Opinion ID: 2741507
Heading Depth: 1
Heading Rank: 9

Heading: conditioning of authorizations

Text: The HIPAA regulations prohibit only the conditioning of medical treatment or health care benefits on the execution of a HIPAA authorization. See 45 C.F.R. § 164.508(b)(4) (“A covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization[.]”). Even that limited prohibition has rather broad exceptions. A covered entity may condition medical treatment on the signing of an authorization when: (1) the treatment is research-related and the information to be disclosed is to be used in the research; (2) a health plan conditions enrollment in the health plan or eligibility for benefits on the signing of an authorization if the 21 Case: 13-14637 Date Filed: 10/10/2014 Page: 22 of 36 authorization is necessary for the health plan’s underwriting or risk rating determinations and the authorization is not for the disclosure of psychotherapy notes; or (3) “the provision of health care . . . is solely for the purpose of creating protected health information for disclosure to a third party,” when the authorization permits disclosure to that third party. Id. § 164.508(b)(4)(i)-(iii). In responding to issues raised by public comments, the Secretary has interpreted the HIPAA regulations to allow other benefits to be conditioned on the signing of a HIPAA authorization. See 65 Fed. Reg. at 82,658. The Secretary considered suggestions that it “prohibit the provision of anything of value” from being conditioned on an authorization for disclosure of protected information. Id. After such consideration, the Secretary acknowledged that, due to its limited authority, it “cannot entirely prevent individuals from being coerced into signing these [authorization] forms.” Id. The Secretary added that “[w]e do not, for example, have the authority to prohibit an employer from requiring its employees to sign an authorization as a condition of employment.” Id. Similarly, the Secretary said “a program such as the Job Corps may make such an authorization a condition of enrollment in the Job Corps program.” Id. In that same comment section, the Secretary also recognized that many states require state Medicaid agencies to obtain, for payment purposes, an individual’s HIPAA authorization as a condition of enrolling an individual as a 22 Case: 13-14637 Date Filed: 10/10/2014 Page: 23 of 36 Medicaid recipient. “If state law requires a Medicaid agency to obtain the individual’s authorization for providers to disclose protected health information to the Medicaid agency for payment purposes, the agency may do so under § 164.508(e). This authorization must not be a condition of enrollment or eligibility, but may be a condition of payment of a claim for specified benefits if the disclosure is necessary to determine payment of the claim.” Id. State law may thus require a Medicaid agency to condition payment of a claim for benefits on an individual’s signing an authorization if the disclosure of protected health information is necessary to determine payment. See id.