Changes to privacy rule could lessen access load
May 1, 2002 3 minutes read
Changes to privacy rule could lessen access load
Consent requirements lightened
Provisions of the Health Insurance Portability and Accountability Act’s privacy rule that have drawn criticism from some health care providers — and could be problematic for access personnel — have been modified in changes proposed by Department of Health and Human Services (HHS) Secretary Tommy Thompson.
The proposed changes, published in the March 27 Federal Register, correct unintended consequences that threaten patients’ access to quality health care, according to an HHS statement. Comments regarding the revisions were accepted through April 26.
Among other things, the modifications would remove some requirements having to do with the obtaining of patient consent. Proposed revisions that have particular relevance for access personnel include:
- Strengthening notice provisions and remove consent requirements hindering access to care.
Under the proposed changes, patients would be asked to acknowledge the privacy notice, but physicians and other providers could treat them if they did not. Under the rule as now written, patients could be required to visit a pharmacy in person to sign paperwork before a pharmacist could fill their prescriptions. In addition, physicians could refuse to treat patients who refused to sign their privacy consent form.
- Maintaining the "minimum-necessary" rule, while allowing treatment-related conversations.
By covering oral communications and limiting the use of personal health information to the "minimum necessary," the privacy rule raised concerns that routine conversations between physicians and patients, nurses, and others involved in a patient’s care could violate the rule.
The proposed changes would continue to cover oral communications and maintain the "minimum-necessary" requirement, but would make clear that physicians could discuss a patient’s treatment with other health care professionals involved in their care. As long as reasonable safeguards are taken to protect personal health information, incidental disclosures — such as another patient hearing a snippet of conversation — would not be subject to penalties. Improper disclosures still would violate the rule.
- Assuring appropriate parental access to children’s records.
There was concern that the current rule unintentionally limits parents’ access to their children’s medical records. The proposal clarifies that state law governs disclosures to parents. In cases where state law is silent or unclear, the provisions would permit a health care provider to use discretion to provide or deny a parent access to such records.
- Simplifying authorizations.
The changes would allow the use of a single type of authorization form to obtain a patient’s permission for a specific use or disclosure that otherwise would not be permitted under the rule. Patients will still need to grant permission in advance for each use or disclosure, but the proposal would eliminate the need to use different types of forms to obtain that advance permission.
The American Hospital Association (AHA) in Chicago has come out in favor of the proposed changes, saying they "will help restore much-needed balance between protecting patient privacy and giving patients access to responsive health care."
AHA president Dick Davidson, who wrote an op-ed column in USA Today supporting the revisions, said that removing the "redundant" written consent form requirement and replacing it with a "simple but effective" written acknowledgement "is a common-sense way to enhance privacy."
Davidson’s position runs counter to that of the newspaper’s editorial board, which says the changes favor health care industry convenience over patient privacy. Additional information about the privacy rule is available on the web at www.hhs.gov/ocr/hipaa.
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