Which entities are subject to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule: health plans, health care clearinghouses, or other?

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From the Guidelines

The correct option is F. B and C, as the Health Insurance Portability and Accountability Act (HIPAA) privacy rule specifically applies to health plans and health care clearinghouses, which are considered covered entities under the law 1.

Key Points

  • Health plans include insurance companies, HMOs, Medicare, and Medicaid programs that pay for healthcare.
  • Health care clearinghouses are entities that process nonstandard health information they receive from another entity into a standard format.
  • HIPAA was designed to protect sensitive patient health information from being disclosed without the patient's consent or knowledge, and these two types of organizations routinely handle such protected health information.
  • According to the study published in Circulation in 2017, HIPAA regulations provide protection for identifiable health information but only when it is collected and shared by “covered entities,” which include healthcare plans, healthcare clearinghouses, and any healthcare provider who transmits healthcare information electronically 1.

Entities Not Covered

  • Institutional Review Boards and Scientific Advisory Committees, while they may encounter health information in their work, are not specifically designated as covered entities under HIPAA regulations.
  • The privacy rule establishes national standards to protect individuals' medical records and other personal health information by requiring appropriate safeguards and setting limits on uses and disclosures, but this does not apply to entities not considered covered entities under the law.

From the Research

HIPAA Privacy Rule Applicability

The HIPAA privacy rule applies to certain entities that handle protected health information. The options provided are:

  • A. Institutional Review Boards
  • B. A health plan
  • C. A health care clearinghouse
  • D. Scientific Advisory Committees
  • E. A and D
  • F. B and C

Relevant Entities

The correct answer is F. B and C, which includes:

  • B. A health plan
  • C. A health care clearinghouse These entities are directly involved in the handling of protected health information and are therefore subject to the HIPAA privacy rule.

Non-Applicable Entities

The other options are not directly applicable to the HIPAA privacy rule, including:

  • A. Institutional Review Boards: while they may handle protected health information, they are not the primary entities subject to the HIPAA privacy rule
  • D. Scientific Advisory Committees: these committees may provide guidance, but they are not typically involved in the direct handling of protected health information
  • E. A and D: this combination is incorrect, as Institutional Review Boards and Scientific Advisory Committees are not the primary entities subject to the HIPAA privacy rule

Lack of Direct Evidence

There are no research papers provided that directly address the applicability of the HIPAA privacy rule to these entities 2, 3, 4, 5, 6. However, based on general knowledge of the HIPAA privacy rule, it is clear that health plans and health care clearinghouses are subject to the rule.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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