HIPAA: A Funny Acronym for a Very Serious Law

HIPAA is the acronym for a vital body of federal law, The Health Insurance Portability and Accountability Act that has existed since 1996. Because it is a federal law (codified laws are sometimes called “statutes”), it applies to all states.

Like virtually all statutes, HIPAA addresses a number of topics, sometimes disparate ones. Also, like other federal statutes, they are implemented by “rules” that are also created on the federal level. We will discuss a couple of the main provisions of the HIPAA statute here. Both provisions to be discussed, apply to the clients at NeuLife who receive post-acute rehabilitation, specialized rehabilitation and neurorehabilitation for catastrophic injuries resulting from a variety of medical conditions, neurologic issues and trauma.

One of the main thrusts of HIPAA is the way in which personally identifiable health information is used by a “covered entity.” The law is intended to ensure the privacy of the medical information of individuals who are within its scope and who are provided with medical care or whose medical information comes into the possession of a “covered entity.” A “covered entity” can be:

• A healthcare provider;
• A health plan;
• A healthcare clearinghouse. A healthcare clearinghouse is an entity that acts as a middle man between a healthcare provider and another entity that needs the information of a healthcare provider. The other entity might be, for example, an insurance company that has to pay the provider. In that example, the clearinghouse essentially translates the information from the provider into a form that the insurance company can understand to facilitate payment. For example, if an individual becomes a client at NeuLife, his or her challenging diagnosis and the prescribed post-acute rehabilitation may have to be “translated” into what is referred to as CPT codes. CPT stands for Current Procedural Terminology. The CPT codes are promulgated by the American Medical Association and are intended to make uniform the diagnostic, medical and surgical information among physicians, coders, patients and others.

Since a healthcare provider, including an innovative post-acute rehabilitation provider such as NeuLife, deals directly with a client, the identity of the client, his or her diagnosis and all specifics of acute care, sub-acute care and post-acute care are known. Therefore, NeuLife is a “covered entity.” It takes privacy seriously and complies with all aspects of HIPAA applicable to it. These include:

• Giving clients control over the disclosure of their health information.
• Defining boundaries for the disclosure and use of health records.
• Complying with national-level standards of privacy compliance.
• Limiting the use of private health information and minimizing the chances of inappropriate disclosure.
• Strictly investigating compliance-related disclosures.

Another extremely important provision of HIPAA deals with what is referred to as “portability” In fact, that is what the “P” stands for in the acronym. This part of the law is perhaps the one that is most applicable to clients who have attained substantial independence through NeuLife’s innovative rehabilitation, specialized rehabilitation, neurorehabilitation and other clinically relevant services. The innovative post-acute rehabilitation rendered by NeuLife pursuant to a Client Goal Plan benefits all clients. But some attain such a substantial degree of independence that they are able to perform activities of daily living (ADLs) by themselves and function well within the residential level of rehabilitation that NeuLife provides, or even, on their own. They may feel that they are ready to go home, and many are. Some of these individuals might include those who became clients as a result of traumatic amputations, some types of spinal cord injuries, work-related injuries, motor vehicle accidents, mild brain injuries and some neurologic dysfunctions.

Many, or most, of these clients were working prior to their injuries. Doubtless, most all wish to return to work, and it is NeuLife’s goal to help them to do so. However, some of our clients may be concerned that, despite being sufficiently rehabilitated at NeuLife to function at a job, because of their injuries, they are effectively uninsurable either under group or individual health insurance. It is in that respect that HIPAA is also important. While HIPAA expands opportunities for insurance after both catastrophic and non-catastrophic injuries that did not exist before the statute’s enactment, it is important to understand that it does not guarantee a specific kind or extent of coverage, at a particular cost, to all persons, at all times or in all cases. Nonetheless some of the fundamentals of this attribute of HIPPA include:

• Limitations on the ability of a new employer plan to exclude coverage for pre-existing conditions.
• Additional opportunities to enroll in a group plan if other coverage is lost or if certain life experiences occur.
• The prohibition of discrimination against employees or their dependent family members based on any health factor they may have, including prior medical conditions, previous claims experience or genetic conditions.
• Guarantees that certain individuals will have access to, and can renew, certain individual health insurance policies.

The rights conferred upon individuals and dependent family members by HIPAA are broad, complicated and time sensitive. They also may interrelate with other provisions of state and federal law. Therefore, this article is intended only as a very broad overview of an extremely complex topic. It is not intended as legal or financial advice, which should only be obtained from a licensed professional.