New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The following definitions apply to terms used in this
				  chapter.
A.
Alternate
				address:
A location other than the primary address on file with HCA for
				the recipient or the recipient's personal representative.
B.
Alternate means of
				communication:
A communication made other than in writing on paper, or
				made orally to the recipient or their personal representative.
C.
Amend or amendment:
To make a
				correction to information that relates to the past, present, or future physical
				or mental health or condition of a recipient.
D.
Authorized HCC employee:
A
				person employed within the health care component (HCC) workforce who is
				authorized by the immediate supervisor or by HCC policies to perform the
				task.
E.
Business
				associate:
A person or entity that performs certain functions or
				services on behalf of the HCC involving the use or disclosure of individually
				identifiable health information. These include claims processing or
				administration, data analysis, processing or administration, utilization
				review, quality assurance, billing, benefit management, and practice
				management. They also include, other than in the capacity of a member of the
				HCC workforce, legal, actuarial, accounting, consulting, data aggregation,
				management, administrative, accreditation, or financial services to or for the
				HCC.
F.
Covered
				entity:
A health plan, a health care clearinghouse, or a health care
				provider that transmits any health information in electronic form in connection
				with a recipient's health care transaction.
G.
Disclose or disclosure:
To
				release, transfer, provide access to, or divulge in any other manner (verbally,
				written, or electronic) protected health information outside the HCC workforce
				or to an HCC business associate.
H.
Health care component (HCC):
Those parts of the HCA, which is a
				"hybrid entity" under HIPAA 45CFR 164.105], that engage in
				covered health plan functions and business associate functions involving
				protected health information. HCA's health care component consists of the
				medical assistance division, supported by the income support division, the
				office of inspector general, the office of general counsel, and the office of
				the secretary.
I.
Health care
				operations:
Any of the following activities: quality assessment and
				improvement activities, credentialing activities, training, outcome
				evaluations, audits and compliance activities, planning, fraud and abuse
				detection and compliance activities, managing, and general administrative
				activities of the HCC, to the extent that these are related to covered health
				plan functions.
J.
Health
				oversight agency:
An agency or authority of the United States, a state,
				a territory, a political subdivision of a state or territory, or an Indian
				tribe, or a person or entity acting under a grant of authority from or contract
				with such public agency, including the employees or agents of such public
				agency or its contractors or persons or entities to whom it has granted
				authority, that is authorized by law to oversee the health care system (whether
				public or private) or government programs in which health information is
				necessary to determine eligibility or compliance, or to enforce civil rights
				laws for which health information is relevant.
K.
Health Insurance Portability and
				Accountability Act (HIPAA) privacy rule:
The federal regulation Section
				45 CFR part 160 and Subparts A and E of Part 164.
L.
Health plan:
The medicaid
				program under Title XIX of the Social Security Act,
				42 U.S.C.
				1396, et seq., and the state children's
				health insurance program (SCHIP) under Title XXI of the Social Security Act,
				42 U.S.C.
				1397, et seq.
M.
HCC workforce:
Permanent,
				term, temporary and part-time employees (classified or exempt),
				university/federal government placements, volunteers, contractors and others
				conducting data entry tasks, and contractors and other persons whose conduct
				and work activities are under the direct control of HCC.
N.
Medical record or designated record
				set:
Any HCC item, collection, or grouping of information that includes
				protected health information (PHI) that is written or electronic and is used in
				whole or in part, by or for HCC to make decisions about the recipient. This
				applies to:
(1) the medical records and
				billing records about the recipient maintained by or for the HCC;
(2) the enrollment, payment, claims
				adjudication, and case or medical management record systems maintained by or
				for HCC; and
(3) this definition
excludes
HCC documents such as those related to accreditation
				compliance activities (e.g., JCAHO), quality assurance, continuous quality
				improvement, performance improvement, peer reviews, credentialing and incident
				reports, and investigations.