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香港六合彩

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道是烦乱的心事困扰着香港六合彩,让香港六合彩一直睡不着,不解开那些心结,香港六合彩会一直失眠下去。可那些心结怎么可能解得开呢?你还是杀了我吧!

倒了杯牛奶给地,度一舟希望这对香港六合彩有帮助。

愿意跟我说说吗?香港六合彩这么大的女生会失眠无外乎家庭出现突然变故,课业太过紧张和感情问题。前两者以公主的个性会找人倾吐,失眠的可能性不大,惟有最后一种情况比较可能,在众多可能的情况中,香港六合彩的外甥——度天涯又是最大的可能。

不用说了,失眠的症结就是度天涯那个绝美的王储殿下。除了香港六合彩,还有谁有这么大的魅力?简直是害人不浅!

跟天涯吵架了?

没有!我怎么会跟香港六合彩吵架呢?香港六合彩俩之间什么关系都没有,我才不会为了香港六合彩而失眠呢!

公主急急的辩解变相地交代了一切,度一舟心中了然。香港六合彩开始庆幸自己学的是临床,连心理医生的功课也一起攻克了,学得多果然还是有用处的,这不就派上用场了嘛!

公主,香港六合彩坐下来,不是为了体现亲切感,而是失眠的后遗症让香港六合彩也有点儿飘。有些男人不会把香港六合彩的在意、香港六合彩的真心放在脸上,那些东西得你自己一点儿一点儿去体味。

你就是这样的男人?

……

不光是度一舟,连公主都倒抽一口凉气。两个人以坐着的高度直视过去,首先目睹的是火曦修长的腿,再向上攀升,宽大的衬衫遮住了极限诱惑——地根本什么也没穿,套了件衬衫,还是度一舟的衬衫就跑了下来。

大清早的,这叫什么事?

度一舟扶扶眼镜,香港六合彩要求自己保持

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香港六合彩

  1. 1. 1 Eighth National HIPAA Summit Baltimore, MD PreConference I: HIPAA Boot Camp: The Basics of HIPAA for Providers, Health Plans, Employers and Patients Employer and Group Health Plan Issues By Gerald E. DeLoss, Esquire Barnwell Whaley Patterson & Helms, LLC Charleston, South Carolina
  2. 2. 2 HIPAA and Employers • Only Certain Health Care Providers, Health Plans, and Health Care Clearinghouses Are Covered Entities • Employers Not Generally Covered Unless Fall Under Above Definitions • Caveat: Medical Information Provided to Employers and Employer Sponsored Group Health Plans
  3. 3. 3 Employment Records and PHI • Definition of Protected Health Information (“PHI”) Specifically Excludes: – Employment Records Held by a Covered Entity in its Role as Employer • 45 C.F.R. § 165.501 • Example: Drug Testing or Fitness for Duty – Must be Provided to CE in Capacity as Employer – If Conducting Testing, Must Get Authorization to Transmit to HR • Example: Professional Sports Teams’ Player Information
  4. 4. 4 Employer Issues • Covered Entity May Disclose to an Employer About an Employee or Workforce Member of Employer, If: – Covered Entity is a Covered Health Care Provider Who is a Member of the Employer’s Workforce or Who Provides Health Care to Employee or Member At Request of Employer to • Conduct Evaluation Relating to Medical Surveillance of Workplace; or • Evaluate Whether the Employee or Member Has a Work- Related Illness or Injury – 45 C.F.R. § 164.512(b)(v)
  5. 5. 5 Employer Issues • The PHI Disclosed Concerns a Work-Related Illness or Injury or Work-Related Medical Surveillance; or • The Employer Needs Findings for OSHA Requirements; and • Notice is Provided to Employee or Member – By Giving a Copy of Notice of Privacy Practices, or – Posting of Notice if in Same Worksite • 45 C.F.R. § 164.512(b)(v)
  6. 6. 6 Group Health Plan • Definition of Health Plan Includes: – Employee Welfare Benefit Plan or any Other Arrangement that is Established or Maintained for the Purpose of Offering or Providing Health Benefits to the Employees of Two or More Employers •45 C.F.R. § 160.103
  7. 7. 7 Group Health Plan Group Health Plan • Means an Employee Welfare Benefit Plan (as Defined Under ERISA), Including Insured and Self-Insured Plans to Extent the Plan Provides Medical Care to Employees or Their Dependents, Directly or Through Insurance, That: – Has 50 or More Participants; or – Is Administered by a Third Party • 45 C.F.R. § 160.103
  8. 8. 8 Third Party Administrators • Third Party Administrator Not Generally a Covered Entity Under HIPAA – Most Likely Considered a Business Associate of Group Health Plan • DHHS FAQ No. 365
  9. 9. 9 Group Health Plan • Plan Sponsor means: – The Employer if a Single Employer; – The Employee Organization; – Where Two or More Employers or Employee Organizations, the Association, Committee, Joint Board, or Other Similar Representatives Who Establish or Maintain the Plan • 29 U.S.C. § 1002(16)(B)
  10. 10. 10 Group Health Plan as Small Health Plan • Many Group Health Plans Fall Under Definition of Small Health Plan – Means a Health Plan with Annual Receipts of $5 Million or Less • Small Health Plan Compliance Deadline is April 14, 2004 – 45 C.F.R. § 164.534(b)
  11. 11. 11 Group Health Plan – Flexible Spending Accounts/Cafeteria Plans • According to DHHS: – To the Extent That a Flexible Spending Account or a Cafeteria Plan Meets Definition of an Employee Welfare Benefit Plan Under ERISA and Pays for Medical Care, It Is a Group Health Plan – Unless It Has Fewer Than 50 Participants and Is Self-administered •DHHS FAQ No. 421
  12. 12. 12 Group Health Plan – Flexible Spending Accounts/Cafeteria Plans • FSA or Cafeteria Plan Could Be Considered Group Health Plan – Fully Insured or Self Insured? – Summary Health Information or PHI? – To Extent Qualifies, Must Satisfy Group Health Plan Requirements
  13. 13. 13 Group Health Plan • Business Associate Requirements – Generally Covered Entity may Only Disclose to a Business Associate PHI, or Allow Business Associate to Create or Receive PHI, if Agreement – Requirement Does Not Apply to Disclosures by a Group Health Plan or Insurer, to the Plan Sponsor if Other Requirements Met • 45 C.F.R. § 164.504(f)
  14. 14. 14 Disclosures for Group Health Plan • To Disclose PHI to Plan Sponsor or • To Permit Health Insurer or HMO to Disclose PHI to Plan Sponsor • Must Ensure Plan Documents Restrict Uses and Disclosures •45 C.F.R. § 164.504(f)(1)(i)
  15. 15. 15 Disclosures for Group Health Plan • Group Health Plan, Insurer, or HMO May Disclose Summary Health Information to Plan Sponsor for – Obtaining Premium Bids From Health Plans for Providing Health Insurance under Group Plan – Modifying, Amending, or Terminating the Group Health Plan • Group Health Plan or Insurer or HMO May Disclose Enrollment Information to Plan Sponsor • 45 C.F.R. § 164.504(f)(1)(ii), (iii)
  16. 16. 16 Disclosures for Group Health Plan • Summary Health Information – Summarizes Claims History, Claims Expenses, or Types of Claims Experienced by Individuals for Whom the Plan Sponsor Provided Benefits Under the Group Health Plan – Must Exclude Most Identifying Features, But Not Truly De-Identified • Geographic Information May be Aggregated to 5 digit Zip Code Level – 45 C.F.R. § 164.504(a)
  17. 17. 17 Disclosures for Group Health Plan • Amendment of Plan Documents – Permitted and Required Uses and Disclosures – Certification by Plan Sponsor: • Not Further Use or Disclose PHI • Subcontractors Comply • NOT Use or Disclose for Employment Decisions • Report Any Breach • Make PHI Available for Access, Amendment & Accounting • Make Records Available for Investigation • Return or Destroy PHI – 45 C.F.R. § 164.504(f)(2)(i), (ii)
  18. 18. 18 Disclosures for Group Health Plan • Adequate Separation Between Group Health Plan and Plan Sponsor – Plan Sponsor Employees Who Will Access – Only for Plan Administration Functions – Mechanism for Complaints/Noncompliance – 45 C.F.R. § 164.504(f)(2)(iii)
  19. 19. 19 Group Health Plan Uses and Disclosures • Group Health Plan May: – Disclose PHI to Plan Sponsor for Plan Administration Functions Consistent with Above – Not Permit an Insurer or HMO to Disclose PHI to Plan Sponsor Except as Provided Above – Not Disclose or Permit Insurer or HMO to Disclose PHI to Plan Sponsor Unless in Notice of Privacy Practices – Not Disclose PHI to Plan Sponsor for Employment Related Actions – 45 C.F.R. § 164.504(f)(3)
  20. 20. 20 Group Health Plan – Other Uses or Disclosures 45 C.F.R. § 164.506(a) • Use and Disclosure for Treatment, Payment, and Health Care Operations (“TPO”) – Covered Entity Generally May Use and Disclose PHI for TPO – No Consent – Now Notice of Privacy Practices – Treatment • Use or Disclose to Any Provider – Payment • Use or Disclose Minimum Necessary to Any Other
  21. 21. 21 Group Health Plan -- Other Uses or Disclosures 45 C.F.R. § 164.501 • Health Care Operations – Quality Assurance Activities • Quality Assessment and Guidelines, Case Mgmt. – Professional Competency Activities • Accreditation, Credentialing, Licensing – Insurance Activities • Underwriting, Premium Rating – Compliance Activities • Fraud and Abuse Compliance – Business Activities • Legal, Auditing, Business Planning, Sale of Practice
  22. 22. 22 Group Health Plan – Other Uses or Disclosures 45 C.F.R. § 164.514 • De-Identified Information – Not PHI – May Statistically Determine That PHI has Been De-Identified •Qualified Individual Offer Professional Conclusion •Mathematically Not Identifiable
  23. 23. 23 Group Health Plan – Other Uses or Disclosures • De-Identified Information Safe Harbor – Names – Geographic Subdivisions – Dates – Telephone Numbers – Facsimile Numbers – Email Address – Social Security Numbers – Medical Record Numbers – Health Plans Numbers
  24. 24. 24 Group Health Plan – Other Uses or Disclosures • De-Identified Information Safe Harbor – Account Numbers – License Numbers – Vehicle Identifiers – Device Identifiers – URLs – Internet Addresses – Biometric – Finger and Voice Prints – Facial Photographs – Etc.
  25. 25. 25 Authorization 45 C.F.R. § 164.508 • Elements – Meaningful Description of PHI – Identify Entities or Class Disclosing – Identify Entities or Class Receiving – Purpose – Expiration Date or Event – Individual’s Rights – Revocation – Marketing = Remuneration – Dated and Signed
  26. 26. 26 Authorization • Typically Cannot Condition Treatment Upon Execution • Allowed to Condition if for Third Party – Fitness for Duty, etc. • Health Plan May Condition for Underwriting or Risk Rating • Provider May Condition for Research
  27. 27. 27 Authorization • Psychotherapy Notes Require • Marketing Requires • Research Typically Requires • Any Use or Disclosure Not Addressed by the Rule
  28. 28. 28 Other Uses or Disclosures Requiring Opportunity to Object 45 C.F.R. § 510 • Covered Entity may Use or Disclose PHI in Limited Situations Based Upon Informal Permission • Disclose to Family Members, Relatives, Individuals Identified Who Are Involved in Care or Treatment • Use or Disclose for Facility Directory to Anyone Asking for by Name, Clergy
  29. 29. 29 Opportunity to Object • Permission in Advance • No Documentation Required • If Emergency, May Disclose to Those Involved in Care, if Professional Judgment Exercised • Covered Entity May Release X-Rays, Rxs, Supplies to Person Acting on Individual’s Behalf, if Professional Judgment
  30. 30. 30 Other Uses or Disclosures Without Opportunity to Object 45 C.F.R. § 164.512 • Covered Entity Must Verify Identity of Requester and Authority • Where Required by Law • Public Health Activities – Reporting Disease – Reporting Vital Statistics – Reporting to FDA – Reporting to Employer – Reporting Communicable Diseases
  31. 31. 31 Disclosures Without Objection • Victims of Abuse, Neglect, or Domestic Violence – Reasonably Believes and Required/Allowed by Law – No Consent or Notification From/to Individual if Danger – Notice to Personal Representative Unless Harm
  32. 32. 32 Disclosures Without Objection • Health Oversight Activities – Audits – Civil or Criminal Investigations – Not Where Individual’s Health is at Issue
  33. 33. 33 Disclosures Without Objection • Law Enforcement – Where Required by Law – Information Must be Relevant – Minimum Necessary Disclosed
  34. 34. 34 Disclosures Without Objection • Decedents – Disclose to Coroners, Medical Examiners, and Funeral Directors to Carry out Duties • Organ, Eye, or Tissue Donation – Use or Disclose PHI to Procurement Organizations
  35. 35. 35 Disclosures Without Objection • Research Purposes – Must Satisfy Conditions With Respect to IRB Waiver • To Avert Serious Threat to Public • Certain Specialized Governmental Functions: National Security, VA, Military, Secret Service • Workers Compensation Act
  36. 36. 36 Disclosures to Attorneys • Subpoenas – Notice and Opportunity to Object or Move for Qualified Protective Order (“QPO”) – QPO Not a Good Choice •Would Appear to Require Return or Destruction •No “Not Feasible” Language in the Order
  37. 37. 37 Subpoenas • Proposed Procedure – Notice Letter to Patient/Patient’s Attorney •Allow for Reasonable Time (14 Days) to File Objection •Dispute Over Notice to Attorney Only? – Upon Conclusion of Time Period Send Subpoena, Copy of Notice Letter, and Cover Letter to Covered Entity •One Package, Not Waiting on Objections
  38. 38. 38 Group Health Plan Notice of Privacy Practices • Individual Enrolled in a Group Health Plan Has Right to Notice: – From Group Health Plan if no Insurer of HMO, i.e., Self Insured – From Insurer or HMO if Fully Insured – 45 C.F.R. § 164.520(a)(2)
  39. 39. 39 Group Health Plan Notice of Privacy Practices • Group Health Plan Which is Fully Insured and Creates or Receives PHI Above and Beyond Summary Health Information and/or Enrollment/Disenrollment, Must: – Maintain Notice of Privacy Practices – Provide Notice Upon Request • If Group Health Plan is Fully Insured and Only Summary Health Information, Then No Notice Required •45 C.F.R. § 164.520(a)(2)
  40. 40. 40 Group Health Plan Administrative Requirements • Group Health Plan Which is Fully Insured and Creates or Receives Only Summary Health Information and/or Enrollment/Disenrollment Has Only Limited Administrative Obligations •45 C.F.R. § 164.530(k)(1)
  41. 41. 41 Group Health Plan Administrative Requirements • Fully Insured Group Health Plan Not Required to: – Designate Privacy Officer – Train Workforce – Implement Safeguards – Complaint Process – Sanctions for Workforce – Mitigate Violations – Implement Policies and Procedures – Only Maintain Documentation of Amended Plan Documents – 45 C.F.R. § 164.530(k)(1),(2)
  42. 42. 42 Group Health Plan Personal Rights • Privacy Rule Does Not Explicitly Exclude Group Health Plans Which Are Fully Insured and Receive Only Summary Health Information From Personal Rights Obligations – Access, Amendment, Accounting, Restrictions, Confidential Communications – Guidance States Are Excluded •65 Fed. Reg. 82645 (December 28, 2000)
  43. 43. 43 Access to PHI 45 C.F.R. § 164.524 • Individual Has Right of Access and Inspection • No Right to Psychotherapy Notes, Information Compiled for Legal Proceeding, or Exempt Under CLIA • May Deny Without Review if For Above, if For Inmate, if During Research, if Under Privacy Act, or if Obtained From Another Party
  44. 44. 44 Right of Access • Must Provide Review if Refused Due to Endangerment, Due to Mention Another Person, or if Access by Personal Representative a Danger • Response to Request Within 30 Days + 30 Day Extension • If Reasonable, Must be in Requested Format or Summary if Acceptable; Cost-based Fee
  45. 45. 45 Denial of Access • Provide Access to Non-Objectionable PHI • Written Denial, in Plain Language, of Basis and Complaint Process • Notify Individual of Location if Not With Covered Entity
  46. 46. 46 Right to Amendment 45 C.F.R. § 164.526 • Individual May Request Amendment to PHI • Covered Entity May Deny if Not Its Record, Not Available for Access, or if Accurate • Covered Entity May Require That in Writing and Provide Reason • 60 Day Time Limit + 30 Day Extension
  47. 47. 47 Acceptance of Amendment • Covered Entity Must Amend/Append Record • Covered Entity Must Notify Individual • Covered Entity Must Notify Third Parties and Business Associates of Amendment
  48. 48. 48 Denial of Amendment • Must Provide Individual With Written Denial • Provide Individual to Submit Statement in Disagreement • Copies Sent Out to Third Parties • Covered Entity May Submit Rebuttal Statement
  49. 49. 49 Accounting of Disclosures 45 C.F.R. § 164.528 • Right to Listing of Disclosures During Prior 6 Years, or Less if Specified • Excluded – For TPO – To Individuals – Incidental Disclosures – If Authorization – For Facility Directory or Care or Notification – National Security or Law Enforcement – Prior to April 14, 2003
  50. 50. 50 Providing the Accounting • Date of Disclosure • Name of Party Receiving • Description of PHI • Brief Statement of Purpose for Disclosure or Copy of the Request • 60 Day Time Limit + 30 Day Extension
  51. 51. 51 Request for Restriction on Use or Disclosure of PHI 45 C.F.R. § 164.522(a) • Request for Restrictions on Any Aspect • Covered Entity Need Not Comply with Request • If Agree, Then may Not Disclose Except in Emergency – Must Obtain Assurance from Recipient That Will Not Further Disclose – Not a Bar to Disclosures for Facility Directory • May Terminate Orally if Documented and Post-PHI Only
  52. 52. 52 Confidential Communications 45 C.F.R. § 164.522(b) • Individual May Request Alternate or Confidential Communications – Binding Upon Covered Entity if Reasonable • Providers May Not Request Reason • Health Plans May Request Reason and Only Comply if Endanger Individual • May Require Payment Arrangements
  53. 53. 53 Conclusion • Non-Health Care Employers Still May Be Caught Up in HIPAA – Obtaining Health Information from Covered Entities – Group Health Plans • Necessary for All Interested Parties to Learn of the Promise and Pitfalls of the Privacy Rule
  54. 54. 54 Conclusion/Questions • Gerald “Jud” E. DeLoss • Barnwell Whaley Patterson & Helms, LLC • 885 Island Park Drive (29492) • Post Office Drawer H • Charleston, South Carolina 29402 • (843) 577-7700 Telephone • (843) 577-7708 Facsimile • gdeloss@barnwell-whaley.com • www.barnwell-whaley.com

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