HIPAA Strategy

1
HIPAA Strategy

• The Planning Process

2
Presentation Agenda

• Review of HIPAA Objectives
• Overview and Update on the Status of HIPAA
• Components/Objectives of a HIPAA Strategic Plan
• Detailed Review of Each Planning Component
• Questions
• Resources

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Review of HIPAA Objectives
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Objectives of HIPAA

• To reduce the administrative costs associated
  with the provision of health care services
• To make the administration of health care
  services more efficient by
• Requiring some transactions to be supported
  electronically
• Standardizing those transactions
• To protect individually identifiable health
  information from
• Physical damage/destruction
• Unauthorized access
• Misuse or inappropriate disclosure
• This is the first step toward a broader
  application of e-commerce in health care

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HIPAA Overview
HIPAA
Title I
Title II
Title III
Title IV
Title V

• Health insurance access, portability and renewal

• Fraud and Abuse
• Medical Liability Reform
• Administrative Simplification

• Medical Savings Accounts
• Tax deduction provisions

• Group health plan provisions

• Revenue offset provisions

• For 9 key payor transactions
• Includes clinical code sets
• Includes key identifiers

Electronic Transaction Standards (EDI)
Security Standards

• For protecting electronic health information

• To spell out permissible uses of patient
  identifiable healthcare information

PrivacyStandards
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HIPAA Overview

• Each component of HIPAA has proceeded
  independently through a development, review and
  approval process
• The lack of forward movement on any one element
  does not necessarily impede the implementation of
  others

Public Comment Period
Public Input
Review of Existing Regulations Standards
Redraft of Rule
Final Rule Published
Regulations Enacted And Enforced
ProposedRule Released
26 Months from Date of Publication
Still Awaiting Action for Some Elements
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Applicability

• From the Act Sec 1172(a) Applicability. Any
  standard under this part shall apply, in whole or
  in part, to the following persons
• A health plan
• A health care clearinghouse
• A health care provider who transmits any health
  information in electronic form in connection with
  a transaction referred to in Section 1173(a)91.

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Provider Responsibilities

• Providers governed under HIPAA must
• Comply with the regulations that impact them no
  later than the published implementation dates for
  those rules
• Ensure that vendors are prepared to deliver
  applications that support EDI and security
  requirements
• Hold those business partners (vendors and others)
  with whom patient-identifiable information is
  shared accountable for complying with the privacy
  and security regulations that apply to the
  covered entity
• Develop EDI, Privacy and Security policies and
  procedures
• Train staff on the Privacy policies and
  procedures
• Document compliance with applicable regulations

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Status of HIPAA Rules
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Status of HIPAA Rules

• The anticipated dates for HHS issuing new
  proposed or revised final HIPAA rules
• The final Security Rule is expected to be
  released in August of this year
• The Employer Identifier final rule has been
  drafted and sent to HHS for final review with
  release expected in June
• The Provider and Payer Identifier final rules are
  expected around August
• The Patient Information (Claims Attachment) NPRM
  is expected in August of this year

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Updates

• The anticipated dates for HHS issuing new
  proposed or revised final HIPAA rules (cont)
• A draft regulation for electronic medical records
  is being developed, which should be available for
  public review by the end of 2002
• The Doctors First Report of Injury NPRM is also
  expected sometime this year
• An Enforcement NPRM is expected to be released
  some time in 2002
• Two proposed revisions to the Transaction and
  Code Set standards have been published
• Changes in the Designated Standard Maintenance
  Organizations or DSMOs and
• Removal of NDC codes as the standard for
  medications

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Update Summary
Compliance Date
Proposed Rule
Final Rule

• Released 5/98
• Released 5/98
• Released 6/98
• Expected 2001
• ON HOLD

• Published 8/2000
• Expected 8/2002
• Expected 6/2002
• Expected 8/2002
• ON HOLD

• 10/16/2002/03

• Transactions Code Sets
• Provider ID
• Employer ID
• Payer ID
• Patient ID

Electronic Transaction Standards (EDI)

• Released 8/98

• Expected August 2002

Security Standards

• 26 months from date final rule is published

• No action by Congress draft regulation released
  11/99

• Published 12/2000
• Reconfirmed 4/2001

• 4/14/2003

PrivacyStandards

• 7/6/01 received First Guidance (not changes) on
  the final privacy rule
• First proposed changes to the Privacy Rule
  published on 3/27/02

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Components of a HIPAA Strategic Plan
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Steps to Compliance
The key to achieving HIPAA compliance is to take
it one manageable stage at a time
Stage 1 Organization and Planning
Stage 2 Assessment and Design
Stage 3 Implementation and Testing
Stage 4 Compliance Monitoring

• Organizational Structure
• Education
• Policies and Procedures
• Establish Linkages
• High-level Risk Analysis
• Quick Hit Identification

• Detailed Assessment
• Prioritization
• Project Definition
• Budget Development

• Programming/ System Upgrades
• Policy/Process Development
• Contract implementation
• End User Education
• System/Process Testing

• Compliance Audits
• Quality Assurance
• Post Implementation Support
• Regulatory Updates/Changes

We will be discussing these
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Elements of a HIPAA Strategic Plan

• Develop an organizational structure for
  implementing HIPAA
• Review corporate initiatives in light of HIPAA
• Educate organizational decision makers on the
  importance of HIPAA and its impact across the
  organization
• Develop policies and procedures for Privacy and
  Security regulations
• Determine links between HIPAA initiatives and
  organizational strategic initiatives

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Elements of a HIPAA Strategic Plan

• Determine which EDI standards to use
  electronically
• Conduct a high level risk analysis
• Conduct a detailed risk assessment
• Prioritize and schedule tasks to accomplish
• Develop a budget for implementing HIPAA
• Begin the development of policies and procedures
  for EDI

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Stage 1 Organizational Structure

• Appointment of HIPAA coordinator
• Appointment of Privacy Officer
• Appointment of individual(s) to be responsible
  for implementing Security regulations
• Provide staff time to prepare for HIPAA
• Establish reporting mechanisms to Administration
  and the governing body

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Sample HIPAA Governance Structure
HIPAA Coordinator (oversight for assessment,
implementation and ongoing monitoring)
Security Responsibility(Policy
Development Oversight, Training )
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Stage 2 Corporate Initiatives

• Identify strategic initiatives that HIPAA will
  impact
• These initiatives should be divided into two
  primary categories information technology (IT)
  and business initiatives
• The HIPAA regulations will touch most major
  clinical, financial and administrative areas
  within the health system. As such, most of the
  strategic initiatives will require modification
  or consideration of the new HIPAA regulations
• Submit request for EDI extension

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Stage 3 Education

• HIPAA 101 - Overview of HIPAA
• HIPAA 201 - Advanced Topics on EDI, Codes Sets
  and Identifiers
• HIPAA 202 - Advanced Privacy Course
• HIPAA 203 - Advanced Security Course

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Stage 4 Policies and Procedures

• Develop policies and procedures for
• Privacy
• Material from Michael Best and Friedrich to
  customize
• EDI
• Dependent upon standard transactions to be used
• Security
• Health Future IT task force to develop sample
  policies
• Address HIPAA compliance in organizational HR
  policies
• Background checks
• Sanctions for non-compliance
• General policies on confidentiality

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Stage 5 Linking Initiatives

• Identify trading partners/business associates
• Develop contractual assurances of HIPAA
  compliance
• Evaluate vendor preparedness to support HIPAA

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Stage 6 Selection of EDI Standards to Implement

• Develop a plan for transaction implementation
• Initiate cost/benefit analysis to determine which
  standards will yield most positive results
• Develop a schedule for implementation
• Determine resources required for implementation
• Submit request for EDI extension
• Prior to October 16, 2002

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Stage 7 Risk Assessment

• Conduct a high level risk analysis and initiate
  quick hit remediation
• Assign responsibility for EDI, Privacy and
  Security assessments
• Conduct detailed assessment tool training
• Perform assessments
• Define the boundaries of acceptable risk

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High-level Risk Analysis

• A high-level analysis of the current environment
  from an EDI, Privacy, and Security perspective to
  see where the largest gaps are would include
  questions like those below
• What electronic systems are in place for
  billing/clinical/medical records?
• How many clearinghouses (if any) are used?
• Are business associates/trading partners HIPAA
  compliant?
• Which of the 7 approved standard transactions are
  being done?
• Will PHI be accessible to physicians off-site?
• Are security policies in place that meet the
  categories outlined in the proposed rule?
• How much data sharing is currently allowable in
  the system?
• Are there system access controls and audit
  functions?
• What is the level of complexity of systems across
  the network?
• Do users have unique IDs and passwords and do
  they share?

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Stage 8 Preliminary Budget

• Summarize compliance gaps identified through the
  risk assessment
• Develop operating budget for incremental labor
  costs and savings
• Develop capital budget for HIPAA compliance

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Stage 9 Project Definition

• Review results of the assessment
• Prioritize tasks to achieve compliance
• Assign responsibility for compliance projects

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Stage 1 - Project Timeline
July
May
June
August
Sept
Oct
Nov
Dec
Education

Corporate Initiatives
Policies and Procedures
Establish Linkages
Transaction Selection
Risk Assessment
Budget
Project Definition
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Initiate Prioritization
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How to Prioritize HIPAA Initiatives

• HIPAA activities need to be prioritized using
  several factors, for example
• Compliance deadlines
• Potential for enforcement
• Budget constraints (cost/benefit)
• Resource constraints/requirement for external
  resources
• Organizational readiness
• Organizational impact
• Integration with other projects
• Enterprise-wide importance

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Sample Immediate Initiatives

• HIPAA Governance Model
• Solidify organizational responsibility for the
  development of regulatory policies and
  procedures, approval processes, enforcement and
  oversight of all organizational HIPAA initiatives
• Policy and Procedure Documentation
• Initiate the development of, and update policies
  and procedures to meet HIPAA requirements and
  establish the organizations defensible
  position
• Business Associates and Trading Partners
• Inventory contracts and identify organizations
  that are business associates and trading partners
  with whom protected health information is shared

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Sample High Priority Initiatives

• Implement/Update Standard Transaction Sets
• Transition to HIPAA-compliant versions of those
  transactions being performed electronically today
• Implement/Update Standard Code Sets
• Clean-up proprietary clinical codes to align with
  HIPAA code sets
• Purchase additional code sets if needed
• Remediate Applications
• Remediate applications to HIPAA compliant versions

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Sample Medium Priority Initiatives

• Staff Education
• Conduct general and detailed HIPAA education
• Privacy Documentation Requirements
• Develop documents required to comply with Privacy
  regulations
• Utilize documents developed by the WSHA and other
  business partners that are recommended for use
  statewide
• Focused Strategy Assessment
• Determine strategic approach to HIPAA and
  complete focused HIPAA assessments to determine
  compliance gaps and scope implementation efforts
• Communication Plan
• Establish communication methods and begin to
  conduct HIPAA education and distribute
  documentation

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Ranking Definitions
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Initiatives Prioritization Matrix
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Questions and Discussion
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Resources
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Resources
Association for Electronic Health Care Transactions (AFEHCT) Impacts of HIPAA (particularly EDI) Security Self-Evaluation Checklist http//www.afehct.org
American Health Information Management Association (AHIMA) Benchmark information and case studies Interim Steps for Getting Started http//www.ahima.org/hipaa.html
American Society for Testing and Materials (ASTM) Standards guides for security http//www.astm.org
Center for Healthcare Information Management (CHIM) Up-to-date industry perspective on proposed rules and their status http//www.chim.org
Computer-Based Patient Record Institute (CPRI) CPRI Security Toolkit http//www.cpri-host.org
Department of Health and Human Services HIPAA Administrative Simplification Latest News on Regulations Current proposed and final rules http//aspe.hhs.gov/admnsimp/index.htm
Electronic Healthcare Network Accreditation Commission (EHNAC) Certification Program for HIPAA Compliance (under development) http//www.ehnac.org
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Resources (cont.)
For the Record Protecting Electronic Health Information (National Academy Press, 1997) 800-624-6242 Full Report http//www.nap.edu
Health Privacy Forum Comparison of Privacy proposed and final rules Comparison of state privacy laws http//www.healthprivacy.org
HIMSS Protecting the Security and Confidentiality of Healthcare Information (Volume 12, Number 1, Spring 1998) Articles http//www.himss.org
HIPAA Home Page http//www.hcfa.gov/hipaa/hippahm.htm
HIPAA Transaction Implementation Guides from the Washington Publishing Company http//www.wpc-edi.com
Joint Healthcare Information Technology Alliance (JHITA) Summary of Privacy rules Upcoming HIPAA conferences http//www.jhita.org
Links to other HIPAA sites http//www.hcfa.gov/medicare/edi/hipaaedi.htm
Medicare EDI http//www.hcfa.gov/medicare/edi/edi.htm
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Resources (cont.)
National Uniform Billing Committee http//www.nubc.org
National Uniform Claims Committee http//www.nucc.org
Washington Publishing Company ANSI ASC X12N HIPAA Implementation Guides http//www.wpc-edi.com/hipaa
Subscribe to email release of HIPAA documents (such as notice of proposed rule making) http//www.hcfa.gov/medicare/edi/admnlist.htm
Workgroup for Electronic Data Interchange (WEDI) Details of SNIP effort (Strategic National Implementation Pilot) http//www.wedi.org