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HIPAA Article for the Texas School Health Bulletin

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to reform and simplify the health care administrative processes. This new federal law may impact schools through HIPAA Electronic Data Interchange (EDI) and Privacy Regulations. These regulations apply only to those entities defined in the regulations as "covered entities." Covered entities under HIPAA are group and individual health care plans, clearinghouses, and providers who transmit health information electronically.

HIPAA Privacy Impact:

Even though schools have always been very protective of confidential health information about students, schools may want to review their privacy practices in light of new federal privacy regulations. HIPAA Privacy Regulations are federal laws that govern the use and disclosure of confidential health information.

The HIPAA privacy regulations do not apply to health information in education records covered by the Family Educational Rights and Privacy Act (FERPA). However, school districts may be impacted if they provide health care to students and submit electronic transactions to receive payment from Medicaid or private insurers.

The enforcement authority for the HIPAA privacy regulations is the Office for Civil Rights (OCR), U.S. Department of Health and Human Services. DSHS has no enforcement role for HIPAA, and no role in determining how HIPAA applies to schools. One excellent resource for schools is the Texas Association of School Boards (TASB). The TASB web site includes several informational articles describing the potential impacts of HIPAA on schools. Visit the TASB web site at www.tasb.org and search for "HIPAA."


HIPAA Electronic Data Interchange (EDI) Impact:

HIPAA requires covered entities that exchange covered electronic transactions to comply with national EDI standards. School Health and Related Services (SHARS) providers will be impacted! HIPAA eliminated all Medicaid local procedure codes and modifiers currently used. Effective for dates of service on or after October 16, 2003, the current codes used for SHARS will be discontinued and will be replaced with national codes. Please refer to Texas Medicaid 2003 HIPAA Special Bulletin No. 170 for a listing of the new national codes. Any updated information will be provided in later Medicaid bulletins, banner messages, Medicaid workshops or on the DSHS HIPAA web site.

For additional information on HIPAA and how it relates to schools, click on School Health HIPAA Info

You may also contact the DSHS School Health Program at
1-800 422-2956 or via Email : HIPAA School Health


Last updated September 24, 2010