What are the implications for your camp?

HIPAA is the acronym for the Health Insurance Portability and Accountability Act. This law, passed by Congress in 1996, helps to protect individuals’ rights to health coverage during events such as changing or losing jobs, pregnancy, moving, or divorce. It also provides rights and protections for employers when getting and renewing health coverage for their employees. HIPAA is NOT an insurance policy.

HIPAA contains a privacy rule (Standards for Privacy of Individually Identifiable Health Information). This rule gives patients greater access to their own medical records and more control over how their personal health information is used. The rule also addresses the obligations of health-care providers and health plans to protect health information. By law, covered entities had until April 14, 2003, to comply.

The privacy provisions of the federal law apply to health information created or maintained by health-care providers who engage in certain electronic transactions, health plans, and health-care clearinghouses.

For patients, it:

• enables them to find out how their health information is used and disclosed;
• limits release of information to the “minimum reasonably needed” for disclosure;
• gives them the right to examine and obtain a copy of their own health records and request corrections; and
• allows them to amend their health information if they believe it is inaccurate.

The Health and Human Services (HHS) Office for Civil Rights (OCR) has implementation and enforcement responsibility for the privacy rule. The OCR has issued a series of guidance materials that answer some of the questions about the new protections for consumers and requirements for doctors, hospitals, and other providers. It also clarifies some of the confusion regarding the meaning of key provisions of the rule. The guidance and other technical assistance materials are posted on the OCR Privacy Web site at: www.hhs.gov/ocr/hipaa.

It is federally mandated that all of the U.S. states and territories comply with HIPAA. Failure to comply with the privacy rule of HIPAA can lead to civil penalties up to $100 per person per violation and up to $25,000 per person for violations of a single standard for a calendar year and/or criminal penalties that can result in a $50,000 to $250,000 fine and one to ten years in jail for improper disclosure of individually identifiable health information.

So, What Does This Mean for Camps?

Your camp is not automatically subject to HIPAA just because you provide health care to campers. HIPAA only applies to health-care providers that electronically engage in one or more specified electronic transactions.¹ Those transactions are (among others that do not apply to directly to health-care providers): submitting health-care claims for payment; making inquiries to health plans about the status of health-care claims; making inquiries to a health plan about a person’s eligibility for health-care benefits; and, certifying and authorizing referrals to health-care providers.²

Simply completing a camper’s health form online or faxing a health form to a treating emergency room is not enough to confer “covered entity” status on a health-care provider. If your camp provides health care and electronically engages in one of the foregoing transactions, you may be a covered entity. For example, if your camp electronically bills a camper’s health insurance for health-care services, you may be covered. However, if your camp does not engage in these electronic transactions, you should not be covered by HIPAA’s privacy rule.

What Should My Camp Be Doing?

Camps have legitimate and important uses for health information such as providing emergency first aid and evaluating a camper’s ability to engage in activities. However, all campers deserve to have their health information kept confidential. Therefore, even if your camp is not directly covered by HIPAA, you should still evaluate how your camp uses health information and limit it to only to necessary uses. The steps outlined in this article, while perhaps not legally required, are still good guidelines to follow when handling campers’ health information.

If your camp is subject to HIPAA, you should have already taken steps to comply. When the privacy rule was initially issued, the American Camping Association (ACA) recommended the following to camps:

First, determine your camp’s current way of handling protected health information (PHI). Remember to consider:

• Who receives completed health forms and who has access to those forms?
• Who of the kitchen staff are typically informed of health issues? Why are they told? Could that pool of people be more limited without jeopardizing safety?
• What health challenges are shared with cabin staff?
• Who in the specialized areas of camp — waterfront, ropes course, horseback riding, tripping, etc. — are told about health challenges? Why are they told?
• Under what circumstances does PHI leave camp? How is the privacy of that information monitored?
• What individuals have access to all and any PHI? Who has limited access and how is that access limited?
• When a person leaves camp — whether on a day trip or at the end of their camp session — how is their health history secured? Who makes decisions regarding the disposition of that information?

Second, talk with your legal counsel regarding “red flags” which surfaced as a result of reviewing this information.³

Hopefully, since this rule went in to effect this April, you’ve already done these things! You should also have developed written policies and procedures to safeguard health information, provided notice to campers regarding how you will use their health information, and trained your staff about privacy.

Important Questions

Several questions have come up that might be useful as you consider your specific situations:

1. The rule talks about providing only the “minimum necessary information.” How do we deal with that at camp?
   The Privacy Rule acknowledges that health-care providers (such as your camp nurse or doctor) need free access to individual health information and in no way seeks to limit that access. In this situation, the rule directs entities to limit access to the minimum necessary or to that which is reasonable. What is meant by “minimal,” “necessary,” and “reasonable” is left to the discretion of the entity — camp, in your case. Because of this, the scope of what a given camp discloses may vary from other camps but, in all cases, only the minimum should be relayed. Thus, for your camp, the camp nurse or doctor has free access to health forms; camp staff generally would not. It should be noted that this Rule does not apply only to written documents — it also refers to oral communication about health information. In camps, we often use oral communication to convey health information about people at camp. This rule directs us to provide “reasonable safeguards” so oral information is limited only to those who need to hear the information. For example, the camp nurse may talk with a cabin counselor about a camper’s care but would do so in a setting which limits — if not eliminates — who else listens to that conversation. Camps should also review screening practices of Opening Day to evaluate who is hearing what about whom during the process.⁴
    
2. What if we need to refer a camper or staff to an out-of-camp provider such as clinics, hospitals, dentists, and chiropractors?
   The camp may freely release a camper’s health information to an out-of-camp health-care provider if it is doing so to further the health-care treatment of a camper. The health-care provider who receives the information has obligations to maintain the confidentiality of the information, too.
    
3. My campers and some staff are minors, what does the rule say about protecting their health information?
   The Privacy Rule recognizes a parent/guardian as the representative of a minor. Consequently, the parent/guardian can sign statements of authorization in the child’s name. In addition, the rule also recognizes another person acting in loco parentis. This is a position that most camps assume with regard to campers.
    
4. With all that is going on in the world, what are the HIPAA implications if public officials approach my camp and want information if they are responding to a bioterrorism threat? Is my camp medical staff permitted to disclose protected health information?
   Yes. The rule recognizes that various agencies or public officials will need protected health information to deal effectively with a bioterrorism threat. You can disclose protected health information, without the individual’s authorization, to a public health authority acting as authorized by law in response to a bioterrorism threat or public health emergency (see 45 CFR 164.512(b), public health activities). The privacy rule also permits a covered entity to disclose protected health information to public officials who are reasonably able to prevent or lessen a serious and imminent threat to public health or safety related to bioterrorism (see 45 CFR 164.512(j), to avert a serious threat to health or safety). In addition, disclosure of protected health information, without the individual’s authorization, is permitted where the circumstances of the emergency implicate law enforcement activities (see 45 CFR 164.512(f)); national security and intelligence activities (see 45 CFR 164.512(k)(2)); or judicial and administrative proceedings (see 45 CFR 164.512(e)).⁵

What Resources Are Available to Me?

• HIPAA Online
• HHS Office for Civil Rights Privacy
• For a copy of the regulations: www.hhs.gov/ocr/hipaa/finalreg.html

HIPAA Privacy & Security Resource Kits: The following Web sites are just a few of the many resources that a health-care provider might consult to conduct a HIPAA privacy and security risk assessment and generate an implementation plan. ACA does not specifically endorse these, or any other, HIPAA consulting service.

• www.hipaarx.net
• www.fasthipaa.com
• www.hipaa-training.com

Information compiled by ACA staff, based on guidance provided by ACA’s legal counsel, Ice Miller, Indianapolis, Indiana.

Notes
¹ 45 CFR 160.102(a)(3).
² 45 CFR 160.103.
³ Privacy and Health Information: New Regs — Who Needs to Know at Camp? Linda Erceg. The CampLine. October 2001.
⁴ Ibid.
⁵ Department of Health and Human Services. Centers for Medicare & Medicaid Services Web Site. December 10, 2002.

Originally published in the 2003 Spring issue of The CampLine.