Do personal representatives need to be HIPAA compliant?

Whether you're a parent managing your child's medical records, an executor of an estate, or holding a healthcare power of attorney, being HIPAA compliant is required to protect the health information of those you represent.

What is a personal representative?

A personal representative is an individual authorized by law to make decisions on behalf of another individual. This could be a parent or legal guardian of a minor, someone holding a healthcare power of attorney, or an executor of an estate managing the healthcare affairs of a deceased person. Personal representatives have the same rights as patients to access and manage the individual’s protected health information (PHI).

See also: HIPAA Compliant Email: The Definitive Guide

The role of HIPAA in healthcare

Enacted in 1996, HIPAA aims to protect the privacy and security of health information. It sets national standards for the protection of PHI, which includes any information that can be used to identify a patient and relates to their health condition, healthcare provision, or payment for healthcare services. HIPAA applies to covered entities like healthcare providers, health plans, healthcare clearinghouses, and their business associates.

Related: What is HIPAA?

Why must personal representatives be HIPAA compliant?

According to the HHS, “subject to certain exceptions, the Privacy Rule at 45 CFR 164.502(g) requires covered entities to treat an individual’s personal representative as the individual with respect to uses and disclosures of the individual’s protected health information, as well as the individual’s rights under the Rule.” Therefore, since personal representatives are treated as individuals seeking medical attention, they must adhere to the same privacy and security standards that healthcare providers and other covered entities follow under HIPAA. Following HIPAA guidance ensures that the individual’s health information is protected against unauthorized access, use, or disclosure.

Responsibilities of a HIPAA compliant Personal Representative

To ensure HIPAA compliance, personal representatives should be aware of the following responsibilities:

• Understand the scope of their authority: Personal representatives should know the extent of their legal authority and the specific decisions or actions they are authorized to take on behalf of the individual.
• Secure PHI: Whether the PHI is in electronic, paper, or oral form, personal representatives must secure it by using strong passwords, encrypting digital records, and storing paper records in locked locations.
• Limit disclosures: PHI should only be disclosed to individuals or entities with a legitimate need to know, according to HIPAA’s Minimum Necessary Rule.
• Be informed of rights and responsibilities. Personal representatives should familiarize themselves with HIPAA’s regulations and guidelines to understand their responsibilities.
• Seek legal guidance if needed: If there’s any doubt about what HIPAA permits or requires, personal representatives should seek legal advice to ensure compliance.

FAQs

What rights does a personal representative have under HIPAA?

A personal representative has the same rights to access and control an individual’s PHI as the individual themselves. The representative can request medical records, make healthcare decisions, and receive communications regarding the individual’s care, all within the scope of their legal authority.

See also: What are patient rights under HIPAA?

Can a healthcare provider refuse to share PHI with a personal representative?

A healthcare provider may refuse to share PHI with a personal representative if:

• They reasonably believe the disclosure could endanger the individual, 
• There is a legal reason that restricts the personal representative’s access, or
• The representative’s authority does not cover the requested information or decision.

Is there any training available for personal representatives about HIPAA compliance?

While formal HIPAA training is not typically required for personal representatives, many resources are available online, including guidelines from the U.S. Department of Health and Human Services (HHS). Legal advisors and healthcare providers can also offer insights and guidance on HIPAA compliance for personal representatives.