Today's health consumers, or "patients" as they were once called, are expected to know about and participate in their care. That includes knowing about health laws and policies that impact care. This page collects information on some current topics in health care policy.

One right conspicuously absent in all of this is the right to sue your HMO, managed care organization or ERISA plan.

"A Federal health privacy law should permit limited disclosures of health information

without patient consent for specifically identified national priority activities."

Make no mistake about it -- the government wants full access to your private medical information. In a report presented to Congress on September 11, 1997, the Secretary of Health and Human Services, Donna Shalala, details several reasons why new federal legislation is necessary to protect patient privacy, including:

• It is necessary to provide rights for patients and define responsibilities for record keepers.
• It is becoming difficult to determine the appropriate person or place where our health information can be accessed or controlled.
• The legal control of health information is, in general, a matter of State laws that vary greatly in scope and strength, and the situation has been described as "a morass of erratic law, both statutory and judicial, defining the confidentiality of health information."
• The Health Care Information System Is Increasingly Interstate. Computerization and telecommunications render the concept of "location" of information nearly meaningless.

The "national priority activities" for which your medical records could be released without your consent under the Secretary's plan include:

• Oversight of the Health Care System
• For Public Health, and in Emergencies Affecting Life or Safety
• For Health Research
• Pursuant to Other Laws or Court Orders

Talk about exceptions that swallow the rule. But you decide for yourself -- here are the links to the Secretary's report.

Submitted to: The Committee on Labor and Human Resources and the Committee on Finance of the

Senate; The Committee on Commerce and the Committee on Ways and Means of the House of

Representatives, September 11, 1997.

 

I. INTRODUCTION

A. Background

B. Why Federal Legislation is Needed

C. Recommendation for Establishing Federal Privacy Standards

D. Principles

E. Boundaries -- Recommended Scope of A Federal Privacy Law

F. Security

G. Consumer Control

H. Accountability

I. Public Responsibility

J. How Federal Privacy Legislation Should Relate to Other Laws

K. Particular Classes of Information

II. RECOMMENDATIONS

A. Coverage

B. Basic Requirements

C. Patient Awareness and Control

D. Disclosures Authorized by the Patient

E. Other Disclosures

F. Specialized Classes of Persons and Entities

G. Relationship to Other Law

H. Enforcement

I. Administration

III. CONCLUSION

IV. FOOTNOTES

• Americans with Disabilities Act of 1990
• ADA Regulations, Table of Contents
• U.S. Disability Law
• 42 USC Sec. 1395dd. Examination and treatment for emergency medical conditions and women in labor (EMTALA)
• THE FAMILY AND MEDICAL LEAVE ACT OF 1993, 29 USC sec. 2601, et. seq.
  • 2601. Findings and purposes.
  • 2611. Definitions.
  • 2612. Leave requirement.
  • 2613. Certification.
  • 2614. Employment and benefits protection.
  • 2615. Prohibited acts.
  • 2616. Investigative authority.
  • 2617. Enforcement.
  • 2618. Special rules concerning employees of local educational agencies.
  • 2619. Notice.
  • 2631. Establishment (Commission on Leave).
  • 2632. Duties.
  • 2633. Membership.
  • 2634. Compensation.
  • 2635. Powers.
  • 2636. Termination.
  • 2651. Effect on other laws.
  • 2652. Effect on existing employment benefits.
  • 2653. Encouragement of more generous leave policies.
  • 2654. Regulations.
• THE PATIENT SELF-DETERMINATION ACT

• 29 CFR Part 825 - THE FAMILY AND MEDICAL LEAVE ACT OF 1993
  • 825.100 What is the Family and Medical Leave Act?
  • 825.101 What is the purpose of the Act?
  • 825.102 When was the Act effective?
  • 825.103 How did the Act affect leave in progress on, or taken before, the effective date of the Act?
  • 825.104 What employers are covered by the Act?
  • 825.105 In determining whether an employer is covered by FMLA, what does it mean to employ 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year?
  • 825.106 How is "joint employment" treated under FMLA?
  • 825.107 What is meant by "successor in interest"?
  • 825.108 What is a "public agency"?
  • 825.109 Are Federal agencies covered by these regulations?
  • 825.110 Which employees are "eligible" to take leave under FMLA?
  • 825.111 In determining if an employee is "eligible" under FMLA, how is the determination made whether the employer employs 50 employees within 75 miles of the worksite where the employee needing leave is employed?
  • 825.112 Under what kinds of circumstances are employers required to grant family or medical leave?
  • 825.113 What do "spouse," "parent," and "son or daughter" mean for purposes of an employee qualifying to take FMLA leave?
  • 825.114 What is a "serious health condition" entitling the employee to FMLA leave?
  • 825.115 What does it mean that "the employee is unable to perform the functions of the position of the employee"?
  • 825.116 What does it mean that an employee is "needed to care for" a family member?
  • 825.117 For an employee seeking intermittent FMLA leave or leave on a reduced leave schedule, what is meant by "the medical necessity for" such leave?
  • 825.118 What is a "health care provider"?
  • 825.200 How much leave may an employee take?
  • 825.201 If leave is taken for the birth of a child, or for placement of a child for adoption or foster care, when must the leave be concluded?
  • 825.202 How much leave may a husband and wife take if they are employed by the same employer?
  • 825.203 Does FMLA leave have to be taken all at once, or can it be taken in parts?
  • 825.204 May an employer transfer an employee to an "alternative position" in order to accommodate intermittent leave or a reduced leave schedule?
  • 825.205 How does one determine the amount of leave used where an employee takes leave intermittently or on a reduced leave schedule?
  • 825.206 May an employer deduct hourly amounts from an employee's salary, when providing unpaid leave under FMLA, without affecting the employee's qualifications for exemption as an executive, administrative, or professional employee, or when utilizing the fluctuating workweek method for payment of overtime compensation, under the Fair Labor Standards Act?
  • 825.207 Is FMLA leave paid or unpaid?
  • 825.208 Under what circumstances may an employer designate leave, paid or unpaid, as FMLA leave and, as a result, count it against the employee's total FMLA leave entitlement?
  • 825.209 Is an employee entitled to benefits while using FMLA leave?
  • 825.210 How may employees on FMLA leave pay their share of health benefit premiums?
  • 825.211 What special health benefits maintenance rules apply to multi-employer health plans?
  • 825.212 What are the consequences of an employee's failure to make timely health plan premium payments?
  • 825.213 May an employer recover costs it incurred for maintaining "group health plan" or non-health benefits coverage during FMLA leave?
  • 825.214 What are an employee's rights on returning to work from FMLA leave?
  • 825.215 What is an equivalent position?
  • 825.216 Are there any limitations on an employer's obligation to reinstate an employee?
  • 825.217 What is a "key employee"?
  • 825.218 What does "substantial and grievous economic injury" mean?
  • 825.219 What are the rights of a key employee?
  • 825.220 How are employees protected who request leave or otherwise assert FMLA rights?
  • 825.300 What posting requirements does the Act place on employers?
  • 825.301 What other notices to employees are required of employers under the FMLA?
  • 825.302 What notice does an employee have to give an employer when the need for FMLA leave is foreseeable?
  • 825.303 What are the requirements for an employee to furnish notice to an employer where the need for FMLA leave is not foreseeable?
  • 825.304 What recourse do employers have if employees fail to provide the required notice?
  • 825.305 When must an employee provide medical certification to support FMLA leave?
  • 825.306 How much information may be required in medical certifications of a serious health condition?
  • 825.307 What may an employer do if it questions the adequacy of a medical certification?
  • 825.308 Under what circumstances may an employer request subsequent recertifications of medical conditions?
  • 825.309 What notice may an employer require regarding an employee's intent to return to work?
  • 825.310 Under what circumstances may an employer require that an employee submit a medical certification that the employee is able (or unable) to return to work (e.g., a "fitness-for-duty" report)?
  • 825.311 What happens if an employee fails to satisfy the medical certification requirements?
  • 825.312 Under what circumstances may a covered employer refuse to provide FMLA leave or reinstatement to eligible employees?
  • 825.400 What may employees do who believe that their rights under FMLA have been violated?
  • 825.401 Where may an employee file a complaint of FMLA violations with the Federal government?
  • 825.402 How is an employer notified of a violation of the posting requirement?
  • 825.403 How may an employer appeal the assessment of a penalty for willful violation of the posting requirement?
  • 825.404 What are the consequences of an employer not paying the penalty assessment after a final order is issued?
  • 825.500 What Records must an employer keep to comply with the FMLA?
  • 825.600 To whom do the special rules apply?
  • 825.601 What limitations apply to the taking of intermittent leave or leave on a reduced leave schedule?
  • 825.602 What limitations apply to the taking of leave near the end of an academic term?
  • 825.603 Is all leave taken during "periods of a particular duration" counted against the FMLA leave entitlement?
  • 825.604 What special rules apply to restoration to "an equivalent position?"
  • 825.700 What if an employer provides more generous benefits than required by FMLA?
  • 825.701 Do State laws providing family and medical leave still apply?
  • 825.702 How does FMLA affect Federal and State anti-discrimination laws?
  • 825.800 Definitions.
• 45 CFR PART 60 - NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS SUBPART A - GENERAL PROVISIONS
  • 45 CFR Sec. 60.1 The National Practitioner Data Bank.
  • 45 CFR Sec. 60.2 Applicability of these regulations.
  • 45 CFR Sec. 60.3 Definitions.
  • 45 CFR Sec. 60.4 How information must be reported.
  • 45 CFR Sec. 60.5 When information must be reported.
  • 45 CFR Sec. 60.6 Reporting errors, omissions, and revisions.
  • 45 CFR Sec. 60.7 Reporting medical malpractice payments.
  • 45 CFR Sec. 60.8 Reporting licensure actions taken by Boards of Medical Examiners.
  • 45 CFR Sec. 60.9 Reporting adverse actions on clinical privileges.
  • 45 CFR Sec. 60.10 Information which hospitals must request from the National Practitioner Data Bank.
  • 45 CFR Sec. 60.11 Requesting information from the National Practitioner Data Bank .
  • 45 CFR Sec. 60.12 Fees applicable to requests for information.
  • 45 CFR Sec. 60.13 Confidentiality of National Practitioner Data Bank information.
  • 45 CFR Sec. 60.14 How to dispute the accuracy of National Practitioner Data Bank information.

• BENEDI v. MCNEIL-P.P.C., INC. (4th Cir., October 10, 1995) (upholding $8 million award for liver damage caused by mixing alcohol with Tylenol)
• Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261 (1990) (U.S. Constitution does not forbid Missouri to require that evidence of an incompetent's wishes as to the withdrawal of life-sustaining treatment be proved by clear and convincing evidence).
• Helling v. McKinney (U.S., June 18, 1993) (prisoner's involuntary exposure to environmental tobacco smoke (ETS) from other inmates' cigarettes posed an unreasonable risk to his health)
• New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., 115 S. Ct.1671, 131 L. Ed. 2d 695 (1995). (surcharges that indirectly impact ERISA plans not preempted)
• Shalala v. Whitecotton (U.S., April 18, 1995) (claimant who experienced symptoms of injury after receiving vaccination does not make out prima facie case for compensation under Vaccine Injury Act when evidence fails to indicate no symptoms of injury prior to vaccination)
• VARITY CORPORATION v. HOWE (U.S. March 19, 1996) (Varity and Massey-Ferguson, acting as ERISA fiduciaries, harmed plan beneficiaries through deliberate deception violating ERISA's 404(a)'s fiduciary obligation)

• Long Term Care: Baby Boom Generation Presents Financing Challenges. T-HEHS-98-107. 14 pp. March 9, 1998.
• Retiree Health Insurance: Erosion in Retiree Health Benefits Offered by Large Employers. T-HEHS-98-110. 12 pp. March 10, 1998.
• Health Insurance: Coverage Leads to Increased Health Care Access for Children. HEHS-98-14. 27 pp. plus 2 enclosures (13 pp.) November 24, 1997.
• Medicare: Fewer and Lower Cost Beneficiaries With Chronic Conditions Enroll in HMOs. HEHS-97-160. 18 pp. plus 2 appendices (6 pp.) August 18, 1997.
• Tax Policy: Health Insurance Tax Credit Participation Rate Was Low (Letter Report, 05/02/94, GAO/GGD-94-99). This report provides information on the health insurance tax credit, which was established to encourage low-income workers to buy private health insurance for their families.
• Breastfeeding: WIC's Efforts to Promote Breastfeeding Have Increased (Letter Report, 12/16/93, GAO/HRD-94-13). The Department of Health and Human Services has set a goal, by the year 2000, of increasing the percentage of women who breastfeed their infants to at least 75 percent at hospital discharge and to at least 50 percent at five to six months postpartum.
• Medicare and Medicaid: Many Eligible People Not Enrolled in Qualified Medicare Beneficiary Program (Letter Report, 01/20/94, GAO/HEHS-94-52). The Qualified Medicare Beneficiary Program pays many out-of-pocket expenses for Medicare recipients whose incomes are not quite low enough to qualify them for regular Medicare benefits.
• Medicare: Beneficiary Liability for Certain Paramedic Services May Be Substantial (Briefing Report, 04/15/94, GAO/HEHS-94-122BR). Volunteer ambulance companies often transport Medicare patients to hospitals.
• Health Insurance for the Elderly: Owning Duplicate Policies Is Costly and Unnecessary (Letter Report, 08/03/94, GAO/HEHS-94-185). Owning multiple health insurance policies to supplement Medicare is both costly and unnecessary. GAO estimated that about 3 million elderly Medicare beneficiaries paid about $1.8 billion in 1991 for policies that probably involved duplicate coverage.
• Health Care Reform: "Report Cards" Are Useful but Significant Issues Need to Be Addressed (Chapter Report, 09/29/94, GAO/HEHS-94-219). As part of the debate over health care reform, Congress is considering requiring health plans to provide prospective purchasers with information on the quality of care they furnish.
• Patient Self-Determination Act: Providers Offer Information on Advance Directives but Effectiveness Uncertain (Letter Report, 09/01/95, GAO/HEHS-95-135). Pursuant to a congressional request, GAO provided information on the implementation of the Patient Self-Determination Act (PSDA), and the effectiveness of advance directives in ensuring a patient's desired care.
• Prescription Drugs and the Elderly: Many Still Receive Potentially Harmful Drugs Despite Recent Improvements (Letter Report, 07/24/95, GAO/HEHS-95-152). Pursuant to a congressional request, GAO examined the elderly's inappropriate use of prescription drugs.
• Health Insurance for Children: Many Remain Uninsured Despite Medicaid Expansion (Letter Report, 07/19/95, GAO/HEHS-95-175). Pursuant to a congressional request, GAO reviewed the status of health insurance for children.
• Health Care: Employers and Individual Consumers Want Additional Information on Quality (Letter Report, 09/29/95, GAO/HEHS-95-201). Pursuant to a congressional request, GAO provided information on health care quality issues, focusing on: (1) how consumers use health care performance reports that contain comparative data on the quality of health care providers; and (2) what information consumers consider most important.
• Health Insurance Portability: Reform Could Ensure Continued Coverage for Up to 25 Million Americans (Letter Report, 09/19/95, GAO/HEHS-95-257). Pursuant to a congressional request, GAO provided information on: (1) the protections offered by current state and federal health insurance portability reforms; (2) the number of people who could be affected by broader national portability standards; and (3) other issues related to the design of national portability standards.
• Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities (Letter Report, 01/24/96, GAO/HEHS-96-18). Pursuant to a congressional request, GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients.
• Medigap Insurance: Alternatives for Medicare Beneficiaries to Avoid Medical Underwriting (Letter Report, 09/10/96, GAO/HEHS-96-180). Pursuant to a legislative requirement, GAO reviewed Medigap policies, focusing on: (1) the extent to which Medicare beneficiaries are subject to medical underwriting when they change Medigap policies; and (2) options for modifying federal Medigap requirements to ensure that medical underwriting is not a problem in such cases.
• Maternity Care: Appropriate Follow-Up Services Critical With Short Hospital Stays (Letter Report, 09/11/96, GAO/HEHS-96-207). Pursuant to a congressional request, GAO reviewed issues surrounding shortened postpartum hospital stays.
• Employment-Based Health Insurance: Costs Increase and Family Coverage Decreases (Letter Report, 02/24/97, GAO/HEHS-97-35). Pursuant to a congressional request, GAO provided information on the decline in employment-based health insurance.
• Health Care Services: How Continuing Care Retirement Communities Manage Services for the Elderly (Letter Report, 01/23/97, GAO/HEHS-97-36). Pursuant to a congressional request, GAO reviewed the processes of managed care in continuing care retirement communities (CCRC), focusing on: (1) CCRC practices for promoting wellness; (2) practices for managing care for elderly people with chronic conditions; and (3) evidence regarding the possible effect of these practices on health status and costs.
• Long-Term Care: Consumer Protection and Quality-of-Care Issues in Assisted Living (Letter Report, 05/15/97, GAO/HEHS-97-93). Pursuant to congressional request, GAO reviewed assisted living facilities (ALF), focusing on: (1) responsibilities of federal and state governments and ALFs in ensuring quality and protecting consumers living in ALFs; and (2) issues that may require further research.
• Cancer Survival: An International Comparison of Outcomes (Chapter Report, 03/07/94, GAO/PEMD-94-5). In comparing U.S. and Canadian survival rates for lung cancer, colon cancer, Hodgkin's disease, and breast cancer, GAO found that breast cancer patients lived longer after diagnosis in the United States than in Canada.
• Americans With Disabilities Act: Effects of the Law on Access to Goods and Services (Letter Report, 06/21/94, GAO/PEMD-94-14). This report looks at the extent to which the Americans With Disabilities Act has improved the access for persons with disabilities to goods and services provided by businesses and state and local governments.
• Immunization: HHS Could Do More to Increase Vaccination Among Older Adults (Chapter Report, 06/08/95, GAO/PEMD-95-14). Pneumonia and influenza are the leading causes of vaccine- preventable death. The elderly suffer the most from these diseases and the costs to the federal government are substantial.
• Cholesterol Treatment: A Review of the Clinical Trials Evidence (Letter Report, 05/14/96, GAO/PEMD-96-7). Pursuant to a congressional request, GAO reviewed the evidence from clinical trials that the National Heart, Lung, and Blood Institute (NHLBI) used to develop its National Cholesterol Education Program guidelines.
• Cost of Health Care Task Force Related Activities (Testimony, 03/14/95, GAO/T-GGD-95-114). In January 1993, President Clinton established a task force on health care reform.
• Hospitals: Chief Executives' Compensation, 1989-1991 (Testimony, 12/07/93, GAO/T-HRD-94-70). In recent years, the media have scrutinized the high salaries--some approaching $1 million annually--paid to health care executives, in some cases linking them to the rising cost of health care.
• Defense of Marriage Act: Federal Benefits, Rights, and Privileges Contingent on Marital Status GAO/OGC-97-16, Jan. 31, 1997.
• Skilled Nursing Facilities: Approval Process for Certain Services May Result in Higher Medicare Costs. HEHS-97-18. 51 pp. plus 7 appendices (82 pp.) December 20, 1996.
• CDC's National Immunization Survey: Methodological Problems Limit Survey's Utility. GAO/PEMD-96-16. September 19, 1996.
• American Hospital Association's Patient's Bill of Rights (1973) The AHA Patient's Bill of Rights, printed in full below, has been influential in the development of similar documents in other parts of the world.
• Consumer Information - Health This service is provided by the Consumer Information Center of the U.S. General Services Administration.
• Health Hotlines Health Hotlines is a compilation of organizations with toll-free telephone numbers.
• Shalala: Breast Cancer War For the first time in four decades, American women can celebrate winning a battle in the war against breast cancer.
• Shalala: Health Resolutions The great baseball manager, Casey Stengel once quipped upon turning eighty, "If I had known I was going to live this long, I would have taken better care of myself."
• Shalala: Violence & Health The holiday season is supposed to be a time of peace, a time to pause and count our blessings with family and friends.
• FACS: Protecting Your Health
• FACS: When You Need an Operation
• FACS: News from the College
• FACS: Information on Patient Choice
• HHS: Health Advisory On Fen/Phen for Obesity
• HHS: Medicare Fraud Hotline Improved and Expanded
• HHS: Operation Restore Trust Accomplishments
• HHS: Shalala Launches Healthfinder Web Site; Improves Consumer Access to Health
• HHS: Vice President Gore Launches Free Access to MEDLINE
• HHS: FDA Proposes New, Easy to Understand Labeling for OTC Drugs
• HHS: Health Advisory On Fen/Phen for Obesity
• HCFA: HIPAA Questions - Consumers
• HCFA: What to look for in a Nursing Home
• HHS Sites
• HCFA: Mammograms
• HCFA Health Watch
• HCFA: 10 Medicare Tips
• HCFA: Managed Care in Medicare and Medicaid
• HCFA: Managing Managed Care
• HCFA: Medicare Fact Sheet
• HCFA: Medicare's Second Opinion Coverage
• HCFA: Physician's Bills
• HCFA: Prohibition on time limits for breast surgery
• HCFA: Rapid Response to Treatment Denial Appeals Promised

• Agency of Health Care Policy & Research (AHCPR) Supported Guidelines Please check the AHCPR copyright notice.
  • PAIN MANAGEMENT
    • Acute Pain Management (Consumers Guide)
    • Acute Pain Management (Clinical Guide)
  • INCONTINENCE
    • Acute and Chronic Incontinence - 1996 Update (Consumer's Guide)
    • Acute and Chronic Incontinence - 1996 Update (Caregiver Guide)
    • Acute and Chronic Incontinence - 1996 Update (Clinical Guide)
  • PRESSURE ULCERS
    • Preventing Pressure Ulcers - Patient's Guide
    • Pressure Ulcers, Clinical Guideline
  • CATARACT
    • Cataract in Adults (Consumer's Guide)
    • Cataract in Adults (Clinical Guide)
  • DEPRESSION
    • Depression in Primary Care (Consumer's Guide)
    • Depression in Primary Care - Detection and Diagnosis (Clinical Guide)
    • Depression in Primary Care - Treatment (Clinical Guide)
  • SICKLE CELL
    • Sickle Cell Disease (Consumer's Guide)
    • Sickle Cell Disease (Clinical Guideline)
  • PROSTATE (BENIGN)
    • Benign Prostatic Hyperplasia (Consumer Guide)
    • Benign Prostatic Hyperplasia (Clinical Guide)
  • CANCER PAIN
    • Management of Cancer Pain (Consumer's Guide)
    • Management of Cancer Pain (Clinical Guide)
  • UNSTABLE ANGINA
    • Unstable Angina (Consumer Guide)
    • Unstable Angina (Clinical Guide)
  • HEART FAILURE
    • Heart Failure (Consumer's Guide)
    • Heart Failure (Clinical Guide)
  • EAR INFECTION
    • Middle Ear Fluid in Young Children (Consumer's Guide)
    • Otitis Media with Effusion in Young Children
  • MAMMOGRAPHY
    • Quality Mammography (Consumer's Guide)
    • Quality Mammography (Clinical Guide)
  • LOW BACK PAIN
    • Understanding Acute Low Back Problems
    • Acute Low Back Problems in Adults
  • PRESSURE ULCER
    • Pressure Ulcer Treatment (Consumer's Guide)
    • Pressure Ulcer Treatment (Clinical Guide)
  • STROKE REHABILITATION
    • Post-Stroke Rehabilitation (Consumer's Guide)
    • Post-Stroke Rehabilitation (Clinical Guide)
  • CARDIAC REHABILITATION
    • Cardiac Rehabilitation (Consumer's Guide)
    • Cardiac Rehabilitation (Clinician's Guide)
  • SMOKING CESSATION
    • Smoking Cessation (Consumer's Guide)
    • Smoking Cessation (Clinical Guide)
• AHCPR Technology Assessments and Reviews
• ATIS Publications
  • Selected CDC Morbidity and Mortality Weekly Reports (MMWR):
  • PHS State-of-the-Art Conference Report:
• NIH Clinical Studies
  • Clinical Studies By Primary Disease Category
  • Clinical Studies By Institute of the Principal Investigator
• NIH Consensus Development Program
  • Consensus Development Conference Reports
  • NIH Technology Assessment Conference Summaries
• Guide to Clinical Preventive Services: Second Edition (1996)
• SAMHSA Treatment Improvement Protocol

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