered entities may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.
  • Essential Government Functions An authorization is not required to use or disclose protected health information for certain essential government functions. Such functions include: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.
  • Workers’ Compensation Covered entities may disclose protected health information as authorized by, and to comply with, workers’ compensation laws and other similar programs providing benefits for work-related injuries or illnesses.42 See additional guidance on Workers’ Compensation.

Limited Data Set

A limited data set is PHI from which certain specified direct identifiers of individuals and their relatives, household members, and employers have been removed. A limited data set may be used and disclosed for research, healthcare operations, and public health purposes, provided the recipient enters into a data use agreement promising specified safeguards for the PHI within the limited data set.

The "certain specified direct identifiers" that must be removed are almost all of the 18 PHI identifiers as listed in Lesson 3 (LII 007 03. What Data Are Protected & General Privacy Principle), but not exactly. They are:

  1. Name
  2. Postal address information, other than town or city, State and zip code (in other words, remove the street address)
  3. Telephone numbers
  4. Fax numbers
  5. Electronic mail (email) addresses
  6. Social security numbers
  7. Medical record numbers (MRN)
  8. Health plan beneficiary numbers
  9. Account numbers
  10. Certificate/license numbers
  11. Vehicle identifiers and serial numbers, including license plate numbers
  12. Device identifiers and serial numbers (medical devices, cell phones, tablets, laptops etc.)
  13. Web Universal Resource Locators (URLs)
  14. Internet Protocol (IP) address numbers
  15. Biometric identifiers, including finger and voice prints
  16. Full face photographic images and any comparable images[2]

Authorized Use & Disclosure

There are three instances where use/disclosure of PHI is always authorized - with certain conditions. Those instances are:

1. Authorization by the Individual. A CE must obtain the individual’s written authorization for any use or disclosure of their PHI that is not for treatment, payment or healthcare operations or otherwise permitted or required by the Privacy Rule. It's also important to note that you cannot make authorization a condition of providing treatment, payment, enrollment or benefits eligibility (except in limited circumstances).

An authorization must be written in specific terms. It may allow use and disclosure of PHI by the CE, or by a third party. Examples of disclosures that would require an individual’s authorization include:

  • Disclosures to a life insurer for coverage purposes
  • Disclosures to an employer of the results of a pre-employment physical or lab test
  • Disclosures to a pharmaceutical firm for their own marketing purposes

All authorizations must be in plain language, and contain specific information regarding:

  • The information to be disclosed or used
  • The person(s) disclosing and receiving the information
  • Expiration
  • Right to revoke in writing, and other data

The Privacy Rule also contains transition provisions applicable to authorizations and other express legal permissions obtained prior to April 14, 2003.[2]

2. Psychotherapy Notes. Using or disclosing PHI is prohibited without the individual's authorization, except in the following cases:

  • The CE who created the notes is allowed to use them for treatment
  • Where the CE needs to use them for one or more of the following:
    • For its own training
    • To defend itself in legal proceedings brought by the individual
    • For HHS to investigate or determine the CE’s compliance with the Privacy Rules
    • To avert a serious and imminent threat to public health or safety
    • To provide to a health oversight agency for lawful oversight of the originator of the psychotherapy notes
    • For the lawful activities of a coroner or medical examiner or as required by law[2]

3. Marketing. HIPAA defines Marketing as "any communication about a product or service that encourages recipients to purchase or use the product or service.[2] The Privacy Rule identifies some health-related activities based on this definition of marketing:

  • Communications to describe health-related products or services, or payment for them, provided by or included in a benefit plan of the covered entity making the communication
  • Communications about participating providers in a provider or health plan network, replacement of or enhancements to a health plan, and health-related products or services available only to a health plan’s enrollees that add value to, but are not part of, the benefits plan
  • Communications for treatment of the individual
  • Communications for case management or care coordination for the individual, or to direct or recommend alternative treatments, therapies, healthcare providers or care settings to the individual

Marketing also is an arrangement between a CE and any other entity whereby the CE discloses PHI in exchange for direct or indirect remuneration, for the other entity to communicate about its own products or services encouraging the use or purchase of those products or services (so marketing...). A CE has to obtain an authorization to use or disclose PHI for marketing, except for face-to-face marketing communications between the CE and an individual, and for a CE’s provision of promotional gifts of nominal value.

No authorization is needed, however, to make a communication that falls within one of the exceptions to the marketing definition. An authorization for marketing that involves the CE’s receipt of direct or indirect remuneration from a third party must reveal that fact.[1]

Limiting

In use and disclosure, even when authorized, it's always important to keep certain conditions and principles in mind. One main concept to always consider is that of always releasing the Minimum Necessary information, to as few parties as possible, in as few cases as possible. That principle and others are described below:

Minimum Necessary

Basically, HIPAA says that in any case of authorized disclosure, the amount of PHI shared must be the minimum necessary. A CE must make reasonable efforts to use, disclose, and request only the minimum amount of PHI needed to accomplish the intended purpose of the use, disclosure, or request. They must also develop and implement policies and procedures to reasonably limit uses and disclosures to the minimum necessary. When the minimum necessary standard applies to a use or disclosure, a CE may not use, disclose, or request the entire medical record for a particular purpose, unless it can specifically justify the whole record as the amount reasonably needed for the purpose.

Like most rules, there are exceptions to this principle. They are:

  1. Disclosure to or a request by a healthcare provider for treatment
  2. Disclosure to an individual who is the subject of the information, or the individual’s personal representative
  3. Use or disclosure made pursuant to an authorization
  4. Disclosure to HHS for complaint investigation, compliance review or enforcement
  5. Use or disclosure that is required by law
  6. Use or disclosure required for compliance with the HIPAA Transactions Rule or other HIPAA Administrative Simplification Rules

Restrict and Control Access and Uses

The tenets of HIPAA, unlike what might be said of many laws, are almost without exception common sense and reasonable measures aimed at protecting people's personally identifiable information. Thus, the idea of restricting and controlling access to that information joins the Minimum Use principle as a sensible idea.

For internal uses, a CE must develop and implement policies and procedures that restrict access and uses of PHI based on the specific roles of the members of their workforce. These policies and procedures must identify the persons, or classes of persons, in the workforce who need access to PHI to carry out their duties, the categories of PHI to which access is needed, and any conditions under which they need the information to do their jobs.

Disclosures and Requests for Disclosures

CEs are required to establish and implement policies and procedures for routine, recurring disclosures or requests for disclosures, so that PHI disclosure meets the "minimum amount reasonably necessary" measurement to achieve the purpose of the disclosure. It can be a policy, so individual review of each disclosure is not required. However, for non-routine, non-recurring disclosures or requests for disclosures that it makes, CEs must develop criteria designed to do the same thing, but with a review of each request individually in accordance with the established criteria.

Reasonable Reliance on Another CE's Compliance

HIPAA allows you to make the reasonable assumption that a request from another CE is in compliance with disclosure rules and principles:

"If another covered entity makes a request for protected health information, a covered entity may rely, if reasonable under the circumstances, on the request as complying with this minimum necessary standard. Similarly, a covered entity may rely upon requests as being the minimum necessary protected health information from: (a) a public official, (b) a professional (such as an attorney or accountant) who is the covered entity’s business associate, seeking the information to provide services to or for the covered entity; or (c) a researcher who provides the documentation or representation required by the Privacy Rule for research."[1]

Patient Notification and Rights

CEs are required by HIPAA to provide information about how they handle a patient's PHI, and to allow access and the ability to update or amend it. Here are the specifics:

Privacy Practices Notice

Each CE, with certain exceptions, must provide a notice of its privacy practices. The Privacy Rule requires that the notice contain certain elements. The notice must:

  • Describe the ways in which the covered entity may use and disclose PHI
  • State the CE’s duties to protect privacy, provide a notice of privacy practices, and abide by the terms of the current notice
  • Describe individuals’ rights, including the right to complain to HHS and to the CE if they believe their privacy rights have been violated
  • Include a point of contact for further information and for making complaints to the CE.

CEs must act in accordance with their notices. The Rule also contains specific distribution requirements for direct treatment providers, all other healthcare providers and health plans. That information is available - along with many other resources and additional information, on the HHS site (http://hhs.gov/hipaa).

Notice Distribution

A covered healthcare provider with a direct treatment relationship with individuals must have delivered a privacy practices notice to patients as follows:

  • Not later than the first service encounter by personal delivery (for patient visits)
  • By automatic and contemporaneous electronic response (for electronic service delivery), and by prompt mailing (for telephonic service delivery)
  • By posting the notice at each service delivery site in a clear and prominent place where people seeking service may reasonably be expected to be able to read the notice
  • In emergency treatment situations, the provider must furnish its notice as soon as practicable after the emergency abates

CEs, whether direct treatment providers or indirect treatment providers (such as laboratories) or health plans also must supply notice to anyone upon request. A CE must also make its notice electronically available on any website it maintains for customer service or benefits information.

The CEs in an organized healthcare arrangement ("OHCA") may use a joint privacy practices notice, as long as each agrees to abide by the notice content with respect to the PHI created or received in connection with the arrangement. Distribution of a joint notice by any CE participating in the OHCA at the first point that an OHCA member has an obligation to provide notice satisfies the distribution obligation of the other participants in the OHCA.

A health plan must distribute its privacy practices notice to each of its enrollees by its Privacy Rule compliance date. Thereafter, the health plan must give its notice to each new enrollee at enrollment, and send a reminder to every enrollee at least once every three years that the notice is available upon request. A health plan satisfies its distribution obligation by furnishing the notice to the “named insured,” that is, the subscriber for coverage that also applies to spouses and dependents.

Acknowledgement of Notice Receipt

A covered healthcare provider with a direct treatment relationship with individuals must make a good faith effort to obtain written acknowledgement from patients of receipt of the privacy practices notice. The Privacy Rule does not prescribe any particular content for the acknowledgement. However, the provider must document the reason for any failure to obtain the patient’s written acknowledgement. The provider is relieved of the need to request acknowledgement in an emergency treatment situation.

Access

Patients have the right to review and obtain a copy of their PHI in a CE’s designated record set, with some exceptions. The “designated record set” is that group of records maintained by or for a CE that is used, in whole or part, to make decisions about individuals, or is a provider’s medical and billing records about individuals or a health plan’s enrollment, payment, claims adjudication, and case or medical management record systems.

The Rule excepts from the right of access the following PHI:

  • Psychotherapy notes
  • Information compiled for legal proceedings
  • Laboratory results to which the Clinical Laboratory Improvement Act (CLIA) prohibits access
  • Information held by certain research laboratories

For information included within the right of access, CEs may deny an individual access in certain specified situations, such as when a healthcare professional believes access could cause harm to the individual or another. In such situations, the individual must be given the right to have such denials reviewed by a licensed healthcare professional for a second opinion. CEs may impose reasonable, cost-based fees for the cost of copying and postage.

Amendment

The Rule gives individuals the right to have CEs amend their PHI in a designated record set when that information is inaccurate or incomplete.

If a CE accepts an amendment request, it must make reasonable efforts to provide the amendment to persons that the individual has identified as needing it, as well as to persons that the CE knows might rely on the information to the individual’s detriment. If the request is denied, CEs must provide the individual with a written denial and allow the individual to submit a statement of disagreement for inclusion in the record. The Rule specifies processes for requesting and responding to a request for amendment. Additionally, if a CE receives notice to amend from another CE, it must amend PHI in its designated record set upon receipt.

Disclosure Accounting

Under HIPAA, individuals have a right to an accounting of the disclosures of their PHI by a CE or the CE’s business associates. The maximum disclosure accounting period is the six years immediately preceding the accounting request. However, a CE is not obligated to account for any disclosure made before its Privacy Rule compliance date.

The Privacy Rule does not require accounting for disclosures: (a) for treatment, payment, or health care operations; (b) to the individual or the individual’s personal representative; (c) for notification of or to persons involved in an individual’s health care or payment for health care, for disaster relief, or for facility directories; (d) pursuant to an authorization; (e) of a limited data set; (f) for national security or intelligence purposes; (g) to correctional institutions or law enforcement officials for certain purposes regarding inmates or individuals in lawful custody; or (h) incident to otherwise permitted or required uses or disclosures. Accounting for disclosures to health oversight agencies and law enforcement officials must be temporarily suspended on their written representation that an accounting would likely impede their activities.

Restriction Request. Individuals have the right to request that a covered entity restrict use or disclosure of protected health information for treatment, payment or health care operations, disclosure to persons involved in the individual’s health care or payment for health care, or disclosure to notify family members or others about the individual’s general condition, location, or death.61 A covered entity is under no obligation to agree to requests for restrictions. A covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.62

Confidential Communications Requirements. Health plans and covered health care providers must permit individuals to request an alternative means or location for receiving communications of protected health information by means other than those that the covered entity typically employs.63 For example, an individual may request that the provider communicate with the individual through a designated address or phone number. Similarly, an individual may request that the provider send communications in a closed envelope rather than a post card.

Health plans must accommodate reasonable requests if the individual indicates that the disclosure of all or part of the protected health information could endanger the individual. The health plan may not question the individual’s statement of endangerment. Any covered entity may condition compliance with a confidential communication request on the individual specifying an alternative address or method of contact and explaining how any payment will be handled.

Personal Representatives and Minors

[1]

References