In addition to requirements to safeguard increasingly vast amounts of patient data, healthcare providers also need to be mindful of when that data can be used and disclosed. One key challenge in that area is understanding whether state or federal law applies. The U.S. Eleventh Circuit Court of Appeals (which covers Florida, Georgia, and Alabama), held that the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) preempted a Florida law, Section 400.145, that allowed for the release of medical records of deceased residents of nursing homes to specified individuals without prior authorization. Opis Management Resources, LLC et al. v. Secretary Florida Agency for Health Care Administration.

The plaintiffs, comprised of several nursing home facilities, filed suit in federal district court challenging the Florida Agency for Health Care Administration’s (“AHCA”) citations to the facilities for their refusal to disclose deceased residents’ medical records to surviving spouses, family members, and attorneys-in-fact who were not personal representatives under the relevant HIPAA provisions. The nursing homes asked a federal district court judge to declare that Florida Statute § 400.145 was preempted by HIPAA. The district (trial) court granted summary judgment in favor of the nursing facilities finding that the Florida law provided nursing home residents less protection than required under HIPAA.

On appeal, the Eleventh Circuit affirmed the district court’s grant of summary judgment concluding that Section 400.145

impedes the accomplishment and execution of the full purposes and objectives of HIPAA and the Privacy Rule in keeping an individual’s protected health information confidential.

As the court explained, HIPAA includes a preemption clause providing that HIPAA supersedes any contrary state law provision, including any state law which “stands as an obstacle to the accomplishment and execution of [HIPAA’s] full purposes and objectives.” In other words, if a state law provides for less stringent protection than that already provided by HIPAA, it is preempted or superseded by HIPAA. HIPAA, however, does not preempt state laws providing more stringent protections.

Since 2000, the federal Department of Health and Human Services has issued extensive regulations, known as the Privacy Rule, that establish procedures by which protected health information (“PHI”) may be used or disclosed by a covered entity or business associate. Under the most recent set of regulations issued in January, HIPAA protection of PHI for deceased individuals remains in effect for a period of fifty (50) years after the individual’s death. The Privacy Rule further provides that PHI may be disclosed to a personal representative (one who under applicable state law is an executor, administrator or other individual with the authority to act on behalf of a deceased person or the individual’s estate). Additionally, a covered entity may disclose a decedent’s PHI to family members and others who were involved in the care or payment for care of the decedent prior to death, unless doing so is inconsistent with any prior expressed preference of the individual that is known to the covered entity. In such a case, PHI of the deceased can be released to the extent it is relevant to such person’s involvement in the care or payment for the care.

Section 400.145, Florida Statutes, provides in pertinent part that “[u]nless expressly prohibited by a legally competent resident, any nursing home licensed pursuant to this part shall furnish to the spouse, guardian, surrogate, proxy, or attorney in fact . . . of a current resident, . . . or of a former resident, . . . a copy of that resident’s records which are in the possession of the facility.” The court found that although the statute lists a number of individuals to whom records could be disclosed, it “does not empower or require an individual to act on behalf of a deceased resident,” and, therefore, does not identify any of those individuals to qualify as personal representatives under HIPAA. Therefore, the statute provides a much broader class of individuals than under HIPAA to whom the deceased’s PHI may be disclosed without authorization. Additionally, the Florida statute does not contain the same limitations or restrictions as the Privacy Rule with regard to releasing PHI of a deceased individual to those involved in the individual’s care or who paid for it and only to the extent the information is relevant to the person’s involvement or payment. Accordingly, the court found HIPAA provided more stringent protections of PHI than the Florida statute and held HIPAA preempts Section 400.145.

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Photo of Joseph J. Lazzarotti Joseph J. Lazzarotti

Joseph J. Lazzarotti is a principal in the Berkeley Heights, New Jersey, office of Jackson Lewis P.C. He founded and currently co-leads the firm’s Privacy, Data and Cybersecurity practice group, edits the firm’s Privacy Blog, and is a Certified Information Privacy Professional (CIPP)…

Joseph J. Lazzarotti is a principal in the Berkeley Heights, New Jersey, office of Jackson Lewis P.C. He founded and currently co-leads the firm’s Privacy, Data and Cybersecurity practice group, edits the firm’s Privacy Blog, and is a Certified Information Privacy Professional (CIPP) with the International Association of Privacy Professionals. Trained as an employee benefits lawyer, focused on compliance, Joe also is a member of the firm’s Employee Benefits practice group.

In short, his practice focuses on the matrix of laws governing the privacy, security, and management of data, as well as the impact and regulation of social media. He also counsels companies on compliance, fiduciary, taxation, and administrative matters with respect to employee benefit plans.

Privacy and cybersecurity experience – Joe counsels multinational, national and regional companies in all industries on the broad array of laws, regulations, best practices, and preventive safeguards. The following are examples of areas of focus in his practice:

  • Advising health care providers, business associates, and group health plan sponsors concerning HIPAA/HITECH compliance, including risk assessments, policies and procedures, incident response plan development, vendor assessment and management programs, and training.
  • Coached hundreds of companies through the investigation, remediation, notification, and overall response to data breaches of all kinds – PHI, PII, payment card, etc.
  • Helping organizations address questions about the application, implementation, and overall compliance with European Union’s General Data Protection Regulation (GDPR) and, in particular, its implications in the U.S., together with preparing for the California Consumer Privacy Act.
  • Working with organizations to develop and implement video, audio, and data-driven monitoring and surveillance programs. For instance, in the transportation and related industries, Joe has worked with numerous clients on fleet management programs involving the use of telematics, dash-cams, event data recorders (EDR), and related technologies. He also has advised many clients in the use of biometrics including with regard to consent, data security, and retention issues under BIPA and other laws.
  • Assisting clients with growing state data security mandates to safeguard personal information, including steering clients through detailed risk assessments and converting those assessments into practical “best practice” risk management solutions, including written information security programs (WISPs). Related work includes compliance advice concerning FTC Act, Regulation S-P, GLBA, and New York Reg. 500.
  • Advising clients about best practices for electronic communications, including in social media, as well as when communicating under a “bring your own device” (BYOD) or “company owned personally enabled device” (COPE) environment.
  • Conducting various levels of privacy and data security training for executives and employees
  • Supports organizations through mergers, acquisitions, and reorganizations with regard to the handling of employee and customer data, and the safeguarding of that data during the transaction.
  • Representing organizations in matters involving inquiries into privacy and data security compliance before federal and state agencies including the HHS Office of Civil Rights, Federal Trade Commission, and various state Attorneys General.

Benefits counseling experience – Joe’s work in the benefits counseling area covers many areas of employee benefits law. Below are some examples of that work:

  • As part of the Firm’s Health Care Reform Team, he advises employers and plan sponsors regarding the establishment, administration and operation of fully insured and self-funded health and welfare plans to comply with ERISA, IRC, ACA/PPACA, HIPAA, COBRA, ADA, GINA, and other related laws.
  • Guiding clients through the selection of plan service providers, along with negotiating service agreements with vendors to address plan compliance and operations, while leveraging data security experience to ensure plan data is safeguarded.
  • Counsels plan sponsors on day-to-day compliance and administrative issues affecting plans.
  • Assists in the design and drafting of benefit plan documents, including severance and fringe benefit plans.
  • Advises plan sponsors concerning employee benefit plan operation, administration and correcting errors in operation.

Joe speaks and writes regularly on current employee benefits and data privacy and cybersecurity topics and his work has been published in leading business and legal journals and media outlets, such as The Washington Post, Inside Counsel, Bloomberg, The National Law Journal, Financial Times, Business Insurance, HR Magazine and NPR, as well as the ABA Journal, The American Lawyer, Law360, Bender’s Labor and Employment Bulletin, the Australian Privacy Law Bulletin and the Privacy, and Data Security Law Journal.

Joe served as a judicial law clerk for the Honorable Laura Denvir Stith on the Missouri Court of Appeals.