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Review: Your limited rights under HIPAA.

Please do not forget your limited rights under HIPAA. While you do not necessarily have complete control of your medical records, federal laws does provide you with some limited control over your personal health information (PHI). Two good questions for everyone to review are:

Can an individual revoke his or her Authorization?

Yes. The Privacy Rule gives individuals the right to revoke, at any time, an Authorization they have given. The revocation must be in writing, and is not effective until the covered entity receives it. In addition, a written revocation is not effective with respect to actions a covered entity took in reliance on a valid Authorization, or where the Authorization was obtained as a condition of obtaining insurance coverage and other law provides the insurer with the right to contest a claim under the policy or the policy itself.

The Privacy Rule requires that the Authorization must clearly state the individual’s right to revoke; and the process for revocation must either be set forth clearly on the Authorization itself, or if the covered entity creates the Authorization, and its Notice of Privacy Practices contains a clear description of the revocation process, the Authorization can refer to the Notice of Privacy Practices. Authorization forms created by or submitted through a third party should not imply that revocation is effective when the third party receives it, since the revocation is not effective until a covered entity which had previously been authorized to make the disclosure receives it.

What is the difference between “consent” and “authorization” under the HIPAA Privacy Rule?

The Privacy Rule permits, but does not require, a covered entity voluntarily to obtain patient consent for uses and disclosures of protected health information for treatment, payment, and health care operations. Covered entities that do so have complete discretion to design a process that best suits their needs.

By contrast, an “authorization” is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. Where the Privacy Rule requires patient authorization, voluntary consent is not sufficient to permit a use or disclosure of protected health information unless it also satisfies the requirements of a valid authorization. An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization.

Health Care Reform gets a little help from Kaiser Family Foundation

The Henry J. Kaiser Family Foundation (KFF) is usually very careful not to endorse public or political health policy.  However, a recent paper released by KFF regarding one of their surveys leaves little room for the reader to believe anything other than HCR is all good and somehow the public just does not understand.

The KFF states that ACA “is expected to expand coverage to 32 million of the uninsured”,  expected by who the reader should ask? The wildest estimates I have seen are 22 million or half the uninsured. The most conservative have been only several million. Remember that the high-risks pools were to have some 375,000 individuals enrolled by the end of 2010, however actual enrollment had not reach 12,000. (read more)

ACA has serious problems, impediments for the uninsured to become insured, and it’s not just public perception: 

  • Consider that health care and premiums have doubled in about 10 years. Quick math: a 30% subsidy will put you back where you were three years ago. It was expensive then too. And it will be too expensive in 2014 for too many Americans even with subsidies.
  • The individual mandate has very little teeth, IRS has almost no authority to go after noncomplying individuals. The Constitution argument is meaningless unless severability become the turning point.
  • The Big One: how will people get enrolled in these subsidized options?  The concept of “if you build it they will come” is a bit naïve.  There are serious demographic concerns in this population and their access to go online, enroll, and pay.
  • Health care reform appears to be alienating the community’s insurance broker so she will not helping with this education and enrollment process.
  • Finally, any reference to the KFF study should be that the general attitude among people is that ACA  just will not help them.  No hope for real affordability.

KFF should demonstrate better respect for the real flaws of ACA and not spin it as if the public just does not understand. People have a sixth sense, KFF would be wise to respect it.

Benefit Summaries Prescribed by the Federal Government

Though the industry has gotten by for decades with benefit descriptions, apparently someone felt the need to have the federal government legislate specific terms. The new health care reform law requires The Department of Health and Human Services (HHS) to establish standards with direct input from the National Association of Insurance Commissioners (NAIC).

On August 17, 2011 HHS released a Notice of Proposed Rulemaking for Uniform Benefit Summaries. This new requirement applies to individual plans, employer plans (fully and self-insured) . Soon, you can expect your benefit summaries to start looking the same or similar to every other employer or insurer.

More details can be found by clicking here, and a good sample of this new design is available here. (scroll down)

Which premium is 9.5% of the family household income?

A new proposed rule from HHS on what counts toward that 9.5% affordability rule. Big premium difference between $5000 and $14,000. So it needed clarification.

One part of health care reform is the 9.5% affordability rule on health care reform. This rule could potentially help a person or family get more affordable coverage through the exchange, or at least in theory. HHS finally clarified the 9.5% rule regarding its application to single coverage or family coverage? Answer: Single coverage only.

Washington Post’s Sarah Kliff does a good job of explain this issue and the new HHS rule.