What is HIPAA and Why Does it Matter for Families?
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that sets national standards for protecting the privacy and security of individuals’ medical information. Passed in 1996, HIPAA aims to balance the need to share health information for effective care with an individual’s right to privacy.
For families caring for aging loved ones or supporting children’s healthcare, understanding HIPAA is crucial. HIPAA can impact your ability to access medical records, communicate with healthcare providers, and be involved in a relative’s care. By knowing the key HIPAA guidelines, families can navigate the healthcare system more effectively and ensure their loved one’s privacy is protected.
In this article, we’ll explore the top 10 things families should know about HIPAA to support their loved ones’ wellbeing while respecting their privacy rights.
1. HIPAA Applies to “Covered Entities” – Not Individual Families
HIPAA’s privacy and security rules primarily apply to “covered entities” – healthcare providers, health plans, and healthcare clearinghouses that handle protected health information (PHI) electronically. As a family member, you are not considered a covered entity under HIPAA. This means the law does not require you to protect your relative’s health information in the same way that their doctor or insurance company must.
2. HIPAA Allows Providers to Share Information with Family Members in Many Cases
Contrary to common misconceptions, HIPAA often permits healthcare providers to share a patient’s health information with their family members and friends. Providers can disclose relevant information if the patient is present and does not object, or if the provider determines that sharing the information is in the patient’s best interest (such as if the patient is incapacitated).
Providers are also allowed to share information with caregivers or legal representatives, like a power of attorney for healthcare. As long as the disclosure is the “minimum necessary” to accomplish the purpose, HIPAA allows this type of family communication.
3. Providers are Not Required to Share Information with Family Members
While HIPAA often allows providers to share information with family, it does not require them to do so. Providers have discretion in deciding whether to disclose information, even if the patient has authorized it. If a provider is concerned about potential harm or feels the disclosure is not in the patient’s best interest, they may choose not to share details with family members.
4. Patients Can Request Restrictions on Who Sees Their Health Information
HIPAA gives patients the right to request restrictions on how their protected health information is used and disclosed. For example, a patient could ask their provider not to share any information with their adult children. Providers must comply with these requests, unless the disclosure is required by law or necessary for the patient’s treatment.
5. Patients Have a Right to Access Their Own Medical Records
One of the core rights granted by HIPAA is the ability for individuals to access their own protected health information. Patients can request copies of their medical records, test results, billing information, and other PHI from their healthcare providers. Providers must comply with these requests, with some limited exceptions.
6. HIPAA Allows for Disclosures in Emergency or Incapacity Situations
If a patient is incapacitated or in an emergency situation, HIPAA permits providers to share relevant health information with family members, friends, or others involved in the patient’s care or payment for care. This is allowed if the provider determines that the disclosure is in the patient’s best interest.
7. Providers Must Use “Minimum Necessary” Disclosures
When sharing a patient’s health information, HIPAA requires providers to disclose only the minimum amount of information necessary to accomplish the intended purpose. This “minimum necessary” principle helps protect patient privacy by limiting unnecessary disclosures.
8. Patients Can Designate a “Personal Representative” to Manage Their HIPAA Rights
HIPAA recognizes that patients may want someone else, such as a family member, to act on their behalf regarding healthcare decisions and information access. Patients can designate a “personal representative” – often through a power of attorney for healthcare – who then has the authority to exercise the patient’s HIPAA rights, like accessing medical records.
9. HIPAA Doesn’t Prevent Family Members from Expressing Concerns to Providers
As a family member, HIPAA does not prohibit you from contacting your loved one’s healthcare providers to share your observations or concerns, even if the provider is not permitted to disclose information back to you. Providers may still find this input valuable in caring for the patient.
10. State Laws May Provide Additional Privacy Protections Beyond HIPAA
While HIPAA establishes a national baseline for healthcare privacy, individual states may have their own laws that provide additional privacy safeguards. Families should be aware of any state-specific HIPAA requirements or restrictions that may apply in their area.
For example, the state of California has a law called the Confidentiality of Medical Information Act (CMIA) that imposes stricter standards for protecting patient information than HIPAA in some cases. Consulting with local healthcare providers or an attorney can help families understand their state’s particular HIPAA guidelines.
By understanding these 10 key points about HIPAA, families can better navigate the healthcare system, advocate for their loved ones’ needs, and ensure their privacy is respected. For more information, you can visit the Stanley Park High School website or the U.S. Department of Health & Human Services’ HIPAA resources.
