The assisted living industry is built on trust. Family members and caregivers trust local facilities to go above and beyond the standards of care, promoting the physical, social, and emotional well-being of seniors. This also means modeling the highest level of HIPAA compliance.
What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act. It's a law designed to protect sensitive health information, giving individuals rights over their medical records. It’s the duty of every healthcare professional to ensure data confidentiality.
The act enforces HIPAA through a set of data protection standards for both physical and digital health records. Healthcare organizations require HIPAA lawyers to navigate complex federal rules to ensure compliance. Legal and compliance teams also work with administrators to develop protected health information (PHI) policies.
Is an Assisted Living Provider a Covered Entity Under HIPAA?
You've likely heard HIPAA discussed in a broader healthcare context, but does it apply to assisted living providers?
The first step in HIPAA compliance is determining whether an assisted living provider is a covered entity. Under HIPAA, a provider is a "covered entity" if it transmits health information during transactions, insurance billing, eligibility verification, and claims processing. Some providers offer medication management, which requires HIPAA oversight.
Having a HIPAA lawyer is crucial here. Even if a provider doesn't directly meet the exact definition of a covered entity, it may still have HIPAA compliance requirements as a business associate. For instance, providers may partner with covered entities to offer assisted living services that involve the handling of PHI.
Once HIPAA status is determined, a provider must assume its legal responsibility to protect senior health data.
What Are the Core HIPAA Principles for Providers?
HIPAA mandates that staff should only access or disclose resident health information when required for a specific task. The task must outline the amount of PHI required to complete said task. This rule protects against any outside communications that could compromise confidentiality
For instance, providers that offer medication management would need to check a medication list. Only certain roles assigned to this task may view this information. This is an example of HIPAA's "minimum necessary" standard.
HIPAA compliance strategies for providers must focus on three primary areas of health data protection: administrative, physical, and electronic.
From an administrative perspective, compliance strategies require comprehensive policy development. Providers should appoint a privacy officer or compliance manager to oversee policy updates and ongoing staff training in HIPAA compliance.
Under HIPAA, physical data is protected by strict storage protocols, ensuring paper charts are stored in locked cabinets. Office computers must be positioned away from public view.
Electronic data protection requires data encryption during storage and transmission. It also includes firewalls, strict user permissions, unique user IDs, and multi-factor authentication.
HIPAA and Third-Party Providers
Under HIPAA, providers must enter into business associate agreements (BAAs) with third-party vendors that handle PHI. This means developing BAAs with third-party billing companies, electronic medical records (EMR) services, and IT support. BAAs ensure third parties are held to the same data protection standards under HIPAA.
Privacy and Security Challenges for Providers
Assisted living providers present unique privacy and security challenges compared to traditional healthcare environments like clinics and hospitals.
Since assisted living environments are designed to be communities, these environments can potentially lead to the casual sharing of health information if ongoing HIPAA training isn't carried out. For example, training would prevent an employee from casually mentioning a resident's osteoarthritis issue in a conversation.
Strict HIPAA compliance protocols also prevent the use of personal smartphones or messaging apps for communicating protected health information or coordinating senior care needs. All communications must be conducted through the provider’s internal systems.
Promoting a HIPAA-first culture is an excellent way to ensure compliance is at the forefront of everyone's minds. This will help prevent breaches that could trigger a HIPAA audit by the Office for Civil Rights. Scenario-based compliance training can reinforce strict protocols for PHI breach detection, containment, notification, and documentation.
Following these steps will substantially lower your PHI breach risk.
Model HIPAA Compliance at Your Assisted Living Community
With its proximity to the healthcare sector, the assisted living industry occupies a unique HIPAA compliance space. Executive directors must determine compliance status, hire a compliance team, draft policies and contracts, and ensure ongoing HIPAA training to promote a culture of compliance.
Leading with a HIPAA-first mindset is essential for maintaining trust with all parties.
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