Rights Responsibilities

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Rights Responsibilities

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Title: Rights Responsibilities

1

Rights Responsibilities Solutions
Avoid Disasters for the Special Needs Population
Comply with the HIPAA Privacy Rule
Linda Sanches, Senior Advisor, HIPAA Privacy
Outreach Training
Eileen Hanrahan, Senior Civil Rights Analyst
Office for Civil Rights, U.S. Department of
Health and Human Services
February 5, 2008
National Emergency Management Summit

2
Topics

What does OCR do
HIPAA
HIPAA Privacy Rule basics
Sharing of health information in a disaster
Sharing information for emergency preparedness
Special needs population
Who is the special needs populationfunctional
approach
How the civil rights laws apply to persons with
special needs in an emergency
Strategies for addressing their needs in an
emergency

3
OCR Protects Through Enforcement

Section 504 of the Rehabilitation Act of 1973
(disability)
Title II of the Americans with Disabilities Act
of 1990 (disability)
Title VI of the Civil Rights Act of 1964 (race,
color, national origin)
Age Discrimination Act of 1975 (age)
Health Insurance Portability and Accountability
Act of 1996 (privacy)
Patient Safety and Quality Improvement Act of
2005 (confidentiality)

4
How OCR Protects Civil Privacy Rights

Resolving Complaints people who believe that
they have been discriminated against or the law
otherwise has been violated may file complaints
with OCR
Opening compliance reviews OCR may initiate a
civil rights review of a program that receives
HHS funds or a Privacy Rule review of any covered
entity
Conducting pre-Grant reviews OCR conducts civil
rights reviews of health care providers who are
applying to participate in the Medicare Part A
program
Offering technical assistance OCR provides
resources, training, and outreach materials

5
What If an OCR Investigation Indicates
Noncompliance?

Emphasis on voluntary compliance through
corrective action and resolution agreements

Civil Rights Enforcement
Terminate HHS funding
Refer to Department of Justice for enforcement

Privacy Enforcement
Assess civil money penalties

6
Recent Emergency Responses Suggest Privacy
Compliance Strategies Are Incomplete

Some paramedics have refused to disclose
information to emergency medical providers
Some state and local authorities have been unable
to confirm that their requests for information
from providers for planning activities are
permitted by HIPAA.
Some emergency responders have refused to make
disclosures because they mistakenly believe that
they are subject to the HIPAA Privacy Rule
Federal Lessons Learned reports note frequent
misunderstanding.

7
Basic Construct of the HIPAA Privacy Rule

Creates a nationwide baseline of privacy
protections for health information
Sets standards
When information can be used or disclosed
How information must be protected
New training, staffing, information management,
contracts, policies and procedures
Establishes rights for individuals
Access, correct, control, complain
Enables HHS to enforce these requirements

8
Who is Covered by the Privacy Rule? Covered
Entities

Health plans
Health care providers who transmit health
information electronically in connection with
standard transactions (e.g., billing).
Health Care Clearinghouses

Health Plans include
employer sponsored health plans, health insurance
companies, HMOs
certain government programs that pay for health
care, such as Medicare Medicaid
Providers include
most doctors offices, pharmacies, hospitals,
clinics, nursing homes,
many other health care providers

9
What is covered? Protected Health Information

Individually identifiable health information
(other than education, employment records)
Transmitted or maintained in any form or medium
By covered entities or their business associates
Protections do not follow information once
released to persons not covered by HIPAA

This includes
Medical records
Conversations the doctor has about care or
treatment with nurses and others
Information about members in health insurer's
computer system
Billing information about patients at a health
clinic
Most other health information held by those who
must follow this law

10
When Can Information Be Shared?

The Rule permits sharing
For treatment, payment, and health care
operations purposes
To the individual
Pursuant to a valid written authorization
When the individual agrees, or does not object in
circumstances that give the individual an
opportunity to agree or object
Relevant information to family or friend
caregivers hospital directories
For specific public policy purposes, such as
public health or law enforcement
purposesrequirements apply to each type

11
Can Health Information Be Shared in a Severe
Disaster?

Yes, for these purpose
Treatment
Notification
To address imminent danger
Facility directories
Public health

Of course, the HIPAA Privacy Rule does not apply
to disclosures if they are made by entities not
covered by the Privacy Rule.
So the HIPAA Privacy Rule does not restrict the
American Red Cross from sharing patient
information.

http//www.hhs.gov/ocr/hipaa/KATRINAnHIPAA.pdf
12
Permitted Disclosures Treatment

Sharing information with other providers
hospitals, clinics, emergency shelter nurses
Referring patients for treatment
linking patients with providers where patients
have relocated
Coordinating patient care with others
emergency relief workers, others finding
health services

13
Permitted Disclosures Notification

As necessary to identify and locate family
members, guardians, or anyone else responsible
for the individual's care, and notify them of the
individual's location, general condition, or
death
In emergency, hospital may notify the police, the
press, or the public at large as appropriate
May share information with disaster relief
organizations that, like the American Red Cross,
are authorized by law or by their charters to
assist in disaster relief efforts
No need to obtain a patient's permission if doing
so would interfere with the organization's
ability to respond to the emergency

14
Permitted Disclosures Others

IMMINENT DANGER Providers can share patient
information with anyone as necessary to prevent
or lessen a serious and imminent threat to the
health and safety of a person or the public --
consistent with applicable law, ethical
standards.
FACILITY DIRECTORY Health care facilities
maintaining a directory of patients can tell
callers (if patient does not opt-out)
Whether an individual is at the facility,
The individuals location in the facility, and
The individuals general condition
he is in the ICU in stable condition

15
Is the HIPAA Privacy Rule Suspended During a
National or Public Health Emergency?

Only applies to certain hospitals, for 72 hours
Only applies re certain provisions, such as
notice distribution, facility directory opt-out.

No, although the Secretary may waive imposition
of penalties against covered entities that do not
comply with certain provisions of the Rule
16
Can Health Care Providers Share Information for
Emergency Preparedness Activities? Yes, when

Many emergency preparedness activities are public
health activities (e.g., those that prevent or
control disease, injury or disability)
Public health authorities must be authorized by
law to collect or receive such information for
the purpose of preventing or controlling disease,
injury, or disability, including the conduct of
public health interventions.

The disclosure is made for public health purposes
to an appropriate public health authority
An entity that is authorized by law to coordinate
disaster relief planning may be a public health
authority

17
Understanding the Privacy Rule Enables
Appropriate Services for the Special Needs
Population

These issues are especially important for
providers and planners seeking to effectively
serve the special needs population.

Privacy Rule may permit providers to disclose
information about their patients for public
health preparedness activities.

18
Avoid Disasters for the Special Needs
Population

Effective planning, response, and recovery
for the special needs population, consistent
with Federal civil rights laws

19
Who Is the Special Needs Population?

Many definitions of special needs population,
at-risk population, and vulnerable population
exist.
In the National Response Framework, the Federal
Government has adopted a single function-based
definition.
A single definition allows for consistency of
intergovernmental planning and exercises to
ensure the safety and security of all.
A function-based definition establishes a
flexible framework that addresses common needs
irrespective of specific diagnosis, statutes or
labels.
It provides useful information to emergency
planners and responders that mere labeling does
not.

20
Definition of Special Needs Population in the
National Response Framework

Before, during, and after an incident, members
of this population may have additional needs in
one or more of the following functional areas
Maintaining independence, communication,
transportation, supervision, and medical care.
Individuals in need of additional response
assistance may include those who
Have disabilities
Live in institutionalized settings
Are elderly
Are children
Are from diverse cultures
Have limited English proficiency or are
non-English speaking
Are transportation disadvantaged

21
We Will Focus on Three Populations That Are
Protected by Federal Civil Rights Laws

Persons with disabilities
Persons from diverse racial/ethnic origins,
including Limited English proficient (LEP)
persons

22
Special Needs PopulationFacts and Figures

In 2000, 18 of the population (47 million
people) spoke a language other than English at
home.
63 of hospitals treat LEP patients daily or
weekly.
Nearly 40 million people have one or more
disabilities.
40 of the population over 65 has one or more
disabilities.
In 2000, persons who were African American,
Hispanic or Asian comprised nearly a third of the
population. This percentage is projected to
increase through 2050.

23
The Experience of These Populations in Emergencies

Historically, emergency preparedness activities
have lacked sufficient focus on individuals with
special needs.
As a result, these populations often
Did not receive important information about
emergencies
Were not evacuated
Were unable to access shelters and
Failed to receive needed services, including
medical assistance.
Many Hurricane Katrina lessons learned reports
noted the importance of including the special
needs population in planning, response, and
recovery efforts for those efforts to be
successful.

24
What Civil Rights Laws Apply to These
Populations?

Title VI of the Civil Rights Act of 1964 (Title
VI) prohibits discrimination on the basis of
race, color, or national origin by recipients of
Federal financial assistance.
Section 504 of the Rehabilitation Act of 1973
(Section 504) prohibits discrimination on the
basis of disability by recipients of Federal
financial assistance.
Title II of the Americans with Disabilities Act
of 1990 (ADA) prohibits discrimination on the
basis of disability by public entities, whether
or not they receive Federal financial assistance.

25
Standards under the Federal Civil Rights
LawsDisability Discrimination

Section 504 and Title II implementing
regulations
Different treatment on the basis of disability
Actions that have the effect of discriminating on
the basis of disability
Program accessibility
Provision of auxiliary aids and services where
necessary to afford equal opportunity, unless
undue burden or fundamental alteration
Modification of policies, practices, and
procedures where necessary to avoid
discrimination, unless fundamental alteration
Administration of services in the most integrated
setting appropriate

26
Standards under the Federal Civil Rights
LawsRace, Color, and National Origin
Discrimination

Title VI implementing regulation
Different treatment on the basis of race, color,
or national origin
Actions that have the effect of discriminating on
the basis of race, color, or national origin
May include the failure to take reasonable steps
to provide LEP persons meaningful access to
the program

27
How Service Providers Can Effectively Address
Functional Needs in an Emergency, Consistent
with Federal Civil Rights Laws

Strategic planning
Location and assessment of the special needs
population
Communication
Avoidance of separation of individuals from their
sources of support or assistance
Integration
Accessibility
Recovery

28
Strategic Planning

Include people with special needs in planning and
exercises
Know your partners and collaborate in developing
plans
Know what resources are available to you in an
emergency
Develop protocols and procedures for providing
services and obtaining resources
Communicate your emergency plan to response and
community stakeholders
Identify and maintain access to expertise about
people with special needs for all staff up and
down the line

29
Location and Assessment

Coordinate with state and local emergency
management officials
Know the populations - population survey data
Know the functions with which people may need
assistance - use of individual intake and
assessment tools
Consider using a voluntary registry to identify
persons with special needs

30
Communication

Coordinate with community and faith-based
organizations
Use multiple, accessible communication
mechanisms, such as
Large print/audio for persons who are blind or
have low vision
Interpreter services for deaf/hard of hearing or
LEP persons, such as language banks, telephonic
interpreter services, bilingual staff, contract
or volunteer interpreters
Picture boards
Captioning of televised messages
Translation of written emergency information into
other languages
Short, simple communication scripts, repeated
frequently

31
Avoidance of Separation from Sources of Support
or Assistance

Durable medical equipment (wheelchairs, walkers,
scooters, catheters, ostomy supplies, etc.)
Service animals
Caregivers and attendants,
family members and companions
Medication, supplies

32
Integration

Avoid isolation of individuals with
special needs unless necessary
Avoid misdirecting individuals to
higher levels of care than what they need,
such as hospitals, acute care facilities,
or medical shelters
Provide access to appropriate equipment,
medication, personnel or other resource support

33
Accessibility

Transportation
Secure accessible transportation (lift equipped)
for the individual and his or her equipment,
service animal, or caregiver
Ensure trained personnel to operate the vehicle
Evacuation
Arrange an inspection by emergency management or
firefighting officials
Inform affected persons about the plan as early
as possible
Employ procedures for 100 accountability

34
Accessibility