Overview:
§164.522(a)(1)
Standard: Right of an individual to request restriction of uses and disclosures.
(i) A covered entity must permit an individual to request that the covered entity restrict: (A) uses or disclosures of protected health information about the individual to carry out treatment, payment, or health care operations; and (B) disclosures permitted under §164.510(b).
(ii) Except as provided in paragraph (a)(1)(vi) of this section, a covered entity is not required to agree to a restriction.
(iii) A covered entity that agrees to a restriction under paragraph (a)(1)(i) of this section may not use or disclose protected health information in violation of such restriction, except that, if the individual who requested the restriction is in need of emergency treatment and the restricted protected health information is needed to provide the emergency treatment, the covered entity may use the restricted protected health information, or may disclose such information to a health care provider, to provide such treatment to the individual.
(iv) If restricted protected health information is disclosed to a health care provider for emergency treatment under paragraph (a)(1)(iii) of this section, the covered entity must request that such health care provider not further use or disclose the information.
(v) A restriction agreed to by a covered entity under paragraph (a) of this section, is not effective under this subpart to prevent uses or disclosures permitted or required under §§164.502(a)(2)(ii), 164.510(a) or 164.512.
(vi) A covered entity must agree to the request of an individual to restrict disclosure of protected health information about the individual to a health plan if:
(A) The disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and
(B) The protected health information pertains solely to a health care item or service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.
Action Items:
1) Obtain and review policies and procedures against the established performance criterion.
2) If the covered entity has agreed to a restriction, obtain and review sample of documentation of each request and subsequent agreement to determine if restrictions are given effect.
Related Documents:
1) Policies and procedures against the established performance criterion.
2) Sample of documentation of each request and subsequent agreement to determine if restrictions are given effect.
Additional Guidance:
Individuals have the right to request that a covered entity restrict use or disclosure of protected health information for treatment, payment or health care operations, disclosure to persons involved in the individual’s health care or payment for health care, or disclosure to notify family members or others about the individual’s general condition, location, or death. A covered entity is under no obligation to agree to requests for restrictions. A covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.
Article ID: 559
Created: September 29, 2022
Last Updated: September 29, 2022
Author: Matthew Burdick
Online URL: http://www.compliancewiki.org/article/hipaa-privacy-right-of-an-individual-to-request-restriction-of-uses-and-disclosures-164-522-a-1-559.html