Any terms used but not defined in any section of this Policy shall, as applicable and as may be required by the context in which they are used, have the meanings ascribed thereto in the HIPAA Privacy Rule, 45 CFR Parts 160 and 164. Any term defined in any section of this Policy shall have the same meaning when used in other sections of this Policy.
"AUTHORIZED USER." An individual that is granted access to PHI for patients through an authorization, IRB waiver or who is performing an activity related to health care operations.
"DEFECTIVE CONSENTS." Lacking an element required in the consent or becoming defective if the consent has been revoked.
"DEPARTMENT." The Fire Department of the Village of Romeoville, as set forth in Chapter 32 of the village Code of Ordinances.
"DESIGNATED RECORD SET." A group of records maintained by or for the department and the village that are:
(1) The medical records and billing records about patients maintained by or for the department and the village;
(2) The enrollment, payments, claims adjudication, and case or medical management record systems maintained by or for a health plan; or
(3) Used, in whole or in part, by or for the department and the village to make decisions about patients.
"DISCLOSURE." The release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information.
"HEALTH CARE OPERATIONS."
(1) Activities related to the department or village's functions as a health care provider, including general administrative and business functions necessary for the department or the village to remain a viable health care provider.
(2) Any one of the following activities to the extent the activities are related to providing health care:
(a) Conducting quality assessment and improvement activities, population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, contacting patients with information about treatment alternatives, and related functions that do not involve treatment;
(b) Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance, conducting training programs in which volunteers, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities;
(c) Underwriting, premium rating, and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing or placing a contract for reinsurance of risk relating to claims for health care;
(d) Conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs;
(e) Business planning and development, such as conducting cost management and planning related analyses related to managing and operating the practice, including formulary development and administration, development or improvement of methods of payment or covered policies; and
(f) Business management and general administrative activities:
1. Management activities related to HIPAA compliance;
2. Customer service;
3. Resolution of internal grievances;
4. Due diligence;
5. Activities designed to de-identify health information; and
6. Fundraising activities for the benefit of the practice.
"HEALTH INFORMATION." Any information, whether oral or recorded in any form, or medium that is received by the village that relates to the past, present or future physical or mental health or condition of an individual, the provision of health care to an individual or the past, present or future payment for the provision of health care to an individual.
"INDIRECT TREATMENT RELATIONSHIP." A relationship between an individual and a health care provider in which:
(1) The health care provider delivers health care to the individual based on the orders of another health care provider; and
(2) The health care provider typically provides services or products, or reports the diagnosis or results associated with the health care, directly to another health care provider, who provides the services, products or reports to the individual.
"INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION/PROTECTED HEALTH INFORMATION ("PHI")." Health information that includes demographic information collected from an individual, that is received by the village or the department that identifies an individual or with respect to which there is a reasonable basis to believe the information can be used to identify an individual.
"INSTITUTIONAL REVIEW BOARD (IRB)." A committee group comprised of department or village personnel and community representatives with varying backgrounds and professional experience that review and approve the research protocol involving human subjects.
"PAYMENT." Any activities undertaken either by a health plan or by a health care provider to obtain premiums, determine or fulfill its responsibility for coverage and the provision of benefits or to obtain or provide reimbursement for the provision of health care. These activities include but are not limited to:
(1) Determining eligibility, and adjudication or subrogation of health benefit claims;
(2) Risk adjusting amounts due based on enrollee health status and demographic characteristics;
(3) Billing, claims management, collection activities, obtaining payment under a contract for reinsurance, and related health care processing;
(4) Review of healthcare services with respect to medical necessity, coverage under a health plan, appropriateness of care, or justification of charges;
(5) Utilization review activities, including pre-certification and preauthorization services, concurrent and retrospective review of services; or
(6) Disclosure to consumer reporting agencies of certain PHI relating to collection of premiums or reimbursement.
"TREATMENT." The provision, coordination, or management of health care related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or for the referral of a patient for health care from one health care provider to another.
"USE, WITH RESPECT TO INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION." The sharing, employment, application, utilization, examination, or analysis of such information within an entity that maintains such information.
"VILLAGE." The Village of Romeoville, its Fire Department, and all other departments of the village.
(Ord. 0030-03, passed 4-2-03)