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Jack Hutson, executive director of the Rhode Island Psychological Association, says that a seminar organized with the Rhode Island Medical Society provided valuable information about the Health Insurance Portability and Accountability Act’s provisions. (photo by Kathryn Hardy) |
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By Elizabeth Millard
Psychologists must get up to speed on the Health Insurance Portability and Accountability Act (HIPAA). One deadline for compliance has passed and two more are approaching. As a result, the American Psychological Association (APA) and state associations are taking steps to educate their memberships about the law's provisions.
Prior to Oct. 15, psychologists should have submitted a transactions rule compliance form with the Department of Health and Human Services (DHHS). The form, containing 26 questions in four sections, includes contact information, a cost estimate for complying with the transaction rule and a strategy for implementing the plan. The rule applies to all psychologists, not only those who transmit patient health information, billing or other administrative activity electronically. Clinicians who provide services through Medicare and Medicaid are required through those programs to submit the form. And, managed care payers must follow the regulations so their network clinicians must comply as well.
The APA and state associations urged members to take advantage of a one-year extension for compliance. This extension would ensure coverage for psychologists who aren't currently dealing with electronic transactions but who may use them later. Those practitioners who missed the deadline should contact their state associations for advice. It is unclear whether failure to file on time will result in a penalty.
"No one knows what action the DHHS will take, if any," according to Attorney Paul Litwak, J.D., author of "A Path to HIPAA Compliance" and a consultant to government agencies, health service systems and information technology companies. "There is some speculation that DHHS may allow non-compliant organizations to submit a corrective action plan."
Eric Harris, Ed.D. J.D., a psychologist and legal counsel to the Massachusetts Psychological Association, assures psychologists that help is on the way to guide them through the intricate HIPAA process.
Along with the APA, he is putting together an interactive CD-ROM of the act's relevant documents for all 50 states. The enormous undertaking, due by mid-February, will attempt to alleviate the anxiety some psychologists are feeling about complying with the regulations.
This project is a difficult undertaking, Harris says, because of the way HIPAA is written. Each state has laws concerning patient privacy. The act mandates that health care professionals follow the more stringent of the laws, whether they are state or federal. "That means that every state's psychologists will have different ways in which to behave," Harris says. "However, in many ways, psychologists have always had great provisions for privacy, so they will probably be less affected than other health care providers. I don't think the changes will be hugely substantive in the way one practices, but it will bureaucratize the relationship between the psychologist and the patient, because there will definitely be more forms to fill out."
Psychologists must pay close attention to the April 14 deadline to adhere to the privacy rule, says Harris. "This (privacy rule) is the one that psychologists should be most concerned about because any psychologist who bills for services is going to be affected by it and that's almost everyone in the psychology profession." Harris says that extensions for this provision are unlikely.
Under the privacy rule, providers will need to furnish patients with written notice of their privacy practices and the patients' privacy rights. Patients will have to sign and acknowledge receipt of the notice and give authorization before the information could be disclosed to an employer or for marketing purposes, for example.
The written privacy procedures should contain a description of who has access to the protected information, how it will be used and when it may be disclosed. Practitioners also need to demonstrate how business associates will protect the privacy of the information. They should also designate an individual to ensure that procedures are followed.
In certain instances, the law allows disclosures of health information without authorization. These circumstances would include emergencies, identification of a deceased person or cause of death, judicial and administrative proceedings, some law enforcement activities and those related to national security or defense. The privacy rule offers limits on these exceptions and it will be up to the professional at times to use his/her policies and ethical judgment.
Psychotherapy notes are given special protection. For example, written authorization will be required for most disclosures and a release form is not sufficient.
The privacy rule also covers the release of records to patients and third parties.
Later this year, the APA's Practice Organization and Insurance Trust will disseminate a resource outlining all of the information, forms and policies necessary to comply with the privacy rule.
The Office for Civil Rights (OCR) also will be releasing information to providers, plans and health clearinghouses on the specifics of the regulation.
The last provision, the security rule, will determine what kind of encryption software will be allowed and specify how client records should be kept and protected, potentially down to the type of lock that should be utilized on a filing cabinet. That rule, however, should not be uppermost in psychologists' minds just yet, Harris says.
Meanwhile, each state association is attempting to get the word out to educate psychologists.
The Rhode Island Psychological Association, for example, held a seminar on the basics and attracted a receptive audience. "Our continuing education event had a very good response," says Jack Hutson, executive director of the RIPA. "We organized it with the Rhode Island Medical Society and basically just did it to get our arms around the thing."
He says that although numerous APA mailings were sent out outlining the legislation and its intricacies, many members still have questions. "There was general concern on the part of all interested parties. They were very concerned about compliance, and we spent some time on discussing specifics. For example, just the act of making a call to a client's home and leaving a message about an appointment time can be considered the release of medical information, so it would be covered under HIPAA. Those are the sorts of tricky situations that are out there and we're trying to find a way to let members know about that," Hutson says.
The Connecticut Psychological Association (CPA) held one workshop to date to explain the HIPAA compliance regulations to its psychologists. Although attendance was not mandatory, approximately 100 of the state's 1,500 psychologists attended this initial session. During the three-hour program, psychologists viewed a PowerPoint presentation and were given the opportunity to ask questions both during and at the conclusion of the session. Handouts were also distributed to those in attendance.
Betty Ann Foy, CPA's administrative director, notes that the state will likely hold additional workshops in the future and will disseminate information regarding HIPAA through its e-newsletter.
Sheila Comerford, executive director of the Maine Psychological Association, says that state will also be conducting a workshop in November concerning HIPAA regulations. The association has put items on its newsletter and posted news on a listserv. Still, she sees a lot of interest by psychologists wanting to learn more. "Far and away, this has been the most popular workshop to sign up for. Everyone wants to take this one. They're worried."
Clifford I. Gordon, Ed.D. helped to organize the Rhode Island seminar and praised the efforts of the main speaker, a local attorney, who gave an overview of privacy rules and regulations around electronic transactions. He also appreciates the amount of effort exerted to keep psychologists appraised of HIPAA changes, although it wasn't always relevant to him.
"I think there were a lot of opportunities to get HIPAA information," he says. "I got a flyer once every two months on HIPAA, but a lot of it wasn't geared toward those in the mental health field. So, we felt an obligation to get information to our membership," Gordon says. Although the seminar covered a great deal, psychologists still seek answers. "It was an overwhelming amount to take in," he says. "What we saw was that people really want templates. They want authorization forms and very specific steps as to what needs to be filled out and when."
"We're all focused on the privacy rule," Harris says. "Everyone in the psychology profession should be, when it comes to HIPAA."
Additional reporting by Phyllis Hanlon, Susan Gonsalves.
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