What Does HIPAA Cover?

It has been 22 years since the Health Insurance Portability and Accountability Act (HIPAA) was Introduced, but there is still some confusion about HIPAA, what the legislation does for patients, who is required to comply with HIPAA Rules, and what does HIPAA cover.

Who Does HIPAA Cover?

HIPAA is a federal law that introduced standards in healthcare relating to patient privacy and the protection of medical data. HIPAA covers healthcare providers, health plans, healthcare clearinghouses, and business associates of HIPAA-covered entities. HIPAA applies to most entities that fall into the above categories, except those that do not conduct transactions electronically.

Healthcare providers include hospitals, clinics, physicians, nursing homes, pharmacies, chiropractors, dentists, and psychologists. Health plans include health insurers, company health plans, HMOs, and government programs that pay for healthcare such as Medicaid and Medicare. Healthcare clearinghouses are organizations that transform nonstandard health data into a standard format. A business associate is an individual or entity that performs functions for a HIPAA covered entity that requires the use or disclosure of protected health information.

What Does HIPAA Cover?

The HIPAA Privacy Rule covers all individually identifiable health information that is created, stored, maintained, or transmitted by a HIPAA covered entity or business associate of a HIPAA covered entity. The HIPAA Privacy Rule applies to all forms of PHI, including paper records, films, and electronic health information, even spoken information.

This information is classed as protected health information when it contains identifiers that would allow a patient or health plan member to be identified. HIPAA does not include information in employment records, even if that information is included in the HIPAA definition of individually identifiable health information or protected health information.

If individually identifiable health information is stripped of all identifiers, it is no longer considered to be protected health information. Information on the 18 identifiers and de-identification of health data can be found here.

How Does HIPAA Benefit Patients?

HIPAA benefits patients in four main ways. HIPAA ensures that health data is safeguarded to prevent it from being accessed by unauthorized individuals. HIPAA protects the privacy of patients by prohibiting certain uses and disclosures of health information. HIPAA allows patients to obtain copies of their health information. HIPAA also ensures that if there is a breach of health information, the breached entity must send notifications to the individuals affected.

Author: Steve Alder has many years of experience as a journalist, and comes from a background in market research. He is a specialist on legal and regulatory affairs, and has several years of experience writing about HIPAA. Steve holds a B.Sc. from the University of Liverpool.