Question

A brief concise explanation regarding the purpose and goals of HIPAA,

Also include the roles of the following regulators:

Department of Health and Human Resources.

Center for Medicare and Medicaid Services,

Office of Inspector General

Office of Civil Rights.

Answer 1

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.

PURPOSE OF HIPAA

Congress introduced the Health Insurance Portability and Accountability Act (HIPAA) 1996, and since then HIPAA has changed the landscape of data protection in the healthcare industry. Initially, HIPAA’s primary function was to address the issue of health insurance coverage for individuals between jobs. Before HIPAA, individuals in this situation could find themselves without healthcare coverage, and therefore potentially unable to access crucial medical treatment. HIPAA’s purpose was to allow individuals to access healthcare coverage even if they were out of work

It is HIPAA’s secondary purpose that has made it such a significant piece of healthcare legislation: the introduction of industry-wide standards of patient data protection in the United States healthcare industry. HIPAA enforces strict stipulations regarding the safeguarding of protected healthcare information (PHI).

HIPAA is a comprehensive legislative act incorporating the requirements of several other legislative acts, including the Public Health Service Act, Employee Retirement Income Security Act, and more recently, the Health Information Technology for Economic and Clinical Health (HITECH) Act.

1. The Privacy Rule of 2000

The purpose of the HIPAA Privacy Rule was to introduce restrictions on the allowable uses and disclosures of protected health information. The Rule stipulates when, with whom, and under what circumstances health information could be shared.

The HIPAA Privacy Rule also gives patients some control over their data. For example, patients also can authorise who can see their medical information. Furthermore, patients can request an organisation to give them access to their health data.

2. The Security Rule of 2003

The HIPAA Security Rule requires organisations to use administrative, technical, and physical safeguards to protect electronic health data. Covered entities must ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit. An auditable trail of PHI activity must be maintained, with access to any PHI carefully recorded and controlled.

3. The Breach Notification Rule of 2009

The purpose of the Breach Notification Rule of 2009 is to inform organisations of their responsibilities in the event of a data breach. The Breach Notification Rule states that covered entities must provide notification of the breach to affected individuals, the Secretary, and, if the breach is of a significant scale, to the media. The Rule also covers business associates, who must notify covered entities if a breach occurs at or by the business associate

4. Other Purposes of HIPAA

Some of HIPAA’s other purposes surround introducing several reforms to improve bureaucracy in the healthcare industry. HIPAA legislation requires compliant healthcare organisations to adopt new standards and practices to increase efficiency in the healthcare system. HIPAA requires healthcare professionals to use code sets along with patient identifiers, which helped pave the way for the efficient transfer of healthcare data between healthcare organisations and insurers. This streamlined process allows for efficient eligibility checks, billing, payments, and other healthcare operations, thus improving a patient’s experience in the healthcare system.

GOAL OF HIPAA

HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs.

The goals of HIPAA are to protect health insurance coverage for workers and their families when they change or lose their jobs (Portability) and to protect health data integrity, confidentiality, and availability (Accountability).

The goals are also to enhance our health care system by making it more efficient, simpler, and less costly. By implementing standard business and system formats we will be able to streamline the processing of health care claims, and reduce the volume of paperwork required in the U.S. health care system.

Improved business and system formats will also allow the U.S. health care system to save billions of dollars, and provide better service to providers, insurers, and the public in general.

The goal of keeping protected health information private.

basic HIPAA goals

1. To limit the use of protected health information to those with a “need to know.”

2. To penalize those who do not comply with confidentiality regulations.

Department of Health and Human Resources.

The department also plays a role in regulating the quality and safety of food products that make it onto grocers' shelves and works to diagnose and treat disease. The DHHS is headed by a secretary (formerly Kathleen Sebelius) who is considered the chief managing officer of the "family" of agencies within the department. This includes 11 operating divisions, 10 regional offices, and the Office of the Secretary. The operating divisions include such agencies as the:

1. Administration for Children and Families

2. Administration for Community Living

3. Agency for Healthcare Research and Quality

4. Agency for Toxic Substances and Disease Registry

5. Center for Disease Control and Prevention

6. Centers for Medicare and Medicaid Services

7. Food and Drug Administration

8. Health Resources and Services Administration

9. Indian Health Services

10. National Institutes of Health

11. Substance Abuse and Mental Health Services Administration

Center for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace.

Through its Center for Consumer Information & Insurance Oversight, the CMS plays a role in the federal and state health insurance marketplaces by helping to implement the Affordable Care Act’s (ACA) laws about private health insurance and providing educational materials to the public.

The CMS plays a role in insurance marketplaces by helping to implement the Affordable Care Act’s laws about private health insurance.

The role of CMS as regulatory agency became even more important: it had to monitor for both overuse and underuse of appropriate medical care. With the evolving role of these entities, the PSROs were remodeled into the peer review organizations (PROs)

Unique Role of Medicaid Programs

On the Federal level, Medicare has received much more attention than Medicaid over the past 40 years, a consequence of Medicaid's decentralized administrative structure that gives States primary responsibility for its operations.

Office of Inspector General

The Legislature formally established an Office of Inspector General (OIG) in each state agency to provide a central point for coordination of and responsibility for activities that promote accountability, integrity, and efficiency in government.

The duties and responsibilities of each Inspector General (IG) include, but are not limited to:

1. Providing direction for, supervising, and coordinating audits, investigations, and management reviews relating to the programs and operations

2. Keeping management (e.g. Department Secretary, Governor’s Chief Inspector General) informed of fraud, abuses, and deficiencies. Recommending corrective action concerning fraud, abuses, and deficiencies, and report on the progress made in implementing corrective action.

3. Ensuring effective coordination and cooperation between the Auditor General, Federal auditors, and other governmental bodies with a view toward avoiding duplication.

4. Conducting, supervising, or coordinating other activities carried out, or financed by that state agency for the purpose of promoting economy and efficiency in the administration of, or preventing and detecting fraud and abuse in its programs and operations.

5. Assessing the reliability and validity of the information provided by the state agency on performance measures and standards.

6. Ensuring that an appropriate balance is maintained between audit, investigative, and other accountability activities.

To learn more about how we meet our statutory responsibilities, please see our annual report and website.

We anticipate that CMS will continue its role to improve health care quality by informing clinical care with data, taking a larger role in chronic disease management, and developing new systems that reward high quality care. Data technology will now allow analysis of close to real-time data and linkage of inpatient, outpatient, and pharmacy databases to facilitate more rapid cycles in quality improvement.

In its role overseeing the State programs, CMS should continue to push the States to expand coverage and improve quality in Medicaid, although the financing challenges will be substantial.

CMS also will need to consider its role as a convener of private industry to advance data use to improve medical care.

CMS can take a leadership role to expand health information systems and the use of data in routine clinical care. CMS will need to work with the Agency for Healthcare Research and Quality and private insurance companies to accomplish this goal.

Office of Inspector General

The Legislature formally established an Office of Inspector General (OIG) in each state agency to provide a central point for coordination of and responsibility for activities that promote accountability, integrity, and efficiency in government.

The duties and responsibilities of each Inspector General (IG) include, but are not limited to:

1. Providing direction for, supervising, and coordinating audits, investigations, and management reviews relating to the programs and operations

2. Keeping management (e.g. Department Secretary, Governor’s Chief Inspector General) informed of fraud, abuses, and deficiencies. Recommending corrective action concerning fraud, abuses, and deficiencies, and report on the progress made in implementing corrective action.

3. Ensuring effective coordination and cooperation between the Auditor General, Federal auditors, and other governmental bodies with a view toward avoiding duplication.

4. Conducting, supervising, or coordinating other activities carried out, or financed by that state agency for the purpose of promoting economy and efficiency in the administration of, or preventing and detecting fraud and abuse in its programs and operations.

5. Assessing the reliability and validity of the information provided by the state agency on performance measures and standards.

6. Ensuring that an appropriate balance is maintained between audit, investigative, and other accountability activities.

Office of Civil Rights.

The Office for Civil Rights (OCR) is an agency within the U.S. Department of Education that enforces civil rights laws tied to federal funding of schools from elementary through post-secondary. Congress created the Office for Civil Rights in 1966

The agency's mission is: "To ensure equal access to education and to promote educational excellence throughout the nation through vigorous enforcement of civil rights."

The Office for Civil Rights' basic message is that students cannot learn and thrive in school if they are being discriminated against. And because the federal government holds the purse strings, it has the power to set and enforce its anti-discrimination rules.

Instead its role is that of a law enforcement agency. Any formalized agreement reached to address and correct "compliance concerns" found during an investigation is between the district and the Office for Civil Rights.