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 ensure protection of PHI is application of 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. 

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 use and disclosure of PHI needed to accomplish daily tasks. 

This includes developing and implementing policies and procedures that align with the practices of the organization. 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 is breaking the minimum necessary rule. 

How to implement HIPAA minimum necessary standard

Here are some things to keep in mind if you run a healthcare business:

1. 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. Healthcare professionals like doctors or nurses require access to patient medical data for treatment purposes on a regular basis. 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. If the day to day functioning of the practice involves recurring disclosure or requests, the policies can be standard protocols that limit PHI disclosure to not exceed than the amount required by the request or disclosure. 

4. 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. 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 it 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 is 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.

Who does the HIPAA minimum necessary standard apply to?

If you are a covered entity or business associate, HIPAA minimum necessary standard is applicable to your business. 

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 the privacy and security rules of HIPAA. If you fail to comply with any legal requirement stated in these regulations, HIPAA enforcement rule may apply to you depending on the severity of the violation. These include civil money penalties as well as procedures for hearings. 

The effortless way to compliance 

Business associates and 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.