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164.506
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5. TREATMENT, PAYMENT AND
HEALTH CARE OPERATIONS (TPO) |
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164.506(a) |
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CE may use or disclose PHI for TPO set forth
in ¶ 5.1.2., provided that such use or disclosure is consistent
with other applicable requirement of these privacy rules.
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| 164.506(b) |
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Standard: Consent
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5.1.1.1.
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A CE may obtain consent of the individual
to use or disclose PHI to carry out TPO.
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5.1.1.2.
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Consent shall not be effective when an
authorization is required or when another condition must be
met for such use and disclosure to be permissible under the
Privacy Rules.
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164.506(c) |
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Implementation: TPO
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5.1.2.1.
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CE may use or disclose PHI for its
own TPO.
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5.1.2.2.
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CE may disclose PHI for treatment
activities of a provider.
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5.1.2.3.
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CE may disclose PHI to another
CE or provider for the payment activities of an entity
that receives the information.
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5.1.2.4.
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CE may disclose PHI to another
CE for health care operations activities of the entity
that receives the information, if each entity either
has or had a relationship with the individual who is
the subject of the PHI being requested, the PHI pertains
to such relationship, and the disclosure is:
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5.1.2.4.1.
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for the purposes listed in
¶ 1.14.1, 1.14.2 ; or
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5.1.2.4.2.
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for the purpose of health
care fraud and abuse detection or compliance.
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5.1.2.5.
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CE that participates in an organized
health care arrangement may disclose PHI about an individual
to another CE that participates in the organized health
arrangement for any health care operations activities
of the organized health care arrangement.
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