Use and Disclosure of Protected Health Information

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POLICY NO: 6057
EFFECTIVE DATE: 03/17/03
REVISED DATES: 02/04/2010, 05/29/2013
LAST REVIEWED DATE: 05/29/2013

Basis for Policy

To establish guidelines for the use and disclousre of protected health information (PHI) in accordance with HIPAA. (45 CFR 164.502)

Policy

The University of Nebraska Medical Center (UNMC) shall use and disclose protected health information (PHI) in accordance with HEalth Insurance Portability and Accountability Act of 1996 (HIPAA) requirements and Executive Memorandum No. 27.

Definitions


Treatment means the provision, coordination of management of healthcare and related services by one or more healthcare providers, including the coordination or management of healthcare by a healthcare provider with a third party; consultation between healthcare providers relating to a patient; or the referral of a patient for healthcare from one healthcare provider to another.

Payment means activities undertaken by a healthcare provider or health plan to obtain reimbursement for the provision of healthcare. Activities include determinations of insurance coverage, premiums, provision of benefits under a health plan, adjudication of health benefit claims, billing, collection activities, claims management, medical data processing, medical necessity determinations, utilization review activities including pre-certification and pre-authorization, disclosure to consumer reporting agencies related to collection of premiums or reimbursement, and healthcare data processing related to the above listed activities

Healthcare operations means the following activities related to UNMC’s function as an affiliated healthcare provider and sponsor of a self-insured health plan:

  1. Quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of any studies resulting from such activities; otherwise these activities may be classified as research if PHI is included
  2. Population-based activities relating to improving health or reducing health care costs
  3. Protocol development
  4. Contacting of health care providers and patients with information about treatment alternatives
  5. Case management and care coordination
  6. Risk assessment
  7. Reviewing the competence or qualifications and accrediting/licensing of healthcare providers and plans
  8. Training future healthcare professionals (students and residents)
  9. Conducting or arranging for legal services
  10. Business planning and development
  11. Business management activities
  12. General administrative and business functions
  13. Conducting or arranging for medical review and auditing services
  14. Insurance activities relating to the renewal of a contract of insurance
  15. Evaluating healthcare provider and plan performance
  16. Resolution of internal grievances
  17. Fundraising

Protected Health Information (PHI) is individually identifiable health information. Individually identifiable health information is a subset of health information including demographic information, collected from an individual, whether oral or recorded in any medium that

  1. Is created or received by ACE; and
  2. Relates to the past, present, or future physical or mental health or condition of an individual; the provision of healthcare to an individual; or the past, present, or future payment for the provision of healthcare to an individual.

Protected Health Information includes genetic information containing individual identifiers which are defined as:

  1. Information about an individual's gentic tests; or
  2. The genetic tests of family members of the individual; or
  3. The manifestation of a disease or disorder in family members of such individual (i.e., family medical history)

Protected health information excludes individually identifiable health information of a person who has been deceased for more than fifty (50) years.

Protected health information excludes education records covered by the Family Educational Rights and Privacy Act (FERPA), and employment records held by UNMC in its role as employer.

Affiliated Covered Entity (ACE) means University of Nebraska Medical Center, The Nebraska Medical Center, UNMC Physicians, University Dental Associates, Bellevue Medical Center and The Nebraska Pediatric Practice Plan as one covered entity for the purpose of sharing PHI under HIPAA.

Individual means the person who is the subject of the protected health information. Personal representatives of the individual have the same rights as the individuals under HIPAA. Personal representatives include the legal guardian and anyone else authorized by law to act on behalf of the individual.

Marketing means to make a communication about a product or service that encourages recipients of the communication to purchase or use the product or service. See Use and Disclosure of PHI for Marketing

Research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalized knowledge. Generalized knowledge is knowledge that can be applied to populations outside the population service by the ACE. See Use and Disclosure of PHI for Research

Sale of Protected Health Information means disclosure of protected health information by a covered entity or business associate, if applicable, where the covered entity or business associate directly or indirectly receives remuneration from or on behalf of the recipient of the protected health information in exchange for the protected health information. See Sale of Protected Health Information


Procedures




This page updated on Monday, February 16, 2004, by dkp.

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