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The attached white paper might be a good source reference, if you have interest in this subject. Leah Hole-Curry, JD, Fox Systems, shares this with ShareHIPAA subscribers. You are welcome to use and share as long as it is not sold, and the appropriate attribution and copyrights are retained. (ShareHIPAA no copyright waiver approved with reservations) This is not and is not intended to be legal advice. Please contact the author with comments or questions:
> Leah Hole-Curry, JD
> FOX Systems, Inc.
> 602.708.1045
----- Original Message -----
From: "Leah Hole-Curry" <Leah.Hole-Curry@...>
To: <mcgowins@...>
Sent: Friday, June 06, 2003 4:50 PM
Subject: Re: [Countyhipaa] Advocates & Ombudsman
> Thanks!
>
> Attached is a research note that relates to this issue that you may use,
> as long as it is not sold, and that appropriate attribution and
> copyrights are retained.
>
> lhc
> >>> "Barbara McGowin" <mcgowins@...> 05/30/03 23:10 PM >>>
> Leah,
>
> This is one of the greatest emails I have read concerning application of
> the intent of HIPAA compliance. I think you have reasonableness nailed!
> Do you have a white paper, or PowerPoint on the problem resolution
> below?
> If you do, and you may, would you consider sharing?
>
> Barbara McGowin, CPC
> Executive Recruiter
> HIT Recruiting
> (843) 824-8537
> mcgowins@...
> Connecting Healthcare Organizations with People,
> Products and Services to Achieve HIPAA Compliance.
> ----- Original Message -----
> From: "Leah Hole-Curry" <Leah.Hole-Curry@...>
> To: <countyhipaa; <@state.xx.us>
> Sent: Friday, May 30, 2003 6:00 PM
> Subject: Re: [Countyhipaa] Advocates & Ombudsman
>
>
> > xxxxx,
> >
> > to me, the responsibilities you describe (ensuring access to, and
> > quality care) that are required by your state law fall under "health
> > oversight authority" provisions and the advocates and ombudsmen should
> > have access to PHI under HIPAA under that authority.(definition at
> > 164.501, and permissible use/disclosure at 164.512(d)).
> >
> > As you mention, it could also fall under the generic "required by
> law".
> > The restrictions in (a)(2) merely indicate that if the requirement of
> > law is related to the referenced sections (e.g. victims of abuse,
> > judicial or administrative proceedings, or law enforcement) then the
> > requirements of those sections must be met as well.
> >
> > I don't think it fits under treatment or payment. However, there are
> > other alternatives. I imagine that the "advocacy" process is
> initiated
> > by contact with the individual. At that time, the advocate could (a)
> > either request that the individual appoint them as a personal
> > representative for the issues/concerns related to the advocacy, or (b)
> > request that the individual sign an authorization for the advocate to
> > obtain information related to the issues/concerns.
> >
> > Finally, under section 164.510(b) a covered entity is permitted to
> > disclose information to individuals involved in a person's care or
> > payment for that care if the individual is given an opportunity to
> agree
> > or object, or reasonably infers that the individual does not object.
> > Because the advocate is clearly involved in the persons care or
> payment
> > for care (to the extent of the issues or concerns discussed) this
> > provision is applicable. However, this provision merely indicates
> that
> > a covered entity "may" disclose the information, not that they must,
> so
> > if a covered entity refused, you may have to resort to one of the
> other
> > avenues to get the information.
> >
> > Regards, lhc
> > >>> <@state.xx.us> 05/30/03 12:56 PM >>>
> > Scenario: Various "health plans" are under contract with our state
> > Department of Human Services to coordinate health care for state
> health
> > plan
> > enrollees. The "plans," in turn, subcontract with various providers
> for
> > services.
> >
> > Meanwhile, state law (xxxxxxxx) provides for a state "ombudsperson"
> and
> > for
> > "county advocates" to protect the interests of enrollees (counties
> > enroll
> > participants and management cases). The assistance provided by
> advocates
> > "must include educating recipients about available health care
> options,
> > enrolling recipients..., providing necessary eligibility and
> enrollment
> > information to health plans and the state agency, and coordinating
> > complaints and appeals with the ombudsman." To assist advocates in
> > accomplishing these goals:
> >
> > The provider or health plan must respond directly to county
> > advocates and the state prepaid medical assistance ombudsperson
> > regarding
> > service delivery and must be accountable to the state regarding
> > contracts
> > with medical assistance and general assistance medical care funds...
> >
> > Some providers and plans are now leery to provide PHI to advocates,
> > citing
> > HIPAA as a roadblock.
> >
> > Questions:
> >
> > 1. I am taking the position that the advocates work falls within
> > the
> > ambit of treatment, payment, or both. Is this a stretch?
> > 2. Alternatively, assuming that the disclosures to advocates are
> > arguably "required by law," does º 164.512(a)(1) apply, given the
> > apparent
> > limitation of its applicability described in (a)(2)? (How are folks
> > reading
> > the restrictions described in (a)(2))?
> >
> > Any assistance will be appreciated.
> >
> > xxxxxxxx Department of Human Services
> >
> >
> > _______________________________________________
> > Countyhipaa mailing list
> FOX Systems, Inc.
> 602.708.1045
----- Original Message -----
From: "Leah Hole-Curry" <Leah.Hole-Curry@...>
To: <mcgowins@...>
Sent: Friday, June 06, 2003 4:50 PM
Subject: Re: [Countyhipaa] Advocates & Ombudsman
> Thanks!
>
> Attached is a research note that relates to this issue that you may use,
> as long as it is not sold, and that appropriate attribution and
> copyrights are retained.
>
> lhc
> >>> "Barbara McGowin" <mcgowins@...> 05/30/03 23:10 PM >>>
> Leah,
>
> This is one of the greatest emails I have read concerning application of
> the intent of HIPAA compliance. I think you have reasonableness nailed!
> Do you have a white paper, or PowerPoint on the problem resolution
> below?
> If you do, and you may, would you consider sharing?
>
> Barbara McGowin, CPC
> Executive Recruiter
> HIT Recruiting
> (843) 824-8537
> mcgowins@...
> Connecting Healthcare Organizations with People,
> Products and Services to Achieve HIPAA Compliance.
> ----- Original Message -----
> From: "Leah Hole-Curry" <Leah.Hole-Curry@...>
> To: <countyhipaa; <@state.xx.us>
> Sent: Friday, May 30, 2003 6:00 PM
> Subject: Re: [Countyhipaa] Advocates & Ombudsman
>
>
> > xxxxx,
> >
> > to me, the responsibilities you describe (ensuring access to, and
> > quality care) that are required by your state law fall under "health
> > oversight authority" provisions and the advocates and ombudsmen should
> > have access to PHI under HIPAA under that authority.(definition at
> > 164.501, and permissible use/disclosure at 164.512(d)).
> >
> > As you mention, it could also fall under the generic "required by
> law".
> > The restrictions in (a)(2) merely indicate that if the requirement of
> > law is related to the referenced sections (e.g. victims of abuse,
> > judicial or administrative proceedings, or law enforcement) then the
> > requirements of those sections must be met as well.
> >
> > I don't think it fits under treatment or payment. However, there are
> > other alternatives. I imagine that the "advocacy" process is
> initiated
> > by contact with the individual. At that time, the advocate could (a)
> > either request that the individual appoint them as a personal
> > representative for the issues/concerns related to the advocacy, or (b)
> > request that the individual sign an authorization for the advocate to
> > obtain information related to the issues/concerns.
> >
> > Finally, under section 164.510(b) a covered entity is permitted to
> > disclose information to individuals involved in a person's care or
> > payment for that care if the individual is given an opportunity to
> agree
> > or object, or reasonably infers that the individual does not object.
> > Because the advocate is clearly involved in the persons care or
> payment
> > for care (to the extent of the issues or concerns discussed) this
> > provision is applicable. However, this provision merely indicates
> that
> > a covered entity "may" disclose the information, not that they must,
> so
> > if a covered entity refused, you may have to resort to one of the
> other
> > avenues to get the information.
> >
> > Regards, lhc
> > >>> <@state.xx.us> 05/30/03 12:56 PM >>>
> > Scenario: Various "health plans" are under contract with our state
> > Department of Human Services to coordinate health care for state
> health
> > plan
> > enrollees. The "plans," in turn, subcontract with various providers
> for
> > services.
> >
> > Meanwhile, state law (xxxxxxxx) provides for a state "ombudsperson"
> and
> > for
> > "county advocates" to protect the interests of enrollees (counties
> > enroll
> > participants and management cases). The assistance provided by
> advocates
> > "must include educating recipients about available health care
> options,
> > enrolling recipients..., providing necessary eligibility and
> enrollment
> > information to health plans and the state agency, and coordinating
> > complaints and appeals with the ombudsman." To assist advocates in
> > accomplishing these goals:
> >
> > The provider or health plan must respond directly to county
> > advocates and the state prepaid medical assistance ombudsperson
> > regarding
> > service delivery and must be accountable to the state regarding
> > contracts
> > with medical assistance and general assistance medical care funds...
> >
> > Some providers and plans are now leery to provide PHI to advocates,
> > citing
> > HIPAA as a roadblock.
> >
> > Questions:
> >
> > 1. I am taking the position that the advocates work falls within
> > the
> > ambit of treatment, payment, or both. Is this a stretch?
> > 2. Alternatively, assuming that the disclosures to advocates are
> > arguably "required by law," does º 164.512(a)(1) apply, given the
> > apparent
> > limitation of its applicability described in (a)(2)? (How are folks
> > reading
> > the restrictions described in (a)(2))?
> >
> > Any assistance will be appreciated.
> >
> > xxxxxxxx Department of Human Services
> >
> >
> > _______________________________________________
> > Countyhipaa mailing list
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