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Essay Subject: Discusses issue of confidentiality and the Older Americans Act (OAA).... More...

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Paper Abstract: Discusses issue of confidentiality and the Older Americans Act (OAA). Problem of patient privacy. Legal rights of patients to have medical and other relevant records held in confidence. Contention that laws are inadequate to protect frail, older patients receiving home health care. Issue of informed consent. Effect of the Health Insurance Portability and Accountability Act (HIPAA). Paper Introduction: Home Health Care, Confidentiality and the Older Americans Act Title of Act: Older Americans Act of 1965 as amended through March 2003 Section: Section 314 (42 U.S.C. 3030-c1) Rights Relating to In-Home Services for Frail Older Individuals Subsection: Subsection(3): “The right to confidentiality of records relating to such individual.” Introduction Contained in Section 314 (3) of the Older Americans Act of 1965 as amended through March 2003 is an enumeration of the rights of older individuals receiving in-home health services. Included in this enumeration is the right to confidentiality of medical records. This brief report will answer a series of questions related to this right an Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. There are likely to be both anticipated and unanticipatedconsequences to such a solution. This briefreport will answer a series of questions related to this rightand its effects. The problem, says Appelbaum (2 ), can negatively impact uponthe entire population of older Americans who receive some type of in-homehealth care; more significantly, perhaps, it impacts upon members of thispopulation receiving care in hospitals, nursing homes and other venues. The Privacy Rule of HIPAA will benefitpatients by ensuring that there are penalties attached to privacy rightsviolations. As the rules currently read,patients must consent in writing to the release of their medicalinformation for treatment and reimbursement purposes. Patients would no longer be able toprevent these companies from obtaining their medical records. 3 3 -c1) Rights Relating to In-HomeServices for Frail Older IndividualsSubsection: Subsection(3): "The right to confidentiality of recordsrelating to such individual." Introduction Contained in Section 314 (3) of the Older Americans Act of 1965 asamended through March 2 3 is an enumeration of the rights of olderindividuals receiving in-home health services. Asingle federal law - no matter how strong or weak - has the furtherpotential to stifle state initiatives (Medical record privacy, 2 2). The social costs for diluting patient rights to record confidentialitycould be enormous. This is the historical antecedent of the problem which led Appelbaum(2 ) to comment that a lack of uniformity and true privacy of medicalrecords continues to exist. On balance, mostcritics of the legislation contend that it has largely failed to achieveits purposes. (2 3). Available at www.cdt.org/privacy/medical/95 mrca_ summary.shtml.Older Americans Act of 1965. Many older Americans, including those who receive in-home healthcareservices, remain vulnerable to invasion of privacy and breech ofconfidentiality when their records are inappropriately shared among serviceproviders without patient consent. The modifications called for by theBush administration were seen as necessary for correcting unintendedconsequences of the existing rules that threaten (or are said to threaten)patients' access to quality health care. Members ofthe general public have let Congress know, says Marwick (1996), that recordconfidentiality is a major concern, particularly in light of newinformation technologies that increase ease of access to such information. (2 3). The problem of record confidentiality is a national problem ratherthan a localized one. Available at www.methodisthealth.com/homehealth/ rights.htm. (2 2). In theory, older Americans covered by the OAA and other laws enjoythe right to medical records privacy when receiving home health care. A discussion of the role of social workers in ensuringthat record confidentiality is maintained will be provided. Under HIPPA, Protected Health Information (PHI) consists ofindividually identifiable health information that is oral or maintained inany form or medium that is: 1) created or received by any healthcareprovider, health plan, public health authority, employer, life insurer,school or university or healthcare clearing house; 2) transmitted byelectronic media;3) transmitted in any other form or by other medium (Patient privacy in theinformation age, 2 1). Enforcement, however, many be a somewhat more difficult issue. One of the most importantissues centered on the rights of patients of all ages, including theelderly, is the right to have medical and other relevant records held inconfidence. Direct Marketing, 64(3), 32-4 .Patient rights. (2 3). Methodist Health Care System. Applebaum (2 ) believes that the existing statute allows any healthplan, including a managed care Medicaid or Medicare plan covering olderAmericans, to pass on medical records to any entity hired by the healthplan to coordinate or manage care. In essence, therefore, though the Act established (as does theOlder Americans Act) the right of the individual to recordsconfidentiality, it allows for a number of potentially critical exceptions. Medical recordsare, nevertheless, seem by Americans as one type of personal informationthat should be more vigorously protected by government from unauthorizedaccess and use (Federal legislation to... It is for this reasonthat numerous legislative efforts - including the OAA, HIPAA, and so on -have been undertaken to address this important issue. Journal of the American Medical Association, 276(4), 27 -272.Medical record privacy. The solution to the privacy and confidentiality issue, as explicit inthis and other legislation including the OAA, is to limit access toconfidential health information and to create a set of proceduralsafeguards that have been designed to prevent unauthorized access or accessthat may be a precursor to discriminatory treatment (Patient privacy in aninformation age, 2 1). Calls for changingthe rules are based on the belief that this requirement could make itdifficult for a relative to pick up a prescription or discourage somedoctors from treating older patients who do not sign privacy consent forms(Condon, 2 2). Exceptions to consent were also identified, including emergencycircumstances, oversight matters such as health care fraud or abuse, publichealth issues, health research, judicial and administrative purposes. This would ultimately weakenthe privacy provisions of the OAA and other legislation. Regulations on the use of medical information havelagged behind the rapidly proliferating purposes for the dissemination ofsuch data. ReferencesApplebaum, P.S. The Bush administration. The solution to the problem is to rid the system of itscurrent patchwork of conflicting state and federal laws and to ensure thata single set of standards applies in all cases - whether the patient isbeing cared for in the home, in hospital, or in a skilled care facility(i.e., nursing home or rehabilitation centers) (Federal legislation to...,2 2). Discussion The problem of record confidentiality is likely to impact on allAmericans, but particularly upon older Americans receiving home and otherforms of health care from numerous providers. According to Appelbaum (2 ), regulations proposed by theDepartment of Health and Human Services (HHS) covering access to medicalrecords have not gone far enough in protecting patients' privacy. Recently, the Bush Administration has proposed revisiting the patientprivacy rules of OAA and HIPAA that took effect in 2 1 but which will notbe enforced until 2 4 (Condon, 2 2). The proposed revisions would have the effect of permittingInsurers, pharmacists, doctors, and home healthcare providers to make onlya "good faith effort" to verify in writing that a patient has been informedof his or her privacy rights (Condon, 2 2). Non-law enforcement subpoenas, law enforcement and certified health informationservices. Home health care patients, according to the National Association forHome Care (NAHC), have the right under current statutes to be able tochoose care providers and to provide informed consent both for proceduresand services and for the sharing of medical records (Patients rights,2 3). Available at www.epic.orgprivacy/medical.The Medical Records Confidentiality Act of 1995. Thoughthe Older Americans Act (OAA) does clearly stipulate that all frail olderpatients receiving some type of home health care have such a right,Appelbaum (2 ) has argued that the federal and state laws addressing thisissue are inadequate; specifically, many public agencies as well as privatesector companies are currently able to access such records without theconsent of the patient. 2 2). The nature and scope of the problem, solutions to the problem andtheir consequences, and implications for social work practice have beendiscussed. USA Today, 131(2689), 1-2.Marwick, C. Home health care patients are protected by OAA and other statutes,but are vulnerable to statutory shifts because many of these patientsdepend almost exclusively on publicly subsidized health insurance andreimbursement programs. Home Health Care, Confidentiality and the Older Americans ActTitle of Act: Older Americans Act of 1965 as amended through March 2 3Section: Section 314 (42 U.S.C. Electronic Privacy Information Center. Congress passed the MedicalRecords Confidentiality act to establish uniform privacy protection forpersonally identifiable health information (The Medical Records..., 2 3).Under Title II of the Act an individual's consent is required to accesspersonally identifiable health information for purposes of payment ortreatment. Thissuggests that informed consent to use or access such information must beobtained by any party seeking to access a patient's private medicalrecords. (2 ). Included in thisenumeration is the right to confidentiality of medical records. Applebaum(2 ) maintains as do many organizations that function as advocates forolder Americans, that a strong national law that eliminates conflictingstate law must be developed. (2 2). There is historical evidence that this issue has been regarded assignificant by lawmakers. In other words, any legislation thateffectively dilutes OAA's privacy provisions in Section 314 would bedetrimental to older Americans. Among those concerned with the problem are advocacy groups forthe elderly, the disabled, and other patient populations who arelegitimately concerned with confidentiality (Marwick, 1996). (2 2). Payors couldrefuse to cover services that were not provided by the care organizationsthey select, regardless of whether or not the patient wishes to receiveservices from that organization. Marwick (1996) noted that the Health InsurancePortability and Accountability Act (HIPAA) of 1996 was one of the mostpromising efforts undertaken to strengthen provisions such as that found inSection 314 of the OAA. (2 1). However, as Marwick (1996) and Appelbaum (2 )have commented, these and other efforts to legislate improved recordconfidentiality have not succeeded in meeting the goals of laws such as theOAA. Consumers' Research Magazine, 85(4), 6.Federal legislation to assure confidentiality. Under HIPPA, and despite the concerns of groupssuch as the healthcare insurance industry and the American MedicalAssociation (AMA), patient rights to privacy are emphasized. (1996). Available at www.tcsg.org/law/oaa/htm.Patient privacy in an information age. Journal of the American Medical Association, 283(6), 795-797.Condon, E.C. Should a weak national law be passed, the door will be opened for thecreation of relatively strong state laws that could leave some persons(such as those dependent largely on Medicare or Medicaid for healthinsurance costs) with less protection than they previously enjoyed. Conclusion This brief report has answered a number of questions relative to theprivacy rights of home health care patients whose rights are discussed inthe OAA. In 1995, the U.S. Threats to the confidentiality of medical records - no place to hide. Increasing use of computerized recordkeeping leads to legislative proposals for medical privacy. It seems reasonable to conclude that a strong national privacylaw must be enacted to ensure the confidentiality of medical records andother wise bolster the rights of an increasing number of Americans. Social workers are particularly affected in that theymust function as patient advocates and assist their clients in obtainingneeded health care services in a manner designed to affirm privacy rights.This issue is important as more and more Americans reach retirement age.It is also important because of the potential for conflict between patientsand managed care companies seeking to reduce service costs. Americans, and particularly older Americans who constitute a growingportion of the national population, have grown grudgingly accustomed tohaving certain aspects of their lives open to inspection. 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