Newsletter XIX August 2001
NSMA Adopts Resolutions At 2001 Annual Meeting
AMA Principles of Medical Ethics, June 2001
Executive Director Notes – HIPPA’s PRIVACY STANDARDS: What’s it all about?
The Nevada State Medical
Association held its 2001 Annual Meeting and Scientific Session May 17-20 at
the Wigwam Resort in
Resolution #2001-1, “MEMORIAL RESOLUTION”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT THE
Robert V. Broadbent, M.D., WCMS,
and be it further RESOLVED: THAT UPON PASSAGE OF THIS RESOLUTION, THE HOUSE OF DELEGATES RISE IN SILENT TRIBUTE.
Resolution #2001-2, “BYLAWS CHANGE”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT THE BYLAWS BE AMENDED TO READ: CHAPTER IV, SECTION 3, PARAGRAPH D – SEATING – A DELEGATE WHOSE CREDENTIALS HAVE BEEN ACCEPTED AND WHOSE NAME HAS BEEN PLACED ON THE ROLL AT THE OPENING OF THE HOUSE OR AT THE OPENING OF REFERENCE COMMITTEE A SHALL REMAIN A DELEGATE UNTIL FINAL ADJOURNMENT OF THAT CONVENTION. AN ALTERNATE DELEGATE MAY SERVE IN THE PLACE OF A DELEGATE PROVIDED ELIGIBILITY REQUIREMENTS HAVE BEEN MET AND CREDENTIALS VERIFIED BY THE ASSOCIATION SECRETARY PRIOR TO THE OPENING OF THE HOUSE OF DELEGATES. THERE IS ONLY ONE VOTE FOR A POSITION; WHICHEVER ONE IS SEATED.
Resolution #2001-3, “KEY CONTACT FOR
LEGISLATORS”, was discussed and recommended for a
RESOLVED: THAT STATE AND FEDERAL
LEGISLATORS FROM
Resolution #2001-4, was divided into 2001-4A and 2001-4B.
Resolution 2001-4A “BME-NSMA COMMUNICATIONS”, was discussed and recommended for REFERRAL TO GOVERNMENTAL AFFAIRS.
RESOLVED: THAT WE REQUIRE THE NSMA ATTORNEY TO ATTEND ALL BME MEETINGS AND THAT HE REVIEW THE BME AGENDA PACKET PRIOR TO THE MEETINGS, SO THAT HE MAY ADVISE US ACCORDINGLY.
REFERRED
Resolution # 2001-4B, “BME COMMUNICATIONS”, was discussed and recommended for DO PASS AS AMENDED.
RESOLVED: THAT THE
Resolution #2001-5, “BME MANDATED RECERTIFICATION”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT
AS IT WOULD NOT ENHANCE THE PUBLIC SAFETY BEYOND THE PRESENT CME REQUIREMENTS.
Resolution #2001-6, “CRIMINAL BACKGROUND CHECKS”, was discussed and recommended for a DO NOT PASS.
RESOLVED:
THAT THE
DO
Resolution #2001-25, “STOCK PURCHASE”, was recommended for REFERRAL TO MAJOR HEALTH ISSUES COMMISSION.
RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION CONSIDER THE PURCHASE ONE SHARE OF STOCK FROM THE MAJOR MEDICAL INSURANCE COMPANIES SO AS TO KNOW THE INSURANCE COMPANY PROFITABILITY, THE CEO’S SALARY, AND GIVE THE NEVADA STATE MEDICAL ASSOCIATION AN OPPORTUNITY TO VOICE OPINIONS AT INSURANCE COMPANY SHARE HOLDERS MEETINGS.
REFERRED
The Federation Unity Project Report was REFERRED BACK TO COUNCIL FOR FURTHER DISCUSSION.
REFERRED
Resolution #2001-7,
“NEVADA STATE BME PUBLISH REGULATIONS”, was discussed and recommended for a
RESOLVED: THAT THE
ALL ADOPTED REGULATIONS PROMULGATED BY THE BOARD IN THE
NEWSLETTER OF THE
Resolution #2001-8, “BME PAIN REGULATIONS”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION PETITION THE NEVADA STATE BOARD OF MEDICAL EXAMINERS TO REMOVE NAC 630.230(1)(M) ( A LICENSEE SHALL NOT “ENGAGE IN THE PRACTICE OF WRITING PRESCRIPTIONS FOR CONTROLLED SUBSTANCES TO TREAT ACUTE PAIN OR CRONIC PAIN IN A MANNER THAT DEVIATES FROM THE GUIDELINES SET FORTH IN THE MODEL GUIDELINES FOR THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF PAIN …”) FROM THE REGULATIONS OF THE NSBME SO THAT NEVADA’S ADOPTION OF FSMB’S MODEL GUIDELINES PARALLELS THAT OF OTHER STATES WHO HAVE ADOPTED THE MODEL GUIDELINES TO CREATE A SAFE HARBOR FOR PHYSICIANS TO TREAT PAIN WITH THE ADEQUATE PRESCRIPTION OF CONTROLLED SUBSTANCES.
Resolution #2001-9, “USUAL & CUSTOMARY PAYMENT FOR LATE FEES”, was withdrawn.
Resolution #2001-10,
“REQUIRING HEALTH PLANS IN
Resolution 2001-11 “ EQUAL COVERAGE FOR MENTAL ILLNESS” and
Resolution 2001-12, RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION CONSIDER THE PURCHASE ONE SHARE OF STOCK FROM THE MAJOR MEDICAL INSURANCE COMPANIES SO AS TO KNOW THE INSURANCE COMPANY PROFITABILITY, THE CEO’S SALARY, AND GIVE THE NEVADA STATE MEDICAL ASSOCIATION AN OPPORTUNITY TO VOICE OPINIONS AT INSURANCE COMPANY SHARE HOLDERS MEETINGS.
FOR SUBSTANCE ABUSE were combined and recommended for REFERRAL TO THE MAJOR HEALTH ISSUES COMMISSION.
RESOLVED:
THAT HEALTH PLANS PROVIDING MEDICAL COVERAGE IN
RESOLVED:
THAT HEALTH PLANS IN
RESOLVED: THAT HEALTH PLANS IN
Resolution #2001-13, “”UNAPPROVAL” BY PAYORS was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT NSMA SUPPORT MEASURES THAT WOULD REQUIRE PAYORS TO ACCEPT THE STANDARD PRIOR AUTHORIZATION AS A GUARANTEE OF PAYMENT FOR THE SERVICE PERFORMED.
Resolution #2001-14, “INSURANCE FALSE ADVERTISING”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT NSMA SUPPORT MEASURES AT THE STATE AND NATIONAL LEVELS TO REQUIRE INSURANCE PLANS BE HELD ACCOUNTABLE FOR ACCURATE AND TIMELY PROVIDER LISTS.
Resolution #2001-22, “DENTAL EMERGENCIES”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED:
THAT THE
Resolution #2001-23, “REINSTITUTION OF MEDICAL PRIVACY PROTECTION”, was recommended for a DO PASS AS AMENDED.
RESOLVED: THAT NSMA SUPPORT THE AMA POSITION THAT HIPPA “REGULATIONS” AS CURRENTLY WRITTEN ARE UNACCEPTABLE, and be it further
RESOLVED:
THAT THE ISSUES PERTAINING TO THE UNIQUE INDIVIDUAL HEALTH IDENTIFIER BE
REFERRED TO THE
Resolution #2001-15, “DELINEATION OF COSMETIC VS MEDICAL PROCEDURES”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION WORK WITH THE NEVADA STATE BOARD OF MEDICAL EXAMINERS, THE BOARD OF COSMETOLOGY, THE STATE BOARD OF OSTEOPATHIC MEDICINE AND THE
STATE BOARD OF HEALTH TO DEVELOP STATE STATUTES AND/OR REGULATIONS TO ADDRESS THE USE OF LASER EQUIPMENT, BOTOX INJECTIONS, COLLAGEN INJECTIONS, AND DERMABRASION.
Resolution #2001-16, “PROHIBITION OF TOBACCO USE IN GROCERY STORES AND RESTAURANTS”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT
Resolution #2001-17, “DRIVERS LICENSE RESTRICTION FOR DRIVERS UNDER 21 YEARS OLD”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT PERSONS UNDER THE AGE OF 18 SHOULD HAVE THEIR INITIAL LICENSE RESTRICTED FOR A PERIOD OF 12 MONTHS ENABLING THEM TO GAIN SAFE DRIVING EXPERIENCE.
Resolution #2001-18, “HEAD PROTECTION AT
RENTAL FACILITIES”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT ALL ESTABLISHMENTS THAT RENT BICYCLES, DOWNHILL SKIS, ROLLER BLADES, SNOWBOARDS, AND SCOOTERS OFFER PROTECTIVE HEAD GEAR WITH THE RENTAL AGREEMENT.
Resolution #2001-19, “COMMUNICATION BARRIERS”, was discussed and recommended for a DO PASS AS AMENDED.
RESOLVED: THAT NSMA THROUGH ITS AMA DELEGATES RECOMMEND THAT
INTERPRETIVE/TRANSLATOR SERVICES (AS REQUIRED BY
Resolution #2001-20, “CHANGE IN HANDICAP PARKING LAWS”, was discussed and recommended for a REFERRAL TO THE APPROPRIATE COMMISSION.
RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION ESTABLISH A COMMITTEE TO REVIEW GUIDELINES FOR THE APPROPRIATE DISTRIBUTION OF HANDICAP PARKING TAGS; and be it further
RESOLVED: THAT THE
Resolution #2001-21,
“UNPLANNED TEENAGE PREGNANCY IN NEVADA”, was discussed and recommended for a
RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION RECOMMEND TO THE STATE BOARD OF HEALTH AND THE STATE LEGISLATURE THAT NEVADA DEVELOP AND IMPLEMENT A COMPREHENSIVE PLAN TO DEAL WITH THE ISSUES OF UNPLANNED TEENAGE PREGNANCIES.
Resolution #2001-24, “HEAD PROTECTION” was recommended for a DO PASS AS AMENDED.
RESOLVED:
THAT THE
Preamble
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.
Principles of Medical Ethics
I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
IX. A physician shall support access to medical care for all people.
Adopted by the AMA’s House of Delegates
Weldon (Don) Havins,
M.D., J.D., CCMS Executive Director and Special Counsel
The United States Health and Human
Services’ (HHS) federal regulations entitled, Standard for Privacy of
Individually Identifiable Health Information (Privacy Rule) provides the first
comprehensive federal protection for the privacy of health information. The Privacy Rule became effective on
The Privacy Rule gives patients more control over their health information, sets boundaries on the use and release of health records, establishes safeguards that health care providers and their business associates must achieve to protect the privacy of individual’s health information, holds violators accountable by imposing civil and criminal penalties for violations, and attempts to balance when public policy requires disclosure of some individually identifiable health information. Under the Privacy Rule, patients have a right to be informed of uses made of their private health information, and a right to limit release of their information to the minimum necessary for the purpose of the disclosure. Patients also have the right to examine, copy and request corrections of the private health information. The Privacy Rule establishes the minimum standards to protect the confidentiality of medical information. State laws which provide stronger privacy protection will continue to apply over the specific provisions of the Privacy Rule.
What is required of the physician health care provider? As a “covered entity,” the physician must:
1. Provide information to patients about their privacy rights and how their information can be used.
2. Adopt specific written privacy policy procedures.
3. Train employees so that they understand and can implement their responsibilities under the Privacy Rule.
4. Designate an individual as the privacy official who will be responsible for seeing that the privacy procedures are adopted and followed.
5. Secure patient records containing individually identifiable health information so that they are not available to those who do not need them.
The privacy official at a physician, or small group practice, office may be the office manager, who may have other non-privacy related duties. The training requirements may be satisfied by providing each office employee with a copy of the privacy policies and documenting that all employees have reviewed and understand the policies. The federal Office of Civil Rights, charged with enforcing the Privacy Rule, maintains a web site with information on regulations and guidance for covered entities, including answers to frequently asked questions. All health care providers should bookmark this site: http://www.hhs.gov/ocr/hippa/
Between now and April 14, 2003, HHS states they will issue modifications to the Privacy Rule to correct any unintended negative effects of the regulations on health care quality or on access to health care. HHS states they will propose the following changes to the Privacy Rule:
1. Permit pharmacists to fill prescriptions phoned in by a patient’s doctor before obtaining the patient’s written consent.
2. Permit direct treatment providers receiving a first time patient referral to schedule appointments, surgery, or other procedures before obtaining the patient’s signed consent.
3. Increase covered entities’ ability to engage in whatever communications are required for quick, effective, high qualify health care, including routine oral communication with family members, treatment discussions with staff involved in coordination of patient care, and using patient names to locate them in waiting areas.
4. Increase covered entities’ confidence that certain common practices, such as use of sign-in sheets and X-ray lightboards, and maintenance of patient medical charts at bedside, are not prohibited under the rule.
5. HHS intends to re-evaluate the Privacy Rule to ensure that parents have appropriate access to information about the health and well-being of their children.
All changes must be made in compliance with the federal Administrative Procedures Act. This entails publishing proposed rule changes in the Federal Register through a Notice of Proposed Rulemaking, which invites public comment. After reviewing those comments, HHS will issue a final rule to implement modifications. HHS and the Office of Civil Rights state that covered entities should begin the process of implementing the privacy standards now in order to meet the compliance deadlines.
Specifically, the Privacy Rule requires that covered entities obtain the patient’s written consent before using or disclosing the patient’s personal health information to carry out treatment, payment, or health care operations (TPO). The Privacy Rule establishes a uniform standard for health care providers having a direct treatment relationship with the patient to obtain patients’ consent for use and disclosure of health information for the purposes of TPO. Exceptions to this required prior written consent are an emergency, when the provider is required by law to treat the individual, and when there are substantial communication barriers.
Providers having an indirect treatment relationship with patients may use and disclose personal health information for the purposes of TPO without obtaining a patient’s consent. In conflict with laws such as EMTALA (Emergency Medical Treatment and Labor Act), the Privacy Rule authorizes providers to refuse to treat a patient who refuses to sign the written consent (apparently the courts will need to resolve this conflict). A patient’s written consent need only be obtained by a provider one time. The consent must be written in plain language, inform the individual that information may be used and disclosed for TPO purposes, state the patient’s rights to review the health care provider’s Notice of Privacy Practices, inform the patient that he or she may request restrictions on the use of private health information used for TPO purposes (and may revoke consent in writing), and must be dated and signed by the individual or his or her legal representative.
While an individual may revoke consent in writing, the revocation will not apply to the extent that the covered entity has taken action in reliance on the consent. The health care provider need not agree to the individual’s request for restriction on the use of private health information, but if the health care provider does agree, he or she is bound by that or those restrictions. Individuals must be given notice of the provider’s Notice of Privacy Practices and may review that notice prior to signing a consent.
A health care provider must retain the signed consent for 6 years from the date it was last in effect. The form in which the signed consent must be retained for the 6 years is not specified in the Privacy Rule. Thus, storage in non-paper form such as microfilm appears permitted. If a covered entity obtains consent for TPO purposes and also receives an authorization, for use of private health information required for other than TPO purposes, the more restrictive document controls, unless the covered entity resolves the conflict with the individual.
This synopsis of the new regulations provides an overview of very detailed requirements which may be found in 45 CFR sections 160 through 165. The Code of Federal Regulations may be found online through web sites such as www.findlaw.com. While the cost, in time and money, of implementing these regulations can be daunting, many of the requirements can be accomplished by the health care provider him/her self, rather than resorting to expensive third parties consultants for all compliance measures. CCMS is conducting a 2.5 hour Category I CME course, free to CCMS members, entitled “HIPAA Privacy Regulations for Physicians,” on two separate dates. If space is available, non-CCMS members may attend for a fee. Attend, learn, and perhaps save yourself a couple grand implementing these regulations. For details, see the information on page 4. CCMS - where membership translates into value.
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