Exploring HIPAA and HITECH Act Definitions: Part 13

From now through December, HIPAA.com is providing a run through of HIPAA transaction & code set, privacy, and security definitions, along with relevant HITECH Act definitions pertaining to breach notification, securing of protected health information, and electronic health record (EHR) standards development and adoption. These definitions are key to understanding the referenced HIPAA and HITECH Act enabling regulations that are effective now and that will require compliance by covered entities and business associates now or in the months ahead, as indicated in HIPAA.com’s timeline. Each posting will contain three definitions, with a date reference to the Federal Register, Code of Federal Regulations (CFR), or statute, as appropriate.

Exploring HIPAA and HITECH Act Definitions:  Parts 11-15, include definitions from:

American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),

Health Information Technology for Economic and Clinical Health Act,

Title XIII—Health Information Technology,

Subtitle D—Privacy,

Section 13400—Definitions.

Health Care Provider

Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“A provider of services (as defined in section 1861(u) of the [Social Security] Act, 42 U.S.C. 1395x(u)), a provider of medial or health services (as defined in section 1861(s) of the [Social Security] Act, 42 U.S.C. 1395x(s), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.”

Health Plan

Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

Health plan means an individual or group plan that provides, or pays the cost of, medical care (as defined in section 2791(a)(2) of the PHS [Public Health Service] Act, 42 U.S.C. 300gg-91(a)(2).

(1) Health plan includes the following, singly or in combination:

(i)            A group health plan, as defined in this section.

(ii)          A health insurance issuer, as defined in this section.

(iii)         An HMO, as defined in this section.

(iv)         Part A or Part B of the Medicare program under title XVIII of the Act.

(v)          The Medicaid program under title XIX of the Act, 42 U.S.C. 1396, et.seq.

(vi)         An issuer of a Medicare supplemental policy (as defined in section 1882(g)(1) of the Act, 42 U.S.C. 1395ss(g)(1)).

(vii)       An issuer of a long-term care policy, excluding a nursing home fixed-indemnity policy.

(viii)      An employee welfare benefit plan or any other arrangement that is established or maintained for the purpose of offering or providing health benefits to the employees of two or more employers.

(ix)         The health care program for active military personnel under title 10 of the United States Code.

(x)          The veterans health care program under 38 U.S.C. chapter 17.

(xi)         The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) (as defined in 10 U.S.C. 1072(4)).

(xii)       The Indian Health Service program under the Indian Health Care Improvement Act, 25 U.S.C. 1601, et.seq.

(xiii)      The Federal Employees Health Benefits Program under 5 U.S.C. 8902, et.seq.

(xiv)      An approved State child health plan under title XXI of the Act, providing benefits for child health assistance that meet the requirements of section 2103 of the Act, 42 U.S.C. 1397, et.seq.

(xv)       The Medicare+Choice program under Part C of title XVIII of the Act, 42 U.S.C. 1395w-21 through 1395w-28.

(xvi)      A high risk pool that is a mechanism established under State law to provide health insurance coverage or comparable coverage to eligible individuals.

(xvii)    Any other individual or group plan, or combination of individual or group plans, that provides or pays for the cost of medical care (as defined in section 2791(a)(2) of the PHS Act, 42 U.S.C. 300gg-91(a)(2)).

(2) Health Plan excludes:

(i)            Any policy, plan, or program to the extent that it provides, or pays for the cost of, excepted benefits that are listed in section 2791(c)(1) of the PHS Act, 42 U.S.C. 300gg-91(c)(1); and

(ii)          A government-funded program (other than one listed in paragraph (1)(i)-(xvi) of this definition):

A.  Whose principal purpose is other than providing, or paying the cost of, health care; or

B.  Whose principal activity is:

(1) The direct provision of health care to persons; or

(2) The making of grants to fund the direct provision of health care to persons.”

National Coordinator

The head of the Office of the national Coordinator for Health Information Technology established under section 3001(a) of the Public Health Service Act, as added by section 13101.

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