HIPAA Minimum Necessary Rule Standard

Much of the administrative simplification rule of HIPAA focuses on preventing unauthorized disclosure of protected health information (PHI). A good practice that helps to protect PHI is applying the HIPAA minimum necessary rule standard. 

This article details what this rule entails, how it works, cases where it is not applicable, and what happens when you fail to comply. 

What is the HIPAA minimum necessary rule?

HIPAA minimum necessary rule requires covered entities to practice data minimization and implement adequate safeguards to ensure that PHI is used and disclosed only to satisfy a purpose. This standard, a key element of the privacy rule, protects the confidentiality of patient data while offering sufficient flexibility to cater to any situation. 

The standard mandates that covered entities undertake reasonable measures to restrict the utilization, disclosure, and requests for PHI to the minimum extent necessary for achieving the intended purpose. This ensures that access to PHI is tailored to the specific needs, promoting a reasonable approach to handling sensitive health data.

How does it work?

The HIPAA minimum necessary rule is built on the privacy principle. It requires covered entities to take appropriate measures to limit the use and disclosure of PHI needed to accomplish daily tasks. 

This includes developing and implementing policies and procedures that align with the organization’s practices. The Department of Health and Human Services (HHS) clarifies that actual implementation might create specific scenarios or contexts where the standard cannot provide an unambiguous solution. 

Example of the minimum necessary rule

Let’s say you are a lawyer working in a hospital where a patient has filed a lawsuit against the practice. If the doctors or nurses reveal medical data about the patient irrelevant to the case, that breaks the minimum necessary rule. 

When does the HIPAA Minimum Necessary Rule Standard not apply?

The HIPAA Minimum Necessary Rule Standard does not apply in the following circumstances:

Disclosures for treatment: When sharing protected health information (PHI) in response to a healthcare provider’s request for treatment purposes, the Minimum Necessary Rule does not apply.

Individual Access Requests: Disclosures to individuals exercising their right of access to obtain information from a designated record set, in accordance with the HIPAA Privacy Rule, are exempt.

Authorizations for specific uses: Any uses or disclosures of PHI specifically authorized by the subject through a signed authorization are not constrained by the Minimum Necessary Rule.

Disclosures to the HHS Secretary: Information shared with the Secretary of the Department of Health and Human Services (HHS) in accordance with 45 CFR Part 160 Subpart C is not subject to the Minimum Necessary Rule.

Uses and disclosures for HIPAA Compliance: Activities necessary for compliance with the requirements of the HIPAA regulations are exempt from the Minimum Necessary Standard.

Uses and disclosures required by Law: The Minimum Necessary Rule does not limit any uses or disclosures of PHI mandated by other applicable laws.

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How to implement HIPAA minimum necessary standard

If you run a healthcare business, it’s important to follow specific rules about handling patient information. One important rule is the HIPAA Minimum Necessary Standard. Here are some things to keep in mind if you run a healthcare business:

1. Identify access requirements

The first step to protect PHI from unnecessary use and disclosure is to:

• Identify individuals within the organization who needs access to fulfill their responsibilities.
• The types or categories of PHI
• The conditions under which access to PHI is acceptable

2. Specify access for treatment purposes

Healthcare professionals like doctors or nurses require regular access to patient medical data for treatment purposes. Conducting a review individually for all such cases is not necessary. In cases where access to full medical history is required, it must be stated explicitly in the policies and procedures, along with a justification.

3. Establish standard protocols for recurring disclosures

Suppose the day-to-day functioning of the practice involves recurring disclosure or requests. In that case, the policies can be standard protocols that limit PHI disclosure not to exceed the amount required by the request or disclosure. 

4. Create criteria for non-recurring requests

Suppose a request or disclosure cannot be categorized as a recurring one. In that case, the CE should create justified criteria to determine and limit the same to only the amount necessary to carry out a function. 

5. Apply the principle of reasonable reliance

In some cases, the privacy rule allows CEs to apply the principle of reasonable reliance, relying on the judgment of the requesting party. Reasonable reliance fulfills the following criteria:

• If a public authority requests PHI to carry out a function where the data is a minimum requirement. The purpose should be covered by 45 CFR 164.512 of the privacy rule.
• If another CE makes the request. 
• A healthcare professional employed by the CE or a business associate requires the information to carry out a specific function where the information is a minimum requirement. 
• If a researcher from an Institutional Review Board (IRB) or Privacy Board requests it with supporting documents.

Is there an easy way to be HIPAA compliant? Yes, that’s where we come in. Sprinto automates multiple facets of compliance and ensures that organizations comply with all applicable laws and regulations concerning patient data safety. This can help reduce non-compliance risk while building trust with customers and business partners.

HIPAA minimum necessary standard exceptions

The HIPAA minimum necessary standard does not apply to the following cases:

• If a healthcare provider/professional requests access to PHI for treatment purposes 
• If it is disclosed to an individual who is subject to that information
• In cases where the use or disclosure of PHI complies with the administrative simplification rule of HIPAA
• If the owner of information grants authorization
• The HHS requires the disclosure under the privacy rule for enforcement purposes. 
• Any use or disclosure under legal requirements

What happens if you break this rule?

As a covered entity or business associate, you should comply with HIPAA’s privacy and security rules. If you fail to comply with any legal requirement stated in these regulations, HIPAA enforcement rules may apply to you depending on the severity of the violation, you could be subject to civil money penalties and hearings. The penalties can range from $127 to $250,000, depending on the nature of the non-compliance incident and the corrective actions taken.

Examples of Minimum Necessary Standard Violations

Examples of Minimum Necessary Standard Violations often involve situations where access to Protected Health Information (PHI) goes beyond what is necessary for a specific task or purpose.

Here are some of the examples are listed below:

1. Unauthorized access 

One of the most common HIPAA violations organizations report is unauthorized access or use of PHI. These activities are:

• Obtaining medical records without a valid purpose.
• Sharing sensitive information with unauthorized people.
• Using PHI for reasons other than delivering patient care.
  

2. Improper disposal of PHI

Improper disposal of PHI occurs when an individual or organization fails to properly dispose of PHI in a way that ensures unauthorized individuals cannot access it. 

PHI must be disposed of securely through destruction, shredding, burning, or other methods approved by the U.S. Department of Health to protect confidential patient data from unauthorized disclosure and misuse.

2. Use of unsecured networks for transmitting PHI

Using unsecured networks to transmit PHI is a severe violation of HIPAA regulations. Unsecured networks can be accessed by unauthorized individuals and malicious actors, leading to the theft or misuse of confidential patient data. Organizations must secure networks with encryption, authentication protocols, and other security measures to avoid risk or exposure. 

The effortless way to compliance 

Business associates and HIPAA-covered entities often find themselves drowning in a sea of regulation. Handling every HIPAA requirement while being compliant is hard – but does not have to be. 

Sprinto automates manual tasks that help you stay compliant with HIPAA. It monitors HIPAA safeguards, manages your vendors or contractors with PHI access, flags unauthorized access, and triggers notifications to alert on failing checks. Sprinto also trains your employees, shows all controls and status from a centralized dashboard and easily integrates with your existing system. 

Want to learn more? See a quick demo.

FAQs

1. Who does the HIPAA minimum necessary standard apply to?

The HIPAA minimum necessary standard applies to covered entities — healthcare providers (doctors, dentists, chiropractors, nursing homes, pharmacies), health plans (insurance companies, HMOs and healthcare clearinghouses, and business associates — individuals or entities that perform functions involving the use or disclosure of PHI.

2. What are instances where the minimum necessary standard may not apply?

Some instances where exceptions to the minimum necessary standard apply include when using or disclosing PHI for treatment purposes, disclosing PHI to the individual subject of the information or HHS’ Office for Civil Rights, complying with legal requirements, or meeting other standards of the Privacy Rule that necessitate disclosures beyond the minimum necessary.

3. How healthcare organizations guarantee adherence to the minimum necessary standard?

Ensuring compliance with the minimum necessary standard in a healthcare organization presents challenges, as it’s impractical for a compliance officer to be constantly present with every staff member. Nonetheless, healthcare organizations can emphasize the significance of the minimum necessary standard through thorough workforce training and implement sanctions consistently in response to standard violations.