HIPAA Q&A

[Editor’s note: This is the first in a series of periodic columns that will address specific questions related to Health Insurance Portability and Accountability Act (HIPAA) implementation. If you have questions, please send them to Sheryl Jackson, Hospital Home Health, American Health Consultants, P.O. Box 740056, Atlanta, GA 30374. Fax: (404) 262-5447. E-mail: sherylsmjackson@cs.com.]

Question: What information can discharge planners give home health agencies without a patient’s permission?

Answer: Because gathering complete and accurate information upon home health admission is important, many home health managers are concerned that HIPAA regulations will restrict the type and amount of information that can be given upon patient referral.

Not so, according to Elizabeth E. Hogue, Esq., a Burtonsville, MD-based attorney who specializes in home health.

"Home care providers should not expect any change in the ability of discharge planners, social workers, or case managers at referral sources to share information with agencies about patients they want to refer once the HIPAA privacy regulations in effect on April 14, 2003," says Hogue.

"First, this is because revisions to the final regulations allow providers to share information for treatment, payment, and health care operations without patients’ consent or authorization," she says.

Since hospitals and long-term care facilities, for example, are required by Medicare conditions of participation to provide discharge planning services, sharing information to comply with this requirement may fall within this exception to the need for consent or authorization, she adds.

This same exception allows providers to share information with other providers for treatment and payment purposes, points out Hogue. This portion of the exception also may serve as the basis for sharing such information since the information is necessary in order for other providers to render services to patients, she adds.

Staff responsible for discharge planning may be concerned, however, about referrals to entities that their employers own or in which they have a financial interest, Hogue says.

Concerns may be based on the section of the revised final HIPAA privacy regulations that state that patients’ authorization is needed for marketing purposes, she says.

"Because discharge planners are making referrals to other entities owned by their hospitals, they may be concerned that such referrals constitute marketing services that require authorization from patients," she explains. On the contrary, the revised final HIPAA privacy regulations make it clear that such activities constitute case coordination, not marketing, for which patients’ authorizations are not needed, she adds.

"Anecdotally, we are already hearing reports of discharge planners who misunderstand the HIPAA privacy requirements," Hogue says. What should agencies do when the discharge planners in their hospitals misunderstand the above requirements?

"The best course of action may be to go to the designated privacy official within the organization to ask for clarification and communication with discharge planners," she suggests.