Metropolitan Boston Emergency Medical Service Council

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HIPAA Compliance

Beginning on April 14, 2003, ambulance service providers will be required to provide notice of their privacy practices to patients. The following information and document links provides information that you can use to provide patients with the privacy practices of your operation and, if necessary, to obtain their signature acknowledging that they have reviewed the notice. These documents will meet the privacy notice requirements of HIPAA.

For non-emergency trips, privacy notices must be given to patients. The provider must make a good faith attempt to obtain a signed acknowledgement from the patient, and if unable to do so, the provider must keep a written record of the attempt and the reason why the acknowledgement was not obtained (e.g., patient was unconscious or in an agitated mental state).

In emergency situations, the provider is required to provide notice to the individual as soon as practicable after the patient is stable. The requirement for making a good faith effort to obtain a written acknowledgement does not apply in emergency situations. In an emergency situation, you need only keep a record of how the privacy notice was given to the individual. It may be practical in your operation to have an arrangement with the hospital to have the notice given to the patient as part of the facility's HIPAA privacy notice requirements.

Page, Wolfberg & Wirth, LLC

Final Modifications to the HIPAA Privacy Rule
Ambulance Industry Overview
August 12, 2002

The Department of Health and Human Services (DHHS) has released the final modifications to the HIPAA Privacy Rule. This means that the regulations are now completed and in place for the April 14, 2003 compliance deadline. The final regulations contain many significant changes. Although the final regulations contain many positive changes for the ambulance industry, HIPAA compliance will continue to be a multi-faceted challenge for ambulance services.

The April 14, 2003 compliance deadline remains in place, and ambulance services are still included as “covered entities” under the Privacy Rule

Some of the most significant changes to the regulations include:

Consent. The most significant changes to the Privacy Rule affecting ambulance services are those dealing with consent. Ambulance services and other covered entities will no longer be required to obtain signed consent forms to use a patient’s Protected Health Information (PHI) for purposes of treatment, payment or health care operations. Consent forms will be optional under the final regulations.

Disclosure for Treatment, Payment, or Health Care Operations of Another Entity. One of the most significant, positive changes for the ambulance industry is that covered entities can disclose protected health information for the treatment and payment activities of another covered entity or a health care provider, and for certain health care operations of another entity. This means that hospitals will be able to give “face sheets” and other patient information to ambulance services for billing purposes without HIPAA barriers.

Notice. The Rule requires ambulance services and other covered entities to provide patients with notice of the patient's privacy rights and the privacy practices of the covered entity. While the consent requirement has been relaxed, the notice requirement has been considerably strengthened, and now requires ambulance services and other covered entities to make a good faith effort to obtain patient's written acknowledgement of the notice of privacy rights and practices. There are exceptions that apply in emergency situations, but the general rule is that providers must obtain written acknowledgment of the patient’s receipt of the Notice of Privacy Practices.

Incidental Use and Disclosure. The final Rule acknowledges that uses or disclosures that are incidental to an otherwise permitted use or disclosure may occur. Such incidental uses or disclosures are not considered a violation of the Rule provided that the covered entity has met the reasonable safeguards and minimum necessary requirements. For example, if these requirements are met, hospitals may keep patient charts at bedside and providers can have discussions about the patient’s care without fear of violating the rule if overheard by a passerby.

Marketing. The final Rule requires a covered entity to obtain an individual's prior written authorization to use his or her protected health information for marketing purposes except for a face-to-face encounter or a communication involving a promotional gift of nominal value. The final Rule defines marketing to distinguish between the types of communications that are and are not marketing, and makes clear that a covered entity is prohibited from selling lists of patients and enrollees to third parties or from disclosing protected health information to a third party for the marketing activities of the third party, without the individual's authorization. The Rule also clarifies that covered entities communicating with patients about the covered entity's own health-related products and services are not considered marketing.

Authorization. The final Rule clarifies the authorization requirements to, among other things, eliminate separate authorization requirements for covered entities. Patients will have to grant permission in advance for each type of non-routine use or disclosure, but providers will not have to use different types of forms. These modifications also consolidate and streamline core elements and notification requirements.

Minimum Necessary. The final Rule exempts from the minimum necessary standards any uses or disclosures for which the covered entity has received an authorization. The Rule previously exempted only certain types of authorizations from the minimum necessary requirement, but since the rule will only have one type of authorization, the exemption is now applied to all authorizations. Minimum necessary requirements are still in effect to ensure an individual's privacy for most other uses and disclosures.

Parents and Minors. The final Rule clarifies that state law, or other applicable law, governs in the area of parents and minors. Generally, the Privacy Rule provides parents with new rights to control the health information about their minor children, with limited exceptions that are based on state or other applicable law and professional practice. For example, where a state has explicitly addressed disclosure of a minor's health information to a parent, or access to a child's medical record by a parent, the final Rule clarifies that state law governs. In addition, the final Rule clarifies that, in the special cases in which the minor controls his or her own health information under such law and that law does not define the parents' ability to access the child's health information a licensed health care provider continues to be able to exercise discretion to grant or deny such access as long as that decision is consistent with the state or other applicable law.

Business Associates. The final Rule gives ambulance services and other providers up to an additional year to change existing written contracts to come into compliance with the business associate requirements. However, if any of your contracts with existing business associates come up for renewal between April 14, 2003 and April 14, 2004, you will have to include the business associate provisions in the contract at the time of the renewal.

Accounting of Disclosures. The final Rule exempts disclosures made pursuant to an authorization from the accounting requirements.

Protected Health Information: Exclusion for Employment Records. The final Rule clarifies that employment records maintained by a covered entity in its capacity as an employer are excluded from the definition of protected health information. The modifications do not change the fact that individually identifiable health information created, received, or maintained by a covered entity in its health care capacity is protected health information.

Other Resources

Sample Privacy Notice (PDF)

Sample Authorization Form (PDF)

HIPPA Covered/Uncovered Decision Tree (PDF)

Sample Business Associate Agreement (PDF)

Department of Health and Human Services