1 Electronic Transactions and Code Sets Enforcement CMS Office of HIPAA Standards.
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Transcript of 1 Electronic Transactions and Code Sets Enforcement CMS Office of HIPAA Standards.
2
Enforcement of Administrative Simplification Standards
CMS named to enforce HIPAA transactions and code setsOCR continues to enforce HIPAA privacyCMS creates Office of HIPAA Standards
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Enforcement Reality
CMPs may not be more than - - $100/violation
- $25,000/calendar year for violation of an identical requirement or prohibition
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Enforcement Authority
Two provisions of HIPAA government enforcement- § 1176: civil monetary penalties (CMPs)
- § 1177: criminal penalties
• HHS has authority to assess CMPs • DOJ has authority for criminal
penalties
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Enforcement Regulation
HHS lead on developing enforcement regulationSimplifies and standardizes the enforcement processProvides a predictable process
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Enforcement Regulation
Notice of what constitutes a violation and how penalties will be determinedHapless vs. WillfulRulemaking process allows for public input
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From Complaint To Compliant
Complaint drivenVoluntary complianceTechnical assistanceCorrective action planProgressive Steps
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Technical Assistance
Focus on educating providers and covered entitiesRoundtables, informational papersASK HIPAA and HIPAA hotline
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Corrective Action Plan
Opportunity to submit corrective action planDemonstrate and document efforts to become compliantExercise reasonable diligence, make efforts to correct problem
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Progressive Steps
Compliance FIRST Corrective Action MIDDLETied for LAST: - CMPs - Exclusion from Medicare Access to care and patient safety
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What CMS WILL DO
Actively listenActively participate in your conferencesWe want voluntary compliance as much IF NOT MORE than you do