Understanding Hipaa Consent and Permitted Disclosures

HIPAA consent is a crucial aspect of protecting patients' sensitive health information.

To obtain valid consent, healthcare providers must inform patients about the types of protected health information (PHI) they will be collecting, using, or disclosing.

Patients have the right to refuse consent, but they must be aware of the potential consequences of doing so, such as limited access to care.

HIPAA permits disclosures for treatment, payment, and healthcare operations, but only if the patient has given consent or an exception applies.

Take a look at this: Hipaa Text Messaging Consent Form

The HIPAA Privacy Rule is a set of standards that address the use and disclosure of protected health information (PHI) by entities subject to the rule.

These entities, called "covered entities", are required to protect individual health information while allowing necessary access to health information, promoting high-quality healthcare, and protecting the public's health.

A covered entity can be a single person, company, or agency, including health care providers, health plans, and health care clearinghouses.

Recommended read: Hipaa Rule of Thumb

These covered entities often use business associates to provide services, but they must have a Business Associate Agreement in place to ensure the proper handling of PHI.

The Privacy Rule requires covered entities to disclose PHI in two situations: to the person in question when requested, and to Human Health Services (HHS) during an investigation.

There are certain instances where a covered entity can use or disclose PHI, but depending on the situation, certain consent is required.

Here are the types of covered entities:

Permitted uses and disclosures of protected health information (PHI) under HIPAA are more extensive than you might think. There are 12 national priority purposes that allow for the use and disclosure of PHI without an individual's authorization or permission.

Here are some of the key permitted uses and disclosures:

Public interest and benefit activities include 12 national priority purposes, such as public health activities, victims of abuse or neglect or domestic violence, and law enforcement.

Permitted Uses and Disclosures are allowed under HIPAA without an individual's authorization. This includes disclosures to the individual themselves, if the information is required for access or accounting of disclosures.

A covered entity can use and disclose Protected Health Information (PHI) for treatment, payment, and healthcare operations. This is a broad category that includes many routine activities, such as billing and medical record-keeping.

The law permits a covered entity to use and disclose PHI for 12 national priority purposes, including public health activities, victims of abuse or neglect, and law enforcement. These purposes are outlined in the HIPAA regulations.

Here are the 12 national priority purposes:

In some cases, a covered entity can use and disclose PHI without explicit authorization, such as when the individual is incapacitated or in an emergency situation. This is done through verbal consent or acquiescence.

A covered entity may not sell PHI without the individual’s authorization. This includes the licensing of PHI, where the covered entity receives payment from the recipient.

If this caught your attention, see: What Constitutes Hipaa Data

The Privacy Rules identify certain actions that do not constitute the “sale of PHI” and therefore do not require an individual’s authorization. The sale or merger of a covered entity’s practice falls into this category.

Covered entities must obtain the individual’s authorization before selling or licensing their PHI. This is a key aspect of maintaining patient trust and confidentiality.

A sale is defined as a disclosure of PHI where the covered entity directly or indirectly receives payment from the recipient of the PHI. This payment can be in the form of cash, goods, or services.

The rules around PHI sales and licensing are in place to protect individuals' sensitive health information. By following these guidelines, covered entities can ensure compliance and maintain patient trust.

A different take: 3 Hipaa Rules

HIPAA requires explicit authorization for the use and disclosure of protected health information. This is known as an authorization in HIPAA terms.

There are three categories of uses and disclosures of PHI regarding the need to obtain the individual's consent: no consent required, verbal consent or acquiescence required, and written consent required.

Worth a look: Kaiser Hipaa Authorization

Written consent is required for general requirements, physicians, marketing, sales, and licensing. This is part of the protection of confidentiality and privacy of patient information.

A valid HIPAA authorization should include several elements, such as:

In general, a covered entity must collect written authorization from the subject before they are legally allowed to use or disclose PHI under the Privacy Rule.

There are certain situations where consent is not required for the use or disclosure of protected health information. These exceptions include disclosures to prevent or control disease, injury, or disability, and disclosures to public health authorities.

A covered entity may disclose PHI without individual authorization in situations such as sending immunization records to schools, reporting to a public health authority for purposes of preventing or controlling disease, injury, or disability, and to warn persons at risk and prevent or control the spread of disease.

Disclosures to family and friends involved in an individual's care or for notification purposes are also exceptions to consent, as long as informal permission is obtained by asking the individual outright or determining that they did not object in circumstances that clearly gave them the opportunity to agree, acquiesce, or object.

A fresh viewpoint: Hipaa Access Control

Here are the exceptions to consent:

In certain situations, a covered entity may disclose protected health information (PHI) without individual authorization. This is often the case when it comes to public health and safety.

Sending immunization records to schools is a common example of this exception. It's a necessary step to ensure public health and safety, and it doesn't require individual authorization.

Reporting to a public health authority for purposes of preventing or controlling disease, injury, or disability is another situation where disclosure is allowed without consent. This can include reporting to a foreign government agency at the direction of a public health authority.

To warn persons at risk and prevent or control the spread of disease, PHI can be disclosed without individual authorization. This is a critical step in protecting public health and safety.

Here are some specific situations where disclosure is allowed without consent:

Exceptions to consent are an essential part of the HIPAA framework, allowing for the sharing of protected health information (PHI) in certain situations.

HIPAA has three categories of consent requirements: no consent required, verbal consent or acquiescence required, and written consent required.

In some cases, no consent is needed, such as when disclosing PHI for treatment, payment, or healthcare operations. This is a key exception to the rule, allowing healthcare providers to share PHI for day-to-day business operations.

For instance, when auditing a company's HIPAA compliance, it's essential to consider these exceptions and determine whether they are reasonable. This requires professional judgment, taking into account the specific circumstances and the need to protect PHI.

Verbal consent can be used in certain situations, such as disclosures to family or facility directories. However, explicit HIPAA authorization is usually required for the use and disclosure of PHI.

The Privacy Rule, as explained in HIPAA, was designed to protect PHI, but it also allows for certain permissions to be shared with care. These permissions are specifically addressed in Privacy Rule 45 CHR 164.501.

Related reading: How Does Hipaa Protect

Here are the definitions of treatment, payment, and healthcare operations, which are essential to understanding how the rule works:

Psychotherapy Notes are a sensitive topic. A covered entity cannot disclose psychotherapy notes without an individual’s written authorization. This is a strict rule to protect patient confidentiality.

Psychotherapy notes are a type of medical record that contains sensitive information about a patient's mental health treatment. They are highly protected by law.

In order to disclose psychotherapy notes, a patient's explicit consent is required. This means that the patient must give their written permission for the notes to be shared.

You have the right to control who sees your health information, but there are some instances where it can be shared without your explicit permission. For example, if you're incapacitated or in an emergency situation, a healthcare provider can disclose your information to family or friends if it's in your best interests.

If you're receiving care from a healthcare provider, they may need to share your information with others involved in your care. This can include family members, friends, or other healthcare professionals. They'll typically ask for your permission first, but in some cases, they can make these disclosures without your explicit consent.

There are 12 national priority purposes that allow for the use and disclosure of your health information without your permission. These purposes include public health activities, victims of abuse or neglect, and law enforcement. If a disclosure falls under one of these categories, your healthcare provider can share your information without asking for your consent.

Here are some examples of when your healthcare provider might disclose your information to others: