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id="toc-Title_I:_Health_Care_Access,_Portability,_and_Renewability" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Title_I:_Health_Care_Access,_Portability,_and_Renewability"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Title I: Health Care Access, Portability, and Renewability</span> </div> </a> <ul id="toc-Title_I:_Health_Care_Access,_Portability,_and_Renewability-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Title_II:_Preventing_Health_Care_Fraud_and_Abuse;_Administrative_Simplification;_Medical_Liability_Reform" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Title_II:_Preventing_Health_Care_Fraud_and_Abuse;_Administrative_Simplification;_Medical_Liability_Reform"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform</span> </div> </a> <ul id="toc-Title_II:_Preventing_Health_Care_Fraud_and_Abuse;_Administrative_Simplification;_Medical_Liability_Reform-sublist" class="vector-toc-list"> <li id="toc-Privacy_Rule" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Privacy_Rule"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.1</span> <span>Privacy Rule</span> </div> </a> <ul id="toc-Privacy_Rule-sublist" class="vector-toc-list"> <li id="toc-2013_Final_Omnibus_Rule_update" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#2013_Final_Omnibus_Rule_update"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.1.1</span> <span>2013 Final Omnibus Rule update</span> </div> </a> <ul id="toc-2013_Final_Omnibus_Rule_update-sublist" class="vector-toc-list"> <li id="toc-HITECH_Act:_privacy_requirements" class="vector-toc-list-item vector-toc-level-5"> <a class="vector-toc-link" href="#HITECH_Act:_privacy_requirements"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.1.1.1</span> <span>HITECH Act: privacy requirements</span> </div> </a> <ul id="toc-HITECH_Act:_privacy_requirements-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Right_to_access_one's_PHI" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Right_to_access_one's_PHI"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.1.2</span> <span>Right to access one's PHI</span> </div> </a> <ul id="toc-Right_to_access_one's_PHI-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Disclosure_to_relatives" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Disclosure_to_relatives"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.1.3</span> <span>Disclosure to relatives</span> </div> </a> <ul id="toc-Disclosure_to_relatives-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Transactions_and_Code_Sets_Rule" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Transactions_and_Code_Sets_Rule"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.2</span> <span>Transactions and Code Sets Rule</span> </div> </a> <ul id="toc-Transactions_and_Code_Sets_Rule-sublist" class="vector-toc-list"> <li id="toc-Brief_5010_Transactions_and_Code_Sets_Rules_Update_Summary" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Brief_5010_Transactions_and_Code_Sets_Rules_Update_Summary"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.2.1</span> <span>Brief 5010 Transactions and Code Sets Rules Update Summary</span> </div> </a> <ul id="toc-Brief_5010_Transactions_and_Code_Sets_Rules_Update_Summary-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Security_Rule" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Security_Rule"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.3</span> <span>Security Rule</span> </div> </a> <ul id="toc-Security_Rule-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Unique_Identifiers_Rule_(National_Provider_Identifier)" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Unique_Identifiers_Rule_(National_Provider_Identifier)"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.4</span> <span>Unique Identifiers Rule (National Provider Identifier)</span> </div> </a> <ul id="toc-Unique_Identifiers_Rule_(National_Provider_Identifier)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Enforcement_Rule" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Enforcement_Rule"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2.5</span> <span>Enforcement Rule</span> </div> </a> <ul id="toc-Enforcement_Rule-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Title_III:_Tax-related_health_provisions_governing_medical_savings_accounts" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Title_III:_Tax-related_health_provisions_governing_medical_savings_accounts"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3</span> <span>Title III: Tax-related health provisions governing medical savings accounts</span> </div> </a> <ul id="toc-Title_III:_Tax-related_health_provisions_governing_medical_savings_accounts-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Title_IV:_Application_and_enforcement_of_group_health_insurance_requirements" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Title_IV:_Application_and_enforcement_of_group_health_insurance_requirements"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4</span> <span>Title IV: Application and enforcement of group health insurance requirements</span> </div> </a> <ul id="toc-Title_IV:_Application_and_enforcement_of_group_health_insurance_requirements-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Title_V:_Revenue_offset_governing_tax_deductions_for_employers" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Title_V:_Revenue_offset_governing_tax_deductions_for_employers"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5</span> <span>Title V: Revenue offset governing tax deductions for employers</span> </div> </a> <ul id="toc-Title_V:_Revenue_offset_governing_tax_deductions_for_employers-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Effects_on_research_and_clinical_care" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Effects_on_research_and_clinical_care"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Effects on research and clinical care</span> </div> </a> <button aria-controls="toc-Effects_on_research_and_clinical_care-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Effects on research and clinical care subsection</span> </button> <ul id="toc-Effects_on_research_and_clinical_care-sublist" class="vector-toc-list"> <li id="toc-Effects_on_research" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effects_on_research"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Effects on research</span> </div> </a> <ul id="toc-Effects_on_research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effects_on_clinical_care" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effects_on_clinical_care"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Effects on clinical care</span> </div> </a> <ul id="toc-Effects_on_clinical_care-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Costs_of_implementation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Costs_of_implementation"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Costs of implementation</span> </div> </a> <ul id="toc-Costs_of_implementation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Education_and_training" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Education_and_training"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Education and training</span> </div> </a> <ul id="toc-Education_and_training-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Misspelling_as_HIPPA" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Misspelling_as_HIPPA"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Misspelling as <i>HIPPA</i></span> </div> </a> <ul id="toc-Misspelling_as_HIPPA-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Violations" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Violations"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Violations</span> </div> </a> <ul id="toc-Violations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Legislative_information" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Legislative_information"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Legislative information</span> </div> </a> <ul id="toc-Legislative_information-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" 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print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"HIPPA" redirects here. For the genus of decapod crustaceans, see <a href="/wiki/Hippa" title="Hippa">Hippa</a>.</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><caption class="infobox-title" style="padding-bottom:0.25em">Health Insurance Portability and Accountability Act of 1996</caption><tbody><tr><td colspan="2" class="infobox-image"><span typeof="mw:File"><a href="/wiki/File:Great_Seal_of_the_United_States_(obverse).svg" class="mw-file-description"><img alt="Great Seal of the United States" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Great_Seal_of_the_United_States_%28obverse%29.svg/140px-Great_Seal_of_the_United_States_%28obverse%29.svg.png" decoding="async" width="140" height="140" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Great_Seal_of_the_United_States_%28obverse%29.svg/210px-Great_Seal_of_the_United_States_%28obverse%29.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Great_Seal_of_the_United_States_%28obverse%29.svg/280px-Great_Seal_of_the_United_States_%28obverse%29.svg.png 2x" data-file-width="600" data-file-height="600" /></a></span></td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.245em;line-height:1.15em;padding-right:0.65em">Other short titles</th><td class="infobox-data" style="text-align:left;line-height:1.3em">Kassebaum–Kennedy Act, Kennedy–Kassebaum Act</td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.245em;line-height:1.15em;padding-right:0.65em">Long title</th><td class="infobox-data" style="text-align:left;line-height:1.3em">An Act To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.</td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.245em;line-height:1.15em;padding-right:0.65em"><a href="/wiki/Acronym" title="Acronym">Acronyms</a> <style data-mw-deduplicate="TemplateStyles:r886047488">.mw-parser-output .nobold{font-weight:normal}</style><span class="nobold">(colloquial)</span></th><td class="infobox-data" style="text-align:left;line-height:1.3em">HIPAA (pronounced <span class="rt-commentedText nowrap"><span class="IPA nopopups noexcerpt" lang="en-fonipa"><a href="/wiki/Help:IPA/English" title="Help:IPA/English">/<span style="border-bottom:1px dotted"><span title="/ˈ/: primary stress follows">ˈ</span><span title="'h' in 'hi'">h</span><span title="/ɪ/: 'i' in 'kit'">ɪ</span><span title="'p' in 'pie'">p</span><span title="/ə/: 'a' in 'about'">ə</span></span>/</a></span></span> <a href="/wiki/Help:Pronunciation_respelling_key" title="Help:Pronunciation respelling key"><i title="English pronunciation respelling"><span style="font-size:90%">HIP</span>-uh</i></a>)</td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.245em;line-height:1.15em;padding-right:0.65em">Enacted by</th><td class="infobox-data" style="text-align:left;line-height:1.3em">the <a href="/wiki/104th_United_States_Congress" title="104th United States Congress">104th United States Congress</a></td></tr><tr><th colspan="2" class="infobox-header" style="background:#bbddff">Citations</th></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.245em;line-height:1.15em;padding-right:0.65em">Public law</th><td class="infobox-data" style="text-align:left;line-height:1.3em"><a href="/wiki/Act_of_Congress#Public_law,_private_law,_designation" title="Act of Congress"><abbr title="Public Law">Pub. L.</abbr></a> <a rel="nofollow" class="external text" href="https://www.govinfo.gov/link/plaw/104/public/191?link-type=html">104–191 (text)</a> <a rel="nofollow" class="external text" href="https://www.govinfo.gov/link/plaw/104/public/191?link-type=pdf&.pdf">(PDF)</a></td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.245em;line-height:1.15em;padding-right:0.65em"><a href="/wiki/United_States_Statutes_at_Large" title="United States Statutes at Large"><span class="wrap">Statutes at Large</span></a></th><td class="infobox-data" style="text-align:left;line-height:1.3em">110 <a href="/wiki/United_States_Statutes_at_Large" title="United States Statutes at Large">Stat.</a> <a rel="nofollow" class="external text" href="https://legislink.org/us/stat-110-1936">1936</a></td></tr><tr><th colspan="2" class="infobox-header" style="background:#bbddff"><span class="nourlexpansion"><a rel="nofollow" class="external text" href="http://thomas.loc.gov/cgi-bin/bdquery/z?d104:HR03103:@@@S">Legislative history</a></span></th></tr><tr><td colspan="2" class="infobox-full-data" style="text-align:left;line-height:1.3em"><div><ul style="line-height:1.3em;text-align:left"><li><b>Introduced</b> in the House as <a rel="nofollow" class="external text" href="https://www.congress.gov/bill/104th-congress/house-bill/3103">H.R. 3103</a> by <a href="/wiki/William_Reynolds_Archer,_Jr." class="mw-redirect" title="William Reynolds Archer, Jr.">Bill Archer</a> (<a href="/wiki/Republican_Party_(United_States)" title="Republican Party (United States)">R</a>-<a href="/wiki/Texas" title="Texas">TX</a>) on March 18, 1996</li><li><b>Committee consideration</b> by <a href="/wiki/United_States_House_Committee_on_Ways_and_Means" title="United States House Committee on Ways and Means">House Ways and Means</a></li><li><b>Passed the House</b> on March 28, 1996 (<a rel="nofollow" class="external text" href="http://clerk.house.gov/evs/1996/roll106.xml">267–151</a>)</li><li><b>Passed the Senate</b> on April 23, 1996 (<a rel="nofollow" class="external text" href="https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=104&session=2&vote=00078">100–0</a>, in lieu of <a rel="nofollow" class="external text" href="https://www.congress.gov/bill/104th-congress/senate-bill/1028">S. 1028</a>)</li><li><b>Reported by the joint conference committee</b> on July 31, 1996; <b>agreed to by the House</b> on August 1, 1996 (<a rel="nofollow" class="external text" href="http://clerk.house.gov/evs/1996/roll393.xml">421–2</a>) and by the <b>Senate</b> on August 2, 1996 (<a rel="nofollow" class="external text" href="https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=104&session=2&vote=00264">98–0</a>)</li><li><b>Signed into law</b> by President <a href="/wiki/Bill_Clinton" title="Bill Clinton">Bill Clinton</a> on August 21, 1996</li></ul></div></td></tr></tbody></table> <p>The <b>Health Insurance Portability and Accountability Act of 1996</b> (<b>HIPAA</b> or the <b><a href="/wiki/Ted_Kennedy" title="Ted Kennedy">Kennedy</a>–<a href="/wiki/Nancy_Kassebaum" title="Nancy Kassebaum">Kassebaum</a> Act</b><sup id="cite_ref-Atchinson/Fox_1-0" class="reference"><a href="#cite_note-Atchinson/Fox-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-WjE7g_2-0" class="reference"><a href="#cite_note-WjE7g-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>) is a United States <a href="/wiki/Act_of_Congress" title="Act of Congress">Act of Congress</a> enacted by the <a href="/wiki/104th_United_States_Congress" title="104th United States Congress">104th United States Congress</a> and signed into law by President <a href="/wiki/Bill_Clinton" title="Bill Clinton">Bill Clinton</a> on August 21, 1996.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> It aimed to alter the transfer of healthcare information, stipulated the guidelines by which <a href="/wiki/Personally_identifiable_information" class="mw-redirect" title="Personally identifiable information">personally identifiable information</a> maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft,<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> and addressed some limitations on <a href="/wiki/Health_insurance_in_the_United_States" title="Health insurance in the United States">healthcare insurance coverage</a>. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The bill does not restrict patients from receiving information about themselves (with limited exceptions).<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Furthermore, it does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends or other individuals not employees of a covered entity. </p><p>The act consists of 5 titles: </p> <ol><li>Title I protects <a href="/wiki/Health_insurance_in_the_United_States" title="Health insurance in the United States">health insurance</a> coverage for workers and their families when they change or lose their jobs.<sup id="cite_ref-XMVOH_6-0" class="reference"><a href="#cite_note-XMVOH-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></li> <li>Title II, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for <a href="/wiki/Electronic_health_record" title="Electronic health record">electronic health care</a> transactions and national identifiers for providers, health insurance plans, and employers.<sup id="cite_ref-8iYhc_7-0" class="reference"><a href="#cite_note-8iYhc-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li>Title III sets guidelines for pre-tax medical spending accounts.</li> <li>Title IV sets guidelines for group health plans.</li> <li>Title V governs company-owned life insurance policies.</li></ol> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Titles">Titles</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=1" title="Edit section: Titles"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are five sections to the act, known as titles. </p> <div class="mw-heading mw-heading3"><h3 id="Title_I:_Health_Care_Access,_Portability,_and_Renewability"><span id="Title_I:_Health_Care_Access.2C_Portability.2C_and_Renewability"></span>Title I: Health Care Access, Portability, and Renewability</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=2" title="Edit section: Title I: Health Care Access, Portability, and Renewability"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code. Furthermore, Title I addresses the issue of "job lock" which is the inability for an employee to leave their job because they would lose their health coverage.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> To combat the job lock issue, the Title protects health insurance coverage for workers and their families if they lose or change their jobs.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Title I requires the coverage of and also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits in relation to preexisting conditions for either 12 months following enrollment in the plan or 18 months in the case of late enrollment.<sup id="cite_ref-IyyXk_10-0" class="reference"><a href="#cite_note-IyyXk-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Title I allows individuals to reduce the exclusion period by the amount of time that they have had "creditable coverage" before enrolling in the plan and after any "significant breaks" in coverage.<sup id="cite_ref-ZBui3_11-0" class="reference"><a href="#cite_note-ZBui3-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.<sup id="cite_ref-SNKGE_12-0" class="reference"><a href="#cite_note-SNKGE-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> A "significant break" in coverage is defined as any 63-day period without any creditable coverage.<sup id="cite_ref-zC46r_13-0" class="reference"><a href="#cite_note-zC46r-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Along with an exception, it allows employers to tie premiums or co-payments to tobacco use, or body mass index. </p><p>Title I mandates that insurance providers must issue policies without exclusions to individuals leaving group health plans, provided they have maintained continuous, credible coverage. (see above) exceeding 18 months, and<sup id="cite_ref-HMoEZ_14-0" class="reference"><a href="#cite_note-HMoEZ-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> renew individual policies for as long as they are offered or provide alternatives to discontinued plans for as long as the insurer stays in the market without exclusion regardless of health condition. </p><p>Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans like dental or vision plans offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits. </p><p>An alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans, such as dental to apply towards exclusion periods of the new plan that does include those coverages. </p><p>Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, must have occurred while the beneficiary was covered under this exact same health insurance contract"). Such clauses must not be acted upon by the health plan. Also, they must be re-written so they can comply with HIPAA.<sup id="cite_ref-6NTTk_15-0" class="reference"><a href="#cite_note-6NTTk-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Title_II:_Preventing_Health_Care_Fraud_and_Abuse;_Administrative_Simplification;_Medical_Liability_Reform"><span id="Title_II:_Preventing_Health_Care_Fraud_and_Abuse.3B_Administrative_Simplification.3B_Medical_Liability_Reform"></span>Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=3" title="Edit section: Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-More_citations_needed_section plainlinks metadata ambox ambox-content ambox-Refimprove" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Health_Insurance_Portability_and_Accountability_Act" title="Special:EditPage/Health Insurance Portability and Accountability Act">improve this article</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a> in this section. Unsourced material may be challenged and removed.</span> <span class="date-container"><i>(<span class="date">April 2010</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>Title II of HIPAA establishes policies and procedures for maintaining the privacy and the security of individually identifiable health information, outlines numerous offenses relating to health care, and establishes civil and criminal penalties for violations. It also creates several programs to control fraud and abuse within the health-care system.<sup id="cite_ref-LB0fN_16-0" class="reference"><a href="#cite_note-LB0fN-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Iu5AU_17-0" class="reference"><a href="#cite_note-Iu5AU-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-668st_18-0" class="reference"><a href="#cite_note-668st-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-auto_19-0" class="reference"><a href="#cite_note-auto-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the <a href="/wiki/United_States_Department_of_Health_and_Human_Services" title="United States Department of Health and Human Services">Department of Health and Human Services</a> (HHS) to increase the efficiency of the health-care system by creating standards for the use and dissemination of health-care information.<sup id="cite_ref-auto_19-1" class="reference"><a href="#cite_note-auto-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>These rules apply to "covered entities", as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses (such as billing services and community health information systems), and health care providers that transmit health care data in a way regulated by HIPAA.<sup id="cite_ref-CodeFedReg|45|160|103_20-0" class="reference"><a href="#cite_note-CodeFedReg|45|160|103-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>Per the requirements of Title II, the HHS has promulgated five rules regarding Administrative Simplification: the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Privacy_Rule">Privacy Rule</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=4" title="Edit section: Privacy Rule"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The HIPAA Privacy Rule is composed of national regulations for the use and disclosure of <a href="/wiki/Protected_health_information" title="Protected health information">Protected Health Information</a> (PHI) in healthcare treatment, payment and operations by "covered entities" (generally, health care clearinghouses, employer-sponsored health plans, health insurers, and medical service providers that engage in certain transactions).<sup id="cite_ref-d07T8_22-0" class="reference"><a href="#cite_note-d07T8-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>The Privacy Rule came into effect on April 14, 2003, with a one-year extension for certain "small plans". By regulation, the HHS extended the HIPAA privacy rule to independent contractors of covered entities who fit within the definition of "business associates".<sup id="cite_ref-1YiYW_23-0" class="reference"><a href="#cite_note-1YiYW-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> PHI is any information that is held by a covered entity regarding health status, provision of health care, or health care payment that can be linked to any individual.<sup id="cite_ref-CodeFedReg|45|160|103_20-1" class="reference"><a href="#cite_note-CodeFedReg|45|160|103-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> This is interpreted rather broadly and includes any part of an individual's <a href="/wiki/Medical_record" title="Medical record">medical record</a> or payment history. Covered entities must disclose PHI to the individual within 30 days upon request.<sup id="cite_ref-tY5YO_24-0" class="reference"><a href="#cite_note-tY5YO-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> They must also disclose PHI when required to do so by law such as reporting suspected <a href="/wiki/Child_abuse" title="Child abuse">child abuse</a> to state child welfare agencies.<sup id="cite_ref-gTkXU_25-0" class="reference"><a href="#cite_note-gTkXU-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; or to identify or locate a suspect, a fugitive, a material witness, or a missing person.<sup id="cite_ref-CYZ6i_26-0" class="reference"><a href="#cite_note-CYZ6i-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>A covered entity may disclose PHI to certain parties to facilitate treatment, payment, or health care operations without a patient's express written authorization.<sup id="cite_ref-JVxqn_27-0" class="reference"><a href="#cite_note-JVxqn-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Any other disclosures of PHI require the covered entity to obtain written authorization from the individual for disclosure.<sup id="cite_ref-Gm6fK_28-0" class="reference"><a href="#cite_note-Gm6fK-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> In any case, when a covered entity discloses any PHI, it must make a reasonable effort to disclose only the minimum necessary information required to achieve its purpose.<sup id="cite_ref-tcjyp_29-0" class="reference"><a href="#cite_note-tcjyp-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>The Privacy Rule gives individuals the right to request a covered entity to correct any inaccurate PHI.<sup id="cite_ref-WfTcp_30-0" class="reference"><a href="#cite_note-WfTcp-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Also, it requires covered entities to take some reasonable steps on ensuring the confidentiality of communications with individuals.<sup id="cite_ref-d9pOh_31-0" class="reference"><a href="#cite_note-d9pOh-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> For example, an individual can ask to be called at their work number instead of home or cell phone numbers. </p><p>The Privacy Rule requires covered entities to notify individuals of uses of their PHI.<sup id="cite_ref-WSWLy_32-0" class="reference"><a href="#cite_note-WSWLy-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Covered entities must also keep track of disclosures of PHI and document privacy policies and procedures.<sup id="cite_ref-C18uY_33-0" class="reference"><a href="#cite_note-C18uY-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> They must appoint a Privacy Official and a contact person<sup id="cite_ref-FaGgD_34-0" class="reference"><a href="#cite_note-FaGgD-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> responsible for receiving complaints and train all members of their workforce in procedures regarding PHI.<sup id="cite_ref-RPFBq_35-0" class="reference"><a href="#cite_note-RPFBq-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p><p>An individual who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).<sup id="cite_ref-t5GiT_36-0" class="reference"><a href="#cite_note-t5GiT-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-MDsuD_37-0" class="reference"><a href="#cite_note-MDsuD-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> In 2006 the <i>Wall Street Journal</i> reported that the OCR had a long backlog and ignores most complaints. "Complaints of privacy violations have been piling up at the Department of Health and Human Services. Between April of 2003 and November 2006, the agency fielded 23,886 complaints related to medical-privacy rules, but it has not yet taken any enforcement actions against hospitals, doctors, insurers or anyone else for rule violations. A spokesman for the agency says it has closed three-quarters of the complaints, typically because it found no violation or after it provided informal guidance to the parties involved."<sup id="cite_ref-mCOnA_38-0" class="reference"><a href="#cite_note-mCOnA-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> However, in July 2011, the <a href="/wiki/University_of_California,_Los_Angeles" title="University of California, Los Angeles">University of California, Los Angeles</a> agreed to pay $865,500 in a settlement regarding potential HIPAA violations. An HHS Office for Civil Rights investigation showed that from 2005 to 2008, unauthorized employees repeatedly and without legitimate cause looked at the electronic protected health information of numerous UCLAHS patients.<sup id="cite_ref-O5U00_39-0" class="reference"><a href="#cite_note-O5U00-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p><p>It is a misconception that the Privacy Rule creates a right for any individual to refuse to disclose any health information (such as chronic conditions or immunization records) if requested by an employer or business. HIPAA Privacy Rule requirements merely place restrictions on disclosure by covered entities and their business associates without the consent of the individual whose records are being requested; they do not place any restrictions upon requesting health information directly from the subject of that information.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading5"><h5 id="2013_Final_Omnibus_Rule_update">2013 Final Omnibus Rule update</h5><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=5" title="Edit section: 2013 Final Omnibus Rule update"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In January 2013, HIPAA was updated via the Final Omnibus Rule.<sup id="cite_ref-tVWwA_43-0" class="reference"><a href="#cite_note-tVWwA-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> The updates included changes to the Security Rule and Breach Notification portions of the HITECH Act. The most significant changes related to the expansion of requirements to include business associates, where only covered entities had originally been held to uphold these sections of the law.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2023)">citation needed</span></a></i>]</sup> </p><p>In addition, the definition of "significant harm" to an individual in the analysis of a breach was updated to provide more scrutiny to covered entities with the intent of disclosing breaches that previously were unreported. Previously, an organization needed proof that harm had occurred whereas now organizations must prove that harm had not occurred. </p><p>Protection of PHI was changed from indefinite to 50 years after death. More severe penalties for violation of PHI privacy requirements were also approved.<sup id="cite_ref-yjddM_44-0" class="reference"><a href="#cite_note-yjddM-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>The HIPAA Privacy rule may be waived during disasters. Limited waivers have been issued in cases such as <a href="/wiki/Hurricane_Harvey" title="Hurricane Harvey">Hurricane Harvey</a> in 2017.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading6"><h6 id="HITECH_Act:_privacy_requirements">HITECH Act: privacy requirements</h6><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=6" title="Edit section: HITECH Act: privacy requirements"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>See the <a href="/wiki/Health_Information_Technology_for_Economic_and_Clinical_Health_Act#Subtitle_D_–_Privacy" title="Health Information Technology for Economic and Clinical Health Act">Privacy section</a> of the <a href="/wiki/Health_Information_Technology_for_Economic_and_Clinical_Health_Act" title="Health Information Technology for Economic and Clinical Health Act">Health Information Technology for Economic and Clinical Health Act</a> (<a href="/wiki/HITECH_Act" class="mw-redirect" title="HITECH Act">HITECH Act</a>). </p> <div class="mw-heading mw-heading5"><h5 id="Right_to_access_one's_PHI"><span id="Right_to_access_one.27s_PHI"></span>Right to access one's PHI</h5><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=7" title="Edit section: Right to access one's PHI"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Privacy Rule requires medical providers to give individuals access to their PHI.<sup id="cite_ref-8PmDn_46-0" class="reference"><a href="#cite_note-8PmDn-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> After an individual requests information in writing (typically using the provider's form for this purpose), a provider has up to 30 days to provide a copy of the information to the individual. An individual may request the information in electronic form or hard-copy, and the provider is obligated to attempt to conform to the requested format. For providers using an electronic health record (<a href="/wiki/Electronic_health_record" title="Electronic health record">EHR</a>) system that is certified using CEHRT (Certified Electronic Health Record Technology) criteria, individuals must be allowed to obtain the PHI in electronic form. Providers are encouraged to provide the information expediently, especially in the case of electronic record requests. </p><p>Individuals have the broad right to access their health-related information, including medical records, notes, images, lab results, and insurance and billing information.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Explicitly excluded are the private psychotherapy notes of a provider, and information gathered by a provider to defend against a lawsuit.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p><p>Providers can charge a reasonable amount that relates to their cost of providing the copy, however, no charge is allowable when providing data electronically from a certified <a href="/wiki/Electronic_health_record" title="Electronic health record">EHR</a> using the "view, download, and transfer" feature which is required for certification. When delivered to the individual in electronic form, the individual may authorize delivery using either encrypted or unencrypted email, delivery using media (USB drive, CD, etc., which may involve a charge), direct messaging (a secure email technology in common use in the healthcare industry), or possibly other methods. When using unencrypted email, the individual must understand and accept the risks to privacy using this technology (the information may be intercepted and examined by others). Regardless of delivery technology, a provider must continue to fully secure the PHI while in their system and can deny the delivery method if it poses additional risk to PHI while in their system.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p><p>An individual may also request (in writing) that their PHI is delivered to a designated third party such as a family care provider. </p><p>An individual may also request (in writing) that the provider send PHI to a designated service used to collect or manage their records, such as a Personal Health Record application. For example, a patient can request in writing that her ob-gyn provider digitally transmit records of her latest prenatal visit to a pregnancy self-care app that she has on her mobile phone. </p> <div class="mw-heading mw-heading5"><h5 id="Disclosure_to_relatives">Disclosure to relatives</h5><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=8" title="Edit section: Disclosure to relatives"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to their interpretations of HIPAA, hospitals will not reveal information over the phone to relatives of admitted patients. This has, in some instances, impeded the location of missing persons. After the <a href="/wiki/Asiana_Airlines_Flight_214" title="Asiana Airlines Flight 214">Asiana Airlines Flight 214</a> San Francisco crash, some hospitals were reluctant to disclose the identities of passengers that they were treating, making it difficult for Asiana and the relatives to locate them.<sup id="cite_ref-Fusd2_50-0" class="reference"><a href="#cite_note-Fusd2-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> In one instance, a man in Washington state was unable to obtain information about his injured mother.<sup id="cite_ref-HfxQ0_51-0" class="reference"><a href="#cite_note-HfxQ0-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>Janlori Goldman, director of the advocacy group <a rel="nofollow" class="external text" href="https://cdt.org/insights/health-privacy-101/">Health Privacy Project</a>, said that some hospitals are being "overcautious" and misapplying the law, the Times reports. Suburban Hospital in Bethesda, Md., has interpreted a federal regulation that requires hospitals to allow patients to opt out of being included in the hospital directory as meaning that patients want to be kept out of the directory unless they specifically say otherwise. As a result, if a patient is unconscious or otherwise unable to choose to be included in the directory, relatives and friends might not be able to find them, Goldman said.<sup id="cite_ref-vyxKm_52-0" class="reference"><a href="#cite_note-vyxKm-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Transactions_and_Code_Sets_Rule">Transactions and Code Sets Rule</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=9" title="Edit section: Transactions and Code Sets Rule"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>HIPAA was intended to make the health care system in the United States more efficient by standardizing health care transactions. HIPAA added a new Part C titled "Administrative Simplification" to Title XI of the Social Security Act.<sup id="cite_ref-Up437_53-0" class="reference"><a href="#cite_note-Up437-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> This is supposed to simplify healthcare transactions by requiring all health plans to engage in health care transactions in a standardized way. </p><p>The HIPAA/EDI (<a href="/wiki/Electronic_data_interchange" title="Electronic data interchange">electronic data interchange</a>) provision was scheduled to take effect from October 16, 2003, with a one-year extension for certain "small plans". However, due to widespread confusion and difficulty in implementing the rule, Centers for Medicare & Medicaid Services (CMS) granted a one-year extension to all parties.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> On January 1, 2012, newer versions, <a href="/wiki/ASC_X12" title="ASC X12">ASC X12</a> 005010 and NCPDP D.0 become effective, replacing the previous ASC X12 004010 and NCPDP 5.1 mandate.<sup id="cite_ref-9srzm_55-0" class="reference"><a href="#cite_note-9srzm-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> The ASC X12 005010 version provides a mechanism allowing the use of <a href="/wiki/ICD-10-CM" title="ICD-10-CM">ICD-10-CM</a> as well as other improvements. </p><p>Under HIPAA, HIPAA-covered health plans are now required to use standardized HIPAA electronic transactions. See, 42 USC § 1320d-2 and 45 CFR Part 162. Information about this can be found in the final rule for HIPAA electronic transaction standards (74 Fed. Reg. 3296, published in the Federal Register on January 16, 2009), and on the CMS website.<sup id="cite_ref-iXRVb_56-0" class="reference"><a href="#cite_note-iXRVb-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p><p>The <b>EDI Health Care Claim Transaction Set</b> (837) is used to submit health care claim billing information, encounter information, or both, except for retail pharmacy claims (see EDI Retail Pharmacy Claim Transaction). It can be sent from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment. </p><p>For example, a state mental health agency may mandate all healthcare claims, Providers and health plans who trade professional (medical) health care claims electronically must use the 837 Health Care Claim: Professional standard to send in claims. As there are many different business applications for the Health Care claim, there can be slight derivations to cover off claims involving unique claims such as for institutions, professionals, chiropractors, dentists, etc. </p><p><b>EDI Retail Pharmacy Claim Transaction (<a href="/wiki/NCPDP" class="mw-redirect" title="NCPDP">NCPDP</a> Telecommunications</b> is used to submit retail pharmacy claims to payers by health care professionals who dispense medications, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit claims for retail pharmacy services and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of retail pharmacy services within the pharmacy health care/insurance industry segment. </p><p>The <b>EDI Health Care Claim Payment/Advice Transaction Set</b> (835) can be used to make a payment, send an Explanation of Benefits (EOB), send an Explanation of Payments (EOP) <a href="/wiki/Remittance_advice" title="Remittance advice">remittance advice</a>, or make a payment and send an EOP remittance advice only from a health insurer to a health care provider either directly or via a financial institution. </p><p>The <b><a href="/wiki/ANSI_834_Enrollment_Implementation_Format" title="ANSI 834 Enrollment Implementation Format">EDI Benefit Enrollment and Maintenance Set</a></b> (834) can be used by employers, unions, government agencies, associations or insurance agencies to enroll members to a payer. The payer is a healthcare organization that pays claims, administers insurance or benefit or product. Examples of payers include an insurance company, healthcare professional (HMO), preferred provider organization (PPO), government agency (Medicaid, Medicare etc.) or any organization that may be contracted by one of these former groups. </p><p><b>EDI Payroll Deducted</b>, and another group, <b>Premium Payment for Insurance Products</b> (820), is a transaction set for making a premium payment for insurance products. It can be used to order a financial institution to make a payment to a payee. </p><p><b>EDI Health Care Eligibility/Benefit Inquiry</b> (270) is used to inquire about the health care benefits and eligibility associated with a subscriber or dependent. </p><p><b>EDI Health Care Eligibility/Benefit Response</b> (271) is used to respond to a request inquiry about the health care benefits and eligibility associated with a subscriber or dependent. </p><p><b>EDI Health Care Claim Status Request</b> (276) is a transaction set that can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim. </p><p><b>EDI Health Care Claim Status Notification</b> (277) is a transaction set that can be used by a healthcare payer or authorized agent to notify a provider, recipient or authorized agent regarding the status of a health care claim or encounter, or to request additional information from the provider regarding a health care claim or encounter. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, is not used for account payment posting. The notification is at a summary or service line detail level. The notification may be solicited or unsolicited. </p><p><b>EDI Health Care Service Review Information</b> (278) is a transaction set that can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of the request for review, certification, notification or reporting the outcome of a health care services review. </p><p><b>EDI Functional Acknowledgement Transaction Set</b> (997) is a transaction set that can be used to define the control structures for a set of acknowledgments to indicate the results of the syntactical analysis of the electronically encoded documents. Although it's not specifically named in the HIPAA Legislation or Final Rule, it's necessary for X12 transaction set processing. The encoded documents are the transaction sets, which are grouped in functional groups, used in defining transactions for business data interchange. This standard doesn't cover the semantic meaning of the information encoded in the transaction sets. </p> <div class="mw-heading mw-heading5"><h5 id="Brief_5010_Transactions_and_Code_Sets_Rules_Update_Summary">Brief 5010 Transactions and Code Sets Rules Update Summary</h5><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=10" title="Edit section: Brief 5010 Transactions and Code Sets Rules Update Summary"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ol><li>Transaction Set (997) will be replaced by Transaction Set (999) "acknowledgment report".</li> <li>The size of many fields {segment elements} will be expanded, causing a need for all IT providers to expand corresponding fields, element, files, GUI, paper media, and databases.</li> <li>Some segments have been removed from existing Transaction Sets.</li> <li>Many segments have been added to existing Transaction Sets allowing greater tracking and reporting of cost and patient encounters.</li> <li>Capacity to use both "International Classification of Diseases" versions 9 (ICD-9) and 10 (ICD-10-CM) has been added.<sup id="cite_ref-QhGXQ_57-0" class="reference"><a href="#cite_note-QhGXQ-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-KUKiA_58-0" class="reference"><a href="#cite_note-KUKiA-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup></li></ol> <div class="mw-heading mw-heading4"><h4 id="Security_Rule">Security Rule</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=11" title="Edit section: Security Rule"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Final Rule on Security Standards was issued on February 20, 2003. The Security Rule complements the Privacy Rule. While the Privacy Rule pertains to all Protected Health Information (PHI) including paper and electronic, the Security Rule deals specifically with Electronic Protected Health Information (EPHI). It lays out three types of security safeguards required for compliance: administrative, physical, and technical.<sup id="cite_ref-H5vrg_59-0" class="reference"><a href="#cite_note-H5vrg-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> For each of these types, the Rule identifies various security standards, and for each standard, it names both required and addressable implementation specifications. Required specifications must be adopted and administered as dictated by the Rule. Addressable specifications are more flexible. Individual covered entities can evaluate their own situation and determine the best way to implement addressable specifications. Some privacy advocates have argued that this "flexibility" may provide too much latitude to covered entities.<sup id="cite_ref-u9GsH_60-0" class="reference"><a href="#cite_note-u9GsH-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> Software tools have been developed to assist covered entities in the risk analysis and remediation tracking. The standards and specifications are as follows: </p> <ul><li>Administrative Safeguards – policies and procedures designed to clearly show how the entity will comply with the act <ul><li>Covered entities (entities that must comply with HIPAA requirements) must adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.</li> <li>The policies and procedures must reference management oversight and organizational buy-in to compliance with the documented security controls.</li> <li>Procedures should clearly identify employees or classes of employees who have access to electronic protected health information (EPHI). Access to EPHI must be restricted to only those employees who have a need for it to complete their job function.</li> <li>The procedures must address access authorization, establishment, modification, and termination.</li> <li>Entities must show that an appropriate ongoing training program regarding the handling of PHI is provided to employees performing health plan administrative functions.</li> <li>Covered entities that out-source some of their business processes to a third party must ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor will meet the same data protection requirements that apply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls are in place.</li> <li>A contingency plan should be in place for responding to emergencies. Covered entities are responsible for backing up their data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures.</li> <li>Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based.</li> <li>Procedures should document instructions for addressing and responding to security breaches that are identified either during the audit or the normal course of operations.</li></ul></li> <li>Physical Safeguards – controlling physical access to protect against inappropriate access to protected data <ul><li>Controls must govern the introduction and removal of hardware and software from the network. (When equipment is retired it must be disposed of properly to ensure that PHI is not compromised.)</li> <li>Access to equipment containing health information should be carefully controlled and monitored.</li> <li>Access to hardware and software must be limited to properly authorized individuals.</li> <li>Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.</li> <li>Policies are required to address proper workstation use. Workstations should be removed from high traffic areas and monitor screens should not be in direct view of the public.</li> <li>If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.</li></ul></li> <li>Technical Safeguards – controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient. <ul><li>Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.</li> <li>Each covered entity is responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.</li> <li>Data corroboration, including the use of a checksum, double-keying, message authentication, and digital signature may be used to ensure data integrity.</li> <li>Covered entities must also authenticate entities with which they communicate. Authentication consists of corroborating that an entity is who it claims to be. Examples of corroboration include password systems, two or three-way handshakes, telephone callback, and token systems.</li> <li>Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.</li> <li>In addition to policies and procedures and access records, information technology documentation should also include a written record of all configuration settings on the components of the network because these components are complex, configurable, and always changing.</li> <li>Documented risk analysis and risk management programs are required. Covered entities must carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act's security requirements are a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)</li></ul></li></ul> <div class="mw-heading mw-heading4"><h4 id="Unique_Identifiers_Rule_(National_Provider_Identifier)"><span id="Unique_Identifiers_Rule_.28National_Provider_Identifier.29"></span>Unique Identifiers Rule (National Provider Identifier)</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=12" title="Edit section: Unique Identifiers Rule (National Provider Identifier)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans must use only the National Provider Identifier (NPI) to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008. Effective from May 2006 (May 2007 for small health plans), all covered entities using electronic communications (e.g., physicians, hospitals, health insurance companies, and so forth) must use a single new NPI. The NPI replaces all other identifiers used by health plans, Medicare, Medicaid, and other government programs.<sup id="cite_ref-n5I5D_61-0" class="reference"><a href="#cite_note-n5I5D-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> However, the NPI does not replace a provider's DEA number, state license number, or tax identification number. The NPI is 10 digits (may be alphanumeric), with the last digit being a checksum. The NPI cannot contain any embedded intelligence; in other words, the NPI is simply a number that does not itself have any additional meaning. The NPI is unique and national, never re-used, and except for institutions, a provider usually can have only one. An institution may obtain multiple NPIs for different "sub-parts" such as a free-standing cancer center or rehab facility. </p> <div class="mw-heading mw-heading4"><h4 id="Enforcement_Rule">Enforcement Rule</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=13" title="Edit section: Enforcement Rule"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule sets civil money penalties for violating HIPAA rules and establishes procedures for investigations and hearings for HIPAA violations. For many years there were few prosecutions for violations.<sup id="cite_ref-XLsYb_62-0" class="reference"><a href="#cite_note-XLsYb-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote"><p>This may have changed with the fining of $50,000 to the Hospice of North Idaho (HONI) as the first entity to be fined for a potential HIPAA Security Rule breach affecting fewer than 500 people. Rachel Seeger, a spokeswoman for HHS, stated, "HONI did not conduct an accurate and thorough risk analysis to the confidentiality of ePHI [electronic Protected Health Information] as part of its security management process from 2005 through Jan. 17, 2012." This investigation was initiated with the theft from an employees vehicle of an unencrypted laptop containing 441 patient records.<sup id="cite_ref-0En06_63-0" class="reference"><a href="#cite_note-0En06-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup></p></blockquote> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output .side-box-flex{display:flex;align-items:center}.mw-parser-output .side-box-text{flex:1;min-width:0}}@media(min-width:720px){.mw-parser-output .side-box{width:238px}.mw-parser-output .side-box-right{clear:right;float:right;margin-left:1em}.mw-parser-output .side-box-left{margin-right:1em}}</style><style data-mw-deduplicate="TemplateStyles:r1237033735">@media print{body.ns-0 .mw-parser-output .sistersitebox{display:none!important}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-en-v2.svg"]{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-en-v2.svg"]{background-color:white}}</style><div class="side-box side-box-right plainlinks sistersitebox"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style> <div class="side-box-flex"> <div class="side-box-image"><span class="noviewer" typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/38px-Wikisource-logo.svg.png" decoding="async" width="38" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/57px-Wikisource-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/76px-Wikisource-logo.svg.png 2x" data-file-width="410" data-file-height="430" /></span></span></div> <div class="side-box-text plainlist"><a href="/wiki/Wikisource" title="Wikisource">Wikisource</a> has original text related to this article: <div style="margin-left: 10px;"><b><a href="https://en.wikisource.org/wiki/American_Recovery_and_Reinvestment_Act_of_2009/Division_A/Title_XIII/Subtitle_D" class="extiw" title="wikisource:American Recovery and Reinvestment Act of 2009/Division A/Title XIII/Subtitle D">American Recovery and Reinvestment Act of 2009/Division A/Title XIII/Subtitle D</a></b></div></div></div> </div> <p>As of March 2013, the <a href="/wiki/United_States_Department_of_Health_and_Human_Services" title="United States Department of Health and Human Services">United States Department of Health and Human Services</a> (HHS) has investigated over 19,306 cases that have been resolved by requiring changes in privacy practice or by corrective action. If noncompliance is determined by HHS, entities must apply corrective measures. Complaints have been investigated against many different types of businesses such as national pharmacy chains, major health care centers, insurance groups, hospital chains and other small providers. There were 9,146 cases where the HHS investigation found that HIPAA was followed correctly. There were 44,118 cases that HHS did not find eligible cause for enforcement; for example, a violation that started before HIPAA started; cases withdrawn by the pursuer; or an activity that does not actually violate the Rules. </p> <div class="mw-heading mw-heading3"><h3 id="Title_III:_Tax-related_health_provisions_governing_medical_savings_accounts">Title III: Tax-related health provisions governing medical savings accounts</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=14" title="Edit section: Title III: Tax-related health provisions governing medical savings accounts"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Title III standardizes the amount that may be saved per person in a <a href="/wiki/Medical_savings_account_(United_States)" title="Medical savings account (United States)">pre-tax medical savings account</a>. Beginning in 1997, a medical savings account ("MSA") became available to employees covered under an employer-sponsored high deductible plan, these being small employer and self-employed individuals. </p> <div class="mw-heading mw-heading3"><h3 id="Title_IV:_Application_and_enforcement_of_group_health_insurance_requirements">Title IV: Application and enforcement of group health insurance requirements</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=15" title="Edit section: Title IV: Application and enforcement of group health insurance requirements"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Title IV specifies conditions for group health plans regarding coverage of persons with preexisting conditions, and modifies continuation of coverage requirements. It also clarifies continuation coverage requirements and includes <a href="/wiki/Consolidated_Omnibus_Budget_Reconciliation_Act_of_1985" title="Consolidated Omnibus Budget Reconciliation Act of 1985">COBRA</a> clarification. </p> <div class="mw-heading mw-heading3"><h3 id="Title_V:_Revenue_offset_governing_tax_deductions_for_employers">Title V: Revenue offset governing tax deductions for employers</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=16" title="Edit section: Title V: Revenue offset governing tax deductions for employers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Title V includes provisions related to company-owned life insurance for employers providing company-owned life insurance premiums, prohibiting the tax-deduction of interest on life insurance loans, company endowments, or contracts related to the company. It also repeals the financial institution rule to interest allocation rules. Finally, it amends provisions of law relating to <a href="/wiki/List_of_former_United_States_citizens_who_relinquished_their_nationality" title="List of former United States citizens who relinquished their nationality">people who give up United States citizenship</a> or permanent residence, expanding the <a href="/wiki/Expatriation_tax" title="Expatriation tax">expatriation tax</a> to be assessed against those deemed to be giving up their U.S. status for tax reasons, and making ex-citizens' names part of the <a href="/wiki/Public_record" class="mw-redirect" title="Public record">public record</a> through the creation of the <a href="/wiki/Quarterly_Publication_of_Individuals_Who_Have_Chosen_to_Expatriate" title="Quarterly Publication of Individuals Who Have Chosen to Expatriate">Quarterly Publication of Individuals Who Have Chosen to Expatriate</a>.<sup id="cite_ref-7Qmkv_64-0" class="reference"><a href="#cite_note-7Qmkv-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Effects_on_research_and_clinical_care">Effects on research and clinical care</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=17" title="Edit section: Effects on research and clinical care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The enactment of the Privacy and Security Rules has caused major changes in the way physicians and medical centers operate. The complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. An August 2006 article in the journal <i>Annals of Internal Medicine</i> detailed some such concerns over the implementation and effects of HIPAA.<sup id="cite_ref-annals_65-0" class="reference"><a href="#cite_note-annals-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Effects_on_research">Effects on research</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=18" title="Edit section: Effects on research"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting them for follow-up. A study from the <a href="/wiki/University_of_Michigan" title="University of Michigan">University of Michigan</a> demonstrated that implementation of the HIPAA Privacy rule resulted in a drop from 96% to 34% in the proportion of follow-up surveys completed by study patients being followed after a <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">heart attack</a>.<sup id="cite_ref-s2fYj_66-0" class="reference"><a href="#cite_note-s2fYj-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> Another study, detailing the effects of HIPAA on recruitment for a study on cancer prevention, demonstrated that HIPAA-mandated changes led to a 73% decrease in patient accrual, a tripling of time spent recruiting patients, and a tripling of mean recruitment costs.<sup id="cite_ref-W1Awg_67-0" class="reference"><a href="#cite_note-W1Awg-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p><p>Under HIPAA, <a href="/wiki/Informed_consent" title="Informed consent">informed consent</a> forms for research studies must document how protected health information will be kept private, potentially increasing barriers to participation.<sup id="cite_ref-annals_65-1" class="reference"><a href="#cite_note-annals-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p><p>These data suggest that HIPAA privacy rules may have negative effects on the cost and quality of <a href="/wiki/Medical_research" title="Medical research">medical research</a>. Dr. Kim Eagle, professor of <a href="/wiki/Internal_medicine" title="Internal medicine">internal medicine</a> at the University of Michigan, was quoted in the <i>Annals</i> article as saying, "Privacy is important, but research is also important for improving care. We hope that we will figure this out and do it right."<sup id="cite_ref-annals_65-2" class="reference"><a href="#cite_note-annals-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Effects_on_clinical_care">Effects on clinical care</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=19" title="Edit section: Effects on clinical care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their legal privacy responsibilities and often responded with an overly guarded approach to disclosing information ... than necessary to ensure compliance with the Privacy rule".<sup id="cite_ref-annals_65-3" class="reference"><a href="#cite_note-annals-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> Reports of this uncertainty continue.<sup id="cite_ref-gEGT2_68-0" class="reference"><a href="#cite_note-gEGT2-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Costs_of_implementation">Costs of implementation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=20" title="Edit section: Costs of implementation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the period immediately before the enactment of the HIPAA Privacy and Security Acts, medical centers and medical practices were charged with complying with the new requirements. Many practices and centers turned to private consultants for compliance assistance.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (March 2024)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Education_and_training">Education and training</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=21" title="Edit section: Education and training"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Education and training of healthcare providers is a requirement for correct implementation of both the HIPAA Privacy Rule and Security Rule.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-70" class="reference"><a href="#cite_note-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> </p><p><span class="anchor" id="HIPPA"></span><span class="anchor" id="HIPAA_acronym"></span> </p> <div class="mw-heading mw-heading2"><h2 id="Misspelling_as_HIPPA">Misspelling as <i>HIPPA</i></h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=22" title="Edit section: Misspelling as HIPPA"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1224211176">.mw-parser-output .quotebox{background-color:#F9F9F9;border:1px solid #aaa;box-sizing:border-box;padding:10px;font-size:88%;max-width:100%}.mw-parser-output .quotebox.floatleft{margin:.5em 1.4em .8em 0}.mw-parser-output .quotebox.floatright{margin:.5em 0 .8em 1.4em}.mw-parser-output .quotebox.centered{overflow:hidden;position:relative;margin:.5em auto .8em auto}.mw-parser-output .quotebox.floatleft span,.mw-parser-output .quotebox.floatright span{font-style:inherit}.mw-parser-output .quotebox>blockquote{margin:0;padding:0;border-left:0;font-family:inherit;font-size:inherit}.mw-parser-output .quotebox-title{text-align:center;font-size:110%;font-weight:bold}.mw-parser-output .quotebox-quote>:first-child{margin-top:0}.mw-parser-output .quotebox-quote:last-child>:last-child{margin-bottom:0}.mw-parser-output .quotebox-quote.quoted:before{font-family:"Times New Roman",serif;font-weight:bold;font-size:large;color:gray;content:" “ ";vertical-align:-45%;line-height:0}.mw-parser-output .quotebox-quote.quoted:after{font-family:"Times New Roman",serif;font-weight:bold;font-size:large;color:gray;content:" ” ";line-height:0}.mw-parser-output .quotebox .left-aligned{text-align:left}.mw-parser-output .quotebox .right-aligned{text-align:right}.mw-parser-output .quotebox .center-aligned{text-align:center}.mw-parser-output .quotebox .quote-title,.mw-parser-output .quotebox .quotebox-quote{display:block}.mw-parser-output .quotebox cite{display:block;font-style:normal}@media screen and (max-width:640px){.mw-parser-output .quotebox{width:100%!important;margin:0 0 .8em!important;float:none!important}}</style><div class="quotebox pullquote floatright" style="width:30%; ;"> <blockquote class="quotebox-quote left-aligned" style=""> <p>"People make up what that acronym stands for." </p> </blockquote> <p style="padding-bottom: 0;"><cite class="left-aligned" style="">Deven McGraw, former <a href="/wiki/United_States_Department_of_Health_and_Human_Services" title="United States Department of Health and Human Services">HHS</a> deputy director, as quoted in <i><a href="/wiki/Vox_(website)" title="Vox (website)">Vox</a></i><sup id="cite_ref-morrison_71-0" class="reference"><a href="#cite_note-morrison-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup></cite></p> </div> <p>Although the acronym <i>HIPAA</i> matches the title of the 1996 Public Law 104-191, <i>Health Insurance Portability and Accountability Act</i>, HIPAA is sometimes incorrectly referred to as <i>HIPPA</i>, variously said to refer to the "Health Information Privacy and Portability Act",<sup id="cite_ref-COURT.HIPPA_72-0" class="reference"><a href="#cite_note-COURT.HIPPA-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-bBi5I_73-0" class="reference"><a href="#cite_note-bBi5I-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> "Health Information Privacy Protection Act",<sup id="cite_ref-morrison_71-1" class="reference"><a href="#cite_note-morrison-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> or "Health Insurance Privacy and Protection Act".<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> The <i>HIPPA</i> misspelling has been observed among <a href="/wiki/COVID-19_scammers" class="mw-redirect" title="COVID-19 scammers">COVID-19 scammers</a>.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Violations">Violations</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=23" title="Edit section: Violations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Hipaa_Violations_by_Type_-_Pie_Chart.png" class="mw-file-description"><img alt="HIPAA Chart illustrating HIPAA violations by Type" src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Hipaa_Violations_by_Type_-_Pie_Chart.png/220px-Hipaa_Violations_by_Type_-_Pie_Chart.png" decoding="async" width="220" height="211" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Hipaa_Violations_by_Type_-_Pie_Chart.png/330px-Hipaa_Violations_by_Type_-_Pie_Chart.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Hipaa_Violations_by_Type_-_Pie_Chart.png/440px-Hipaa_Violations_by_Type_-_Pie_Chart.png 2x" data-file-width="487" data-file-height="466" /></a><figcaption>A breakdown of the HIPAA violations that resulted in the illegal exposure of personal information.</figcaption></figure> <p>According to the US Department of Health and Human Services Office for Civil Rights, between April 2003 and January 2013, it received 91,000 complaints of HIPAA violations, in which 22,000 led to enforcement actions of varying kinds (from settlements to fines) and 521 led to referrals to the US Department of Justice as criminal actions.<sup id="cite_ref-mF2Hl_76-0" class="reference"><a href="#cite_note-mF2Hl-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> Examples of significant breaches of protected information and other HIPAA violations include: </p> <ul><li>The largest loss of data that affected 4.9 million people by Tricare Management of Virginia in 2011<sup id="cite_ref-OLON5_77-0" class="reference"><a href="#cite_note-OLON5-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup></li> <li>The largest fines of $5.5 million levied against Memorial Healthcare Systems in 2017 for accessing confidential information of 115,143 patients and of $4.3 million levied against Cignet Health of Maryland in 2010 for ignoring patients' requests to obtain copies of their own records and repeated ignoring of federal officials' inquiries<sup id="cite_ref-Gp2Kt_78-0" class="reference"><a href="#cite_note-Gp2Kt-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup></li> <li>The first criminal indictment was lodged in 2011 against a Virginia physician who shared information with a patient's employer "under the false pretenses that the patient was a serious and imminent threat to the safety of the public, when in fact he knew that the patient was not such a threat."<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2023)">citation needed</span></a></i>]</sup></li></ul> <p>According to Koczkodaj et al., 2018,<sup id="cite_ref-UibEC_79-0" class="reference"><a href="#cite_note-UibEC-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> the total number of individuals affected since October 2009 is 173,398,820. </p><p>The differences between civil and criminal penalties are summarized in the following table: </p> <table class="wikitable"> <tbody><tr> <th>Type of Violation</th> <th>CIVIL Penalty (min)</th> <th>CIVIL Penalty (max) </th></tr> <tr> <td>Individual did not know (and by exercising reasonable diligence would not have known) that he/she violated HIPAA</td> <td>$100 per violation, with an annual maximum of $25,000 for repeat violations</td> <td>$50,000 per violation, with an annual maximum of $1.5 million </td></tr> <tr> <td>HIPAA violation due to reasonable cause and not due to willful neglect</td> <td>$1,000 per violation, with an annual maximum of $100,000 for repeat violations</td> <td>$50,000 per violation, with an annual maximum of $1.5 million </td></tr> <tr> <td>HIPAA violation due to willful neglect but violation is corrected within the required time period</td> <td>$10,000 per violation, with an annual maximum of $250,000 for repeat violations</td> <td>$50,000 per violation, with an annual maximum of $1.5 million </td></tr> <tr> <td>HIPAA violation is due to willful neglect and is not corrected</td> <td>$50,000 per violation, with an annual maximum of $1,000,000</td> <td>$50,000 per violation, with an annual maximum of $1.5 million </td></tr> <tr> <th>Type of Violation</th> <th>CRIMINAL Penalty </th></tr> <tr> <td>Covered entities and specified individuals who "knowingly" obtain or disclose individually identifiable health information</td> <td>A fine of up to $50,000 <p>Imprisonment up to 1 year </p> </td></tr> <tr> <td>Offenses committed under false pretenses</td> <td>A fine of up to $100,000 <p>Imprisonment up to 5 years </p> </td></tr> <tr> <td>Offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or malicious harm</td> <td>A fine of up to $250,000 <p>Imprisonment up to 10 years </p> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Legislative_information">Legislative information</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=24" title="Edit section: Legislative information"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 1994, President Clinton expressed his goals to improve the healthcare system. However, his reforms did not succeed, most likely due to lack of support.<sup id="cite_ref-:0_80-0" class="reference"><a href="#cite_note-:0-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> The Congressional Quarterly Almanac of 1996 explains how two senators, <a href="/wiki/Nancy_Kassebaum" title="Nancy Kassebaum">Nancy Kassebaum</a> (R-KS) and <a href="/wiki/Ted_Kennedy" title="Ted Kennedy">Ted Kennedy</a> (D-MA) came together and created a bill called the Health Insurance Reform Act of 1995 or more commonly known as the Kassebaum-Kennedy Bill.<sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup> This bill was stalled despite making it out of the Senate. In the 1996 State of the Union address, Clinton pressed the issue, and it resulted in bipartisan cooperation.<sup id="cite_ref-:0_80-1" class="reference"><a href="#cite_note-:0-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> After much debate and negotiation, there was a shift in momentum once a compromise between Kennedy and <a href="/wiki/United_States_House_Committee_on_Ways_and_Means" title="United States House Committee on Ways and Means">Ways and Means Committee</a> Chairman <a href="/wiki/Bill_Archer" title="Bill Archer">Bill Archer</a> was accepted, after alterations were made of the original Kassebaum-Kennedy Bill.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> Soon after this, the bill was signed into law by President Clinton and was named the Health Insurance Portability and Accountability Act of 1996 (HIPAA). </p> <ul><li><a href="/wiki/Act_of_Congress#Public_law,_private_law,_designation" title="Act of Congress"><abbr title="Public Law">Pub. L.</abbr></a> <a rel="nofollow" class="external text" href="https://www.govinfo.gov/link/plaw/104/public/191?link-type=html">104–191 (text)</a> <a rel="nofollow" class="external text" href="https://www.govinfo.gov/link/plaw/104/public/191?link-type=pdf&.pdf">(PDF)</a>, 110 <a href="/wiki/United_States_Statutes_at_Large" title="United States Statutes at Large">Stat.</a> <a rel="nofollow" class="external text" href="https://legislink.org/us/stat-110-1936">1936</a></li> <li><a rel="nofollow" class="external text" href="https://www.congress.gov/bill/104th-congress/house-bill/3103">H.R. 3103</a>; H. Rept. 104–469, part 1; H. Rept. 104-736</li> <li><a rel="nofollow" class="external text" href="https://www.congress.gov/bill/104th-congress/senate-bill/1028">S. 1028</a>; <a rel="nofollow" class="external text" href="https://www.congress.gov/bill/104th-congress/senate-bill/1698">S. 1698</a>; S. Rept. 104-156</li> <li><a href="/wiki/United_States_Department_of_Health_and_Human_Services" title="United States Department of Health and Human Services">HHS</a> Security Standards, <span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/part-160">160</a></span>, <span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/part-162">162</a></span>, and <span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/part-164">164</a></span></li> <li>HHS Standards for Privacy of Individually Identifiable Health Information, <span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/part-160">160</a></span> and <span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/part-164">164</a></span></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_Insurance_Portability_and_Accountability_Act&action=edit&section=25" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-Atchinson/Fox-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-Atchinson/Fox_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFAtchinsonFox1997" class="citation journal cs1">Atchinson, Brian K.; Fox, Daniel M. (May–June 1997). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20140116195505/http://www.library.armstrong.edu/eres/docs/eres/MHSA8635-1_CROSBY/8635_week2_HIPAA_politics.pdf">"The Politics Of The Health Insurance Portability And Accountability Act"</a> <span class="cs1-format">(PDF)</span>. <i><a href="/wiki/Health_Affairs" title="Health Affairs">Health Affairs</a></i>. <b>16</b> (3): 146–150. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1377%2Fhlthaff.16.3.146">10.1377/hlthaff.16.3.146</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9141331">9141331</a>. Archived from <a rel="nofollow" class="external text" href="http://www.library.armstrong.edu/eres/docs/eres/MHSA8635-1_CROSBY/8635_week2_HIPAA_politics.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 2014-01-16<span class="reference-accessdate">. Retrieved <span class="nowrap">2014-01-16</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Health+Affairs&rft.atitle=The+Politics+Of+The+Health+Insurance+Portability+And+Accountability+Act&rft.volume=16&rft.issue=3&rft.pages=146-150&rft.date=1997-05%2F1997-06&rft_id=info%3Adoi%2F10.1377%2Fhlthaff.16.3.146&rft_id=info%3Apmid%2F9141331&rft.aulast=Atchinson&rft.aufirst=Brian+K.&rft.au=Fox%2C+Daniel+M.&rft_id=http%3A%2F%2Fwww.library.armstrong.edu%2Feres%2Fdocs%2Feres%2FMHSA8635-1_CROSBY%2F8635_week2_HIPAA_politics.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-WjE7g-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-WjE7g_2-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.gpo.gov/fdsys/pkg/BILLS-104s1028is/pdf/BILLS-104s1028is.pdf">"104th Congress, 1st Session, S.1028"</a> <span class="cs1-format">(PDF)</span>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20120616142528/http://www.gpo.gov/fdsys/pkg/BILLS-104s1028is/pdf/BILLS-104s1028is.pdf">Archived</a> <span class="cs1-format">(PDF)</span> from the original on 2012-06-16.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=104th+Congress%2C+1st+Session%2C+S.1028&rft_id=http%3A%2F%2Fwww.gpo.gov%2Ffdsys%2Fpkg%2FBILLS-104s1028is%2Fpdf%2FBILLS-104s1028is.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1">"Health insurance portability and accountability act of 1996". <i>Public Law</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Public+Law&rft.atitle=Health+insurance+portability+and+accountability+act+of+1996&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFEdemekongAnnamarajuHaydel2023" class="citation cs2">Edemekong, Peter F.; Annamaraju, Pavan; Haydel, Micelle J. 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Evidence from the Pre-HIPAA Era"</a>. <i>Southern Economic Journal</i>. <b>70</b> (4): 953–976. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.2307%2F4135282">10.2307/4135282</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0038-4038">0038-4038</a>. <a href="/wiki/JSTOR_(identifier)" class="mw-redirect" title="JSTOR (identifier)">JSTOR</a> <a rel="nofollow" class="external text" href="https://www.jstor.org/stable/4135282">4135282</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Southern+Economic+Journal&rft.atitle=Is+There+Job+Lock%3F+Evidence+from+the+Pre-HIPAA+Era&rft.volume=70&rft.issue=4&rft.pages=953-976&rft.date=2004&rft.issn=0038-4038&rft_id=https%3A%2F%2Fwww.jstor.org%2Fstable%2F4135282%23id-name%3DJSTOR&rft_id=info%3Adoi%2F10.2307%2F4135282&rft.aulast=Berger&rft.aufirst=Mark+C.&rft.au=Black%2C+Dan+A.&rft.au=Scott%2C+Frank+A.&rft_id=https%3A%2F%2Fwww.jstor.org%2Fstable%2F4135282&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.dhcs.ca.gov/formsandpubs/laws/hipaa/Pages/1.10HIPAATitleInformation.aspx">"HIPAA Title Information"</a>. <i>www.dhcs.ca.gov</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2021-10-31</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.dhcs.ca.gov&rft.atitle=HIPAA+Title+Information&rft_id=https%3A%2F%2Fwww.dhcs.ca.gov%2Fformsandpubs%2Flaws%2Fhipaa%2FPages%2F1.10HIPAATitleInformation.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-IyyXk-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-IyyXk_10-0">^</a></b></span> <span class="reference-text"><span class="plainlinksneverexpand"><a href="/wiki/Title_29_of_the_United_States_Code" title="Title 29 of the United States Code">29 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/29/1181.html">§ 1181(a)(2)</a></span></span> </li> <li id="cite_note-ZBui3-11"><span class="mw-cite-backlink"><b><a href="#cite_ref-ZBui3_11-0">^</a></b></span> <span class="reference-text"><span class="plainlinksneverexpand"><a href="/wiki/Title_29_of_the_United_States_Code" title="Title 29 of the United States Code">29 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/29/1181.html">§ 1181(a)(3)</a></span></span> </li> <li id="cite_note-SNKGE-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-SNKGE_12-0">^</a></b></span> <span class="reference-text"><span class="plainlinksneverexpand"><a href="/wiki/Title_29_of_the_United_States_Code" title="Title 29 of the United States Code">29 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/29/1181.html">§ 1181(c)(1)</a></span></span> </li> <li id="cite_note-zC46r-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-zC46r_13-0">^</a></b></span> <span class="reference-text"><span class="plainlinksneverexpand"><a href="/wiki/Title_29_of_the_United_States_Code" title="Title 29 of the United States Code">29 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/29/1181.html">§ 1181(c)(2)(A)</a></span></span> </li> <li id="cite_note-HMoEZ-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-HMoEZ_14-0">^</a></b></span> <span class="reference-text">(Sub B Sec 111)</span> </li> <li id="cite_note-6NTTk-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-6NTTk_15-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1"><a rel="nofollow" class="external text" href="https://dx.doi.org/10.4135/9781529727890">"HIPAA for Healthcare Workers: The Privacy Rule"</a>. 2014. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.4135%2F9781529727890">10.4135/9781529727890</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=HIPAA+for+Healthcare+Workers%3A+The+Privacy+Rule&rft.date=2014&rft_id=info%3Adoi%2F10.4135%2F9781529727890&rft_id=http%3A%2F%2Fdx.doi.org%2F10.4135%2F9781529727890&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span> <span class="cs1-visible-error citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_journal" title="Template:Cite journal">cite journal</a>}}</code>: </span><span class="cs1-visible-error citation-comment">Cite journal requires <code class="cs1-code">|journal=</code> (<a href="/wiki/Help:CS1_errors#missing_periodical" title="Help:CS1 errors">help</a>)</span></span> </li> <li id="cite_note-LB0fN-16"><span class="mw-cite-backlink"><b><a href="#cite_ref-LB0fN_16-0">^</a></b></span> <span class="reference-text"><a href="/wiki/Title_42_of_the_United_States_Code" title="Title 42 of the United States Code">42 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/text/42/1320a-7c">§ 1320a-7c</a></span> </li> <li id="cite_note-Iu5AU-17"><span class="mw-cite-backlink"><b><a href="#cite_ref-Iu5AU_17-0">^</a></b></span> <span class="reference-text"><a href="/wiki/Title_42_of_the_United_States_Code" title="Title 42 of the United States Code">42 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/text/42/1395ddd">§ 1395ddd</a></span> </li> <li id="cite_note-668st-18"><span class="mw-cite-backlink"><b><a href="#cite_ref-668st_18-0">^</a></b></span> <span class="reference-text"><a href="/wiki/Title_42_of_the_United_States_Code" title="Title 42 of the United States Code">42 U.S.C.</a> <a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/text/42/1395b-5">§ 1395b-5</a></span> </li> <li id="cite_note-auto-19"><span class="mw-cite-backlink">^ <a href="#cite_ref-auto_19-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-auto_19-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.law.cornell.edu/uscode/text/42/1395ddd">"42 U.S. Code § 1395ddd - Medicare Integrity Program"</a>. <i>LII / Legal Information Institute</i>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20180321192516/https://www.law.cornell.edu/uscode/text/42/1395ddd">Archived</a> from the original on 2018-03-21<span class="reference-accessdate">. Retrieved <span class="nowrap">2018-03-21</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=LII+%2F+Legal+Information+Institute&rft.atitle=42+U.S.+Code+%C2%A7+1395ddd+-+Medicare+Integrity+Program&rft_id=https%3A%2F%2Fwww.law.cornell.edu%2Fuscode%2Ftext%2F42%2F1395ddd&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-CodeFedReg|45|160|103-20"><span class="mw-cite-backlink">^ <a href="#cite_ref-CodeFedReg|45|160|103_20-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CodeFedReg|45|160|103_20-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/section-160.103">160.103</a></span></span> </li> <li id="cite_note-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-21">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.hhs.gov/hipaa/for-professionals/other-administration-simplification-rules/index.html">"Other Administrative Simplification Rules"</a>. 4 December 2015.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Other+Administrative+Simplification+Rules&rft.date=2015-12-04&rft_id=https%3A%2F%2Fwww.hhs.gov%2Fhipaa%2Ffor-professionals%2Fother-administration-simplification-rules%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-d07T8-22"><span class="mw-cite-backlink"><b><a href="#cite_ref-d07T8_22-0">^</a></b></span> <span class="reference-text">Terry, Ken <a rel="nofollow" class="external text" href="http://www.physicianspractice.com/articles/patient-privacy-—-new-threats">"Patient Privacy - The New Threats"</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20151120220654/http://www.physicianspractice.com/articles/patient-privacy-%E2%80%94-new-threats">Archived</a> 2015-11-20 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> <i>Physicians Practice</i> journal, volume 19, number 3, year 2009, access date July 2, 2009</span> </li> <li id="cite_note-1YiYW-23"><span class="mw-cite-backlink"><b><a href="#cite_ref-1YiYW_23-0">^</a></b></span> <span class="reference-text">See <a rel="nofollow" class="external text" href="http://www.medlawplus.com/library/legal/hipaaprivacyreg.htm">45 CFR Sections 160.102 and 160.103</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20120112115921/http://www.medlawplus.com/library/legal/hipaaprivacyreg.htm">Archived</a> 2012-01-12 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a>.</span> </li> <li id="cite_note-tY5YO-24"><span class="mw-cite-backlink"><b><a href="#cite_ref-tY5YO_24-0">^</a></b></span> <span class="reference-text"><span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/section-164.524">164.524</a></span></span> </li> <li id="cite_note-gTkXU-25"><span class="mw-cite-backlink"><b><a href="#cite_ref-gTkXU_25-0">^</a></b></span> <span class="reference-text"><span><a href="/wiki/Title_45_of_the_Code_of_Federal_Regulations" title="Title 45 of the Code of Federal Regulations">45 CFR</a> <a rel="nofollow" class="external text" href="https://www.ecfr.gov/current/title-45/section-164.512">164.512</a></span></span> </li> <li id="cite_note-CYZ6i-26"><span class="mw-cite-backlink"><b><a href="#cite_ref-CYZ6i_26-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREF(OCR)2008" class="citation web cs1">(OCR), Office for Civil Rights (7 May 2008). <a rel="nofollow" class="external text" href="https://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html">"Summary of the HIPAA Privacy Rule"</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20151206123936/http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html">Archived</a> from the original on 6 December 2015.</cite><span 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Retrieved <span class="nowrap">2021-10-10</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.limswiki.org&rft.atitle=Health+Insurance+Portability+and+Accountability+Act+-+LIMSWiki&rft_id=https%3A%2F%2Fwww.limswiki.org%2Findex.php%2FHealth_Insurance_Portability_and_Accountability_Act%23cite_note-CQHIPAAHist-2&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-81"><span class="mw-cite-backlink"><b><a href="#cite_ref-81">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCade1951" class="citation journal cs1">Cade, Dozier C. (1951). <a rel="nofollow" class="external text" href="https://dx.doi.org/10.1177/107769905102800313">"Book Review: Congressional Quarterly Almanac: 81st Congress, 2nd Session. Vol. VI"</a>. <i>Journalism Quarterly</i>. <b>28</b> (3): 389–390. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F107769905102800313">10.1177/107769905102800313</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0022-5533">0022-5533</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:164443756">164443756</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journalism+Quarterly&rft.atitle=Book+Review%3A+Congressional+Quarterly+Almanac%3A+81st+Congress%2C+2nd+Session.+Vol.+VI.&rft.volume=28&rft.issue=3&rft.pages=389-390&rft.date=1951&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A164443756%23id-name%3DS2CID&rft.issn=0022-5533&rft_id=info%3Adoi%2F10.1177%2F107769905102800313&rft.aulast=Cade&rft.aufirst=Dozier+C.&rft_id=http%3A%2F%2Fdx.doi.org%2F10.1177%2F107769905102800313&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHealth+Insurance+Portability+and+Accountability+Act" class="Z3988"></span></span> </li> <li id="cite_note-82"><span class="mw-cite-backlink"><b><a href="#cite_ref-82">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20211010203324/https://www.colleaga.org/article/health-insurance-portability-and-accountability-act-hipaa">"The Health Insurance Portability and Accountability Act (HIPAA) | Colleaga"</a>. <i>www.colleaga.org</i>. 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href="http://www.ohii.ca.gov/calohi/PrivacySecurity/HIPAA.aspx">California Office of HIPAA Implementation</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20121101095424/http://www.ohii.ca.gov/calohi/PrivacySecurity/HIPAA.aspx">Archived</a> 2012-11-01 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> (CalOHI)</li> <li><a rel="nofollow" class="external text" href="https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html">"HIPAA"</a>, Centers for Medicare and Medicaid Services (CMS)</li> <li><a rel="nofollow" class="external text" href="https://digital.library.unt.edu/govdocs/crs/search/?q=hipaa&t=fulltext">Congressional Research Service (CRS) reports regarding HIPAA</a>, University of North Texas Libraries</li> <li><a rel="nofollow" class="external text" href="https://www.gpo.gov/fdsys/search/pagedetails.action?granuleId=CRPT-104hrpt736&packageId=CRPT-104hrpt736">Full text of the Health 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href="/wiki/Insurance" title="Insurance">Insurance</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Types of <br />insurance</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Health_insurance" title="Health insurance">Health</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Accident_insurance" title="Accident insurance">Accident</a></li> <li><a href="/wiki/Accidental_death_and_dismemberment_insurance" title="Accidental death and dismemberment insurance">Accidental death and dismemberment</a></li> <li><a href="/wiki/Dental_insurance" title="Dental insurance">Dental</a></li> <li><a href="/wiki/Disability_insurance" title="Disability 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href="/wiki/Bond_insurance" title="Bond insurance">Bond</a></li> <li><a href="/wiki/Business_interruption_insurance" title="Business interruption insurance">Business interruption</a></li> <li><a href="/wiki/Business_owner%27s_policy" title="Business owner's policy">Business owner</a></li> <li><a href="/wiki/Collateral_protection_insurance" title="Collateral protection insurance">Collateral protection</a></li> <li><a href="/wiki/Directors_and_officers_liability_insurance" title="Directors and officers liability insurance">Directors and officers liability</a></li> <li><a href="/wiki/Fidelity_bond" title="Fidelity bond">Fidelity</a></li> <li><a href="/wiki/Over-redemption_insurance" title="Over-redemption insurance">Over-redemption</a></li> <li><a href="/wiki/Payment_protection_insurance" title="Payment protection insurance">Payment protection</a></li> <li><a href="/wiki/Pollution_insurance" title="Pollution insurance">Pollution</a></li> <li><a href="/wiki/Professional_liability_insurance" title="Professional liability insurance">Professional liability</a></li> <li><a href="/wiki/Protection_and_indemnity_insurance" title="Protection and indemnity insurance">Protection and indemnity</a></li> <li><a href="/wiki/Surety" title="Surety">Surety</a></li> <li><a href="/wiki/Trade_credit_insurance" title="Trade credit insurance">Trade credit</a></li> <li><a href="/wiki/Umbrella_insurance" title="Umbrella insurance">Umbrella</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Residential</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Boiler_insurance" class="mw-redirect" title="Boiler insurance">Boiler</a></li> <li><a href="/wiki/Builder%27s_risk_insurance" title="Builder's risk insurance">Builder's risk</a></li> <li><a href="/wiki/Contents_insurance" title="Contents insurance">Contents</a></li> <li><a href="/wiki/Earthquake_insurance" title="Earthquake insurance">Earthquake</a></li> <li><a href="/wiki/Flood_insurance" title="Flood insurance">Flood</a></li> <li><a href="/wiki/Home_insurance" title="Home insurance">Home</a></li> <li><a href="/wiki/Landlords%27_insurance" title="Landlords' insurance">Landlords'</a></li> <li><a href="/wiki/Lenders_mortgage_insurance" title="Lenders mortgage insurance">Lenders mortgage</a></li> <li><a href="/wiki/Mortgage_insurance" title="Mortgage insurance">Mortgage</a></li> <li><a href="/wiki/Property_insurance" title="Property insurance">Property</a></li> <li><a href="/wiki/Renters%27_insurance" title="Renters' insurance">Renters'</a></li> <li><a href="/wiki/Title_insurance" title="Title insurance">Title</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Transport/<br />Communication</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aviation_insurance" title="Aviation insurance">Aviation</a></li> <li><a href="/wiki/GAP_insurance" title="GAP insurance">GAP insurance</a></li> <li><a href="/wiki/Inland_marine_insurance" title="Inland marine insurance">Inland marine</a></li> <li><a href="/wiki/Public_auto_insurance" title="Public auto insurance">Public auto</a></li> <li><a href="/wiki/Marine_insurance" title="Marine insurance">Marine</a></li> <li><a href="/wiki/Satellite_insurance" title="Satellite insurance">Satellite</a></li> <li><a href="/wiki/Shipping_insurance" title="Shipping insurance">Shipping</a></li> <li><a href="/wiki/Travel_insurance" title="Travel insurance">Travel</a></li> <li><a href="/wiki/Vehicle_insurance" title="Vehicle insurance">Vehicle</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Reinsurance" title="Reinsurance">Reinsurance</a> <ul><li><a href="/wiki/Catastrophe_bond" title="Catastrophe bond">Catastrophe bond</a></li> <li><a href="/wiki/Insurance-linked_security" title="Insurance-linked security">Insurance-linked securities</a></li></ul></li> <li><a href="/wiki/Casualty_insurance" title="Casualty insurance">Casualty</a></li> <li><a href="/wiki/Climate_risk_insurance" title="Climate risk insurance">Climate risk</a></li> <li><a href="/wiki/Insurance#Casualty_insurance" title="Insurance">Crime</a></li> <li><a href="/wiki/Crop_insurance" title="Crop insurance">Crop</a> <ul><li><a href="/wiki/Catastrophic_crop_insurance" title="Catastrophic crop insurance">Catastrophic</a></li> <li><a href="/wiki/Multi-peril_crop_insurance" title="Multi-peril crop insurance">Multi-peril</a></li></ul></li> <li><a href="/wiki/Cyber_insurance" title="Cyber insurance">Cyber</a></li> <li><a href="/wiki/Deposit_insurance" title="Deposit insurance">Deposit</a></li> <li><a href="/wiki/Expatriate_insurance" title="Expatriate insurance">Expatriate</a></li> <li><a href="/wiki/Extended_warranty" title="Extended warranty">Extended warranty</a></li> <li><a href="/wiki/Group_insurance" title="Group insurance">Group</a></li> <li><a href="/wiki/Index-based_insurance" title="Index-based insurance">Index-based</a> <ul><li><a href="/wiki/Parametric_insurance" title="Parametric insurance">Parametric</a></li></ul></li> <li><a href="/wiki/Interest_rate_insurance" title="Interest rate insurance">Interest rate</a></li> <li><a href="/wiki/Kidnap_and_ransom_insurance" title="Kidnap and ransom insurance">Kidnap and ransom</a></li> <li><a href="/wiki/Legal_expenses_insurance" title="Legal expenses insurance">Legal expenses</a></li> <li><a href="/wiki/Liability_insurance" title="Liability insurance">Liability</a></li> <li><a href="/wiki/No-fault_insurance" title="No-fault insurance">No-fault</a></li> <li><a href="/wiki/Pet_insurance" title="Pet insurance">Pet</a></li> <li><a href="/wiki/Political_risk_insurance" title="Political risk insurance">Political risk</a></li> <li><a href="/wiki/Prize_indemnity_insurance" title="Prize indemnity insurance">Prize indemnity</a></li> <li><a href="/wiki/Takaful" title="Takaful">Takaful</a></li> <li><a href="/wiki/Terrorism_insurance" title="Terrorism insurance">Terrorism</a></li> <li><a href="/wiki/Tuition_insurance" title="Tuition insurance">Tuition</a></li> <li><a href="/wiki/War_risk_insurance" title="War risk insurance">War risk</a></li> <li><a href="/wiki/Weather_insurance" title="Weather insurance">Weather</a></li> <li><a href="/wiki/Workers%27_compensation" title="Workers' compensation">Workers' compensation</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Insurance_policy" title="Insurance policy">Insurance <br />policy</a> <br />and <a href="/wiki/Insurance_law" title="Insurance law">law</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Act_of_God" title="Act of God">Act of God</a></li> <li><a href="/wiki/Actuarial_science" title="Actuarial science">Actuarial science</a> <ul><li><a href="/wiki/Actuary" title="Actuary">Actuary</a></li> <li><a href="/wiki/Adverse_selection" title="Adverse selection">Adverse selection</a></li> <li><a href="/wiki/Risk" title="Risk">Risk</a></li> <li><a href="/wiki/Risk_assessment" title="Risk assessment">Risk assessment</a></li> <li><a href="/wiki/Risk_management" title="Risk management">Risk management</a></li> <li><a href="/wiki/Uncertainty" title="Uncertainty">Uncertainty</a>/<a href="/wiki/Knightian_uncertainty" title="Knightian uncertainty">Knightian</a></li> <li><a href="/wiki/Value_of_life" title="Value of life">Value of life</a></li></ul></li> <li><a href="/wiki/Actual_cash_value" title="Actual cash value">Actual cash value</a></li> <li><a href="/wiki/Cash_value" title="Cash value">Cash value</a></li> <li><a href="/wiki/Insurance_broker" title="Insurance broker">Broker</a></li> <li><a href="/wiki/Cancellation_(insurance)" title="Cancellation (insurance)">Cancellation</a> <ul><li><i><a href="/wiki/Pro_rata" title="Pro rata">Pro rata</a></i></li> <li>Short rate table</li></ul></li> <li><a href="/wiki/Cause_of_action" title="Cause of action">Claim</a> <ul><li><a href="/wiki/Claims_adjuster" class="mw-redirect" title="Claims adjuster">Claims adjuster</a></li></ul></li> <li><a href="/wiki/Deductible" title="Deductible">Deductible</a> <ul><li><a href="/wiki/Co-insurance" title="Co-insurance">Co-insurance</a></li> <li><a href="/wiki/Copayment" title="Copayment">Copayment</a></li> <li><a href="/wiki/Out-of-pocket_expense" title="Out-of-pocket expense">Out-of-pocket expense</a></li></ul></li> <li><a href="/wiki/Explanation_of_benefits" title="Explanation of benefits">Explanation of benefits</a></li> <li><i><a href="/wiki/Force_majeure" title="Force majeure">Force majeure</a></i></li> <li><a href="/wiki/General_average" title="General average">General average</a></li> <li><a href="/wiki/Indemnity" title="Indemnity">Indemnity</a></li> <li><a href="/wiki/Insurability" title="Insurability">Insurability</a></li> <li><a href="/wiki/Insurable_interest" title="Insurable interest">Insurable interest</a></li> <li><a href="/wiki/Insurance_fraud" title="Insurance fraud">Insurance fraud</a></li> <li><a href="/wiki/Proximate_cause" title="Proximate cause">Proximate cause</a></li> <li><a href="/wiki/Replacement_value" title="Replacement value">Replacement value</a></li> <li><a href="/wiki/Risk_pool" title="Risk pool">Risk pool</a></li> <li><a href="/wiki/Self-insurance" title="Self-insurance">Self-insurance</a></li> <li><a href="/wiki/Total_loss" title="Total loss">Total loss</a></li> <li><a href="/wiki/Underinsured" title="Underinsured">Underinsurance</a></li> <li><a href="/wiki/Underwriting" title="Underwriting">Underwriting</a> <ul><li><a href="/wiki/Underwriting_profit" title="Underwriting profit">Profit</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Insurance <br />by country</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Insurance_in_Australia" title="Insurance in Australia">Australia</a></li> <li><a href="/wiki/Insurance_industry_in_China" title="Insurance industry in China">China</a></li> <li><a href="/wiki/Insurance_in_India" title="Insurance in India">India</a></li> <li><a href="/wiki/Insurance_in_Pakistan" title="Insurance in Pakistan">Pakistan</a></li> <li><a href="/wiki/Insurance_in_Serbia" title="Insurance in Serbia">Serbia</a></li> <li><a href="/wiki/Insurance_in_the_United_Kingdom" title="Insurance in the United Kingdom">United Kingdom</a></li> <li><a href="/wiki/Insurance_in_the_United_States" title="Insurance in the United States">United States</a> <ul><li><a href="/wiki/Climate_change_and_insurance_in_the_United_States" title="Climate change and insurance in the United States">Climate change</a></li> <li><a href="/wiki/Health_insurance_in_the_United_States" title="Health insurance in the United States">Health insurance</a></li> <li><a href="/wiki/Health_insurance_costs_in_the_United_States" title="Health insurance costs in the United States">Health insurance costs</a></li> <li><a href="/wiki/Health_insurance_coverage_in_the_United_States" title="Health insurance coverage in the United States">Health insurance coverage</a></li> <li><a href="/wiki/Vehicle_insurance_in_the_United_States" title="Vehicle insurance in the United States">Vehicle insurance</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/History_of_insurance" title="History of insurance">History</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Banker_(ancient)" title="Banker (ancient)">Mesopotamian banker</a></li> <li><a href="/wiki/Code_of_Hammurabi" title="Code of Hammurabi">Code of Hammurabi</a> <ul><li><a href="/wiki/Marine_insurance" title="Marine insurance">§100–105; §126</a>; <a href="/wiki/Labour_law" title="Labour law">§234</a>; <a href="/wiki/Marine_insurance" title="Marine insurance">§235–238; §240</a>; <a href="/wiki/Labour_law" title="Labour law">§275–277</a></li></ul></li> <li><i><a href="/wiki/Collegium_(ancient_Rome)" title="Collegium (ancient Rome)">Collegium</a></i> <ul><li><a href="/wiki/Burial_society" title="Burial society">Burial society</a></li> <li><a href="/wiki/Guild" title="Guild">Guild</a></li></ul></li> <li><i><a href="/wiki/Corpus_Juris_Civilis" title="Corpus Juris Civilis">Corpus Juris Civilis</a></i> <ul><li><i><a href="/wiki/Digest_(Roman_law)" title="Digest (Roman law)">Digesta</a></i></li></ul></li> <li><a href="/wiki/Syndicate" title="Syndicate">Syndicate</a></li> <li><a href="/wiki/Benefit_society" title="Benefit society">Benefit</a>/<a href="/wiki/Friendly_society" title="Friendly society">Friendly society</a> <ul><li><a href="/wiki/Cooperative" title="Cooperative">Cooperative</a></li> <li><a href="/wiki/Cooperative_banking" title="Cooperative banking">Cooperative banking</a></li> <li><a href="/wiki/Credit_union" title="Credit union">Credit union</a></li> <li><a href="/wiki/Fraternal_order" title="Fraternal order">Fraternal order</a></li> <li><a href="/wiki/Mutual_organization" title="Mutual organization">Mutual organization</a></li> <li><a href="/wiki/Mutual_savings_bank" title="Mutual savings bank">Mutual savings bank</a></li> <li><a href="/wiki/Rochdale_Principles" title="Rochdale Principles">Rochdale Principles</a></li> <li><a href="/wiki/Savings_and_loan_association" title="Savings and loan association">Savings and loan association</a></li> <li><a href="/wiki/Social_insurance" title="Social insurance">Social insurance</a></li> <li><a href="/wiki/Trade_union" title="Trade union">Trade union</a></li></ul></li> <li><a href="/wiki/Insurance_cycle" title="Insurance cycle">Insurance cycle</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><b><a href="/wiki/Category:Insurance" title="Category:Insurance">Category</a></b></li> <li><b><a href="/wiki/Outline_of_finance#Insurance" title="Outline of finance">List of topics</a></b></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Telemedicine_and_telehealth" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Telemedicine_navbox" title="Template:Telemedicine navbox"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Telemedicine_navbox" title="Template talk:Telemedicine navbox"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Telemedicine_navbox" title="Special:EditPage/Template:Telemedicine navbox"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Telemedicine_and_telehealth" style="font-size:114%;margin:0 4em"><a href="/wiki/Telehealth" title="Telehealth">Telemedicine and telehealth</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Background concepts</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Health_informatics" title="Health informatics">Health informatics</a></li> <li><a href="/wiki/In_absentia_health_care" title="In absentia health care"><i>In absentia</i> health care</a></li> <li><a href="/wiki/Telecommunication" class="mw-redirect" title="Telecommunication">Telecommunication</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_record" title="Medical record">Medical record</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Admission_note" title="Admission note">Admission note</a></li> <li><a href="/wiki/Blue_Button" title="Blue Button">Blue Button</a></li> <li><a href="/wiki/De-identification" title="De-identification">De-identification</a></li> <li><a href="/wiki/Electronic_health_record" title="Electronic health record">Electronic health record</a></li> <li><a class="mw-selflink selflink">Health Insurance Portability and Accountability Act</a></li> <li><a href="/wiki/Personal_health_record" title="Personal health record">Personal health record</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Patient_participation" title="Patient participation">Patient participation</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Decision_aids" title="Decision aids">Decision aids</a></li> <li><a href="/wiki/Doctor%E2%80%93patient_relationship" title="Doctor–patient relationship">Doctor–patient relationship</a></li> <li><a href="/wiki/E-patient" title="E-patient">E-patient</a></li> <li><a href="/wiki/Health_2.0" title="Health 2.0">Health 2.0</a></li> <li><a href="/wiki/Health_education" title="Health education">Health education</a></li> <li><a href="/wiki/Knowledge_translation" title="Knowledge translation">Knowledge translation</a></li> <li><a href="/wiki/MHealth" title="MHealth">mHealth</a></li> <li><a href="/wiki/Participative_decision-making_in_organizations" title="Participative decision-making in organizations">Participative decision-making in organizations</a></li> <li><a href="/wiki/Patient_Activation_Measure" title="Patient Activation Measure">Patient Activation Measure</a></li> <li><a href="/wiki/Shared_decision-making" class="mw-redirect" title="Shared decision-making">Shared decision-making</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Health_information_on_the_Internet" title="Health information on the Internet">Health information on the Internet</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Health_information_on_Wikipedia" title="Health information on Wikipedia">Health information on Wikipedia</a></li> <li><a href="/wiki/Online_patient_education" title="Online patient education">Online patient education</a></li> <li><a href="/wiki/PubMed" title="PubMed">PubMed</a></li> <li><a href="/wiki/PubMed_Central" title="PubMed Central">PubMed Central</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Telemedicine <a href="/wiki/Subspecialty" title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/EHealth" title="EHealth">eHealth</a></li> <li><a href="/wiki/Remote_surgery" title="Remote surgery">Remote surgery</a></li> <li><a href="/wiki/Remote_therapy" title="Remote therapy">Remote therapy</a></li> <li><a href="/wiki/Remote_patient_monitoring" title="Remote patient monitoring">Remote patient monitoring</a></li> <li><a href="/wiki/Tele-audiology" title="Tele-audiology">Tele-audiology</a></li> <li><a href="/wiki/Tele-epidemiology" title="Tele-epidemiology">Tele-epidemiology</a></li> <li><a href="/wiki/Teledentistry" title="Teledentistry">Teledentistry</a></li> <li><a href="/wiki/Teledermatology" title="Teledermatology">Teledermatology</a></li> <li><a href="/wiki/Use_of_technology_in_treatment_of_mental_disorders" title="Use of technology in treatment of mental disorders">Telemental health</a></li> <li><a href="/wiki/Telenursing" title="Telenursing">Telenursing</a></li> <li><a href="/wiki/Teleophthalmology" title="Teleophthalmology">Teleophthalmology</a></li> <li><a href="/wiki/Telepathology" title="Telepathology">Telepathology</a></li> <li><a href="/wiki/Telepharmacy" title="Telepharmacy">Telepharmacy</a></li> <li><a href="/wiki/Telepsychiatry" title="Telepsychiatry">Telepsychiatry</a></li> <li><a href="/wiki/Teleradiology" title="Teleradiology">Teleradiology</a></li> <li><a href="/wiki/Telerehabilitation" title="Telerehabilitation">Telerehabilitation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Roles to play</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_open-source_health_software" title="List of open-source health software">Open-source healthcare software</a></li> <li><a href="/wiki/Patient_opinion_leader" class="mw-redirect" title="Patient opinion leader">Patient opinion leader</a></li> <li><a href="/wiki/Research_participant" title="Research participant">Research participant</a></li> <li><a href="/wiki/Virtual_patient" title="Virtual patient">Virtual patient</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox authority-control" aria-labelledby="Authority_control_databases_frameless&#124;text-top&#124;10px&#124;alt=Edit_this_at_Wikidata&#124;link=https&#58;//www.wikidata.org/wiki/Q606563#identifiers&#124;class=noprint&#124;Edit_this_at_Wikidata" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Authority_control_databases_frameless&#124;text-top&#124;10px&#124;alt=Edit_this_at_Wikidata&#124;link=https&#58;//www.wikidata.org/wiki/Q606563#identifiers&#124;class=noprint&#124;Edit_this_at_Wikidata" style="font-size:114%;margin:0 4em"><a href="/wiki/Help:Authority_control" title="Help:Authority control">Authority control 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