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If a provider offers services to patients over the Internet, is that considered a direct or indirect treatment relationship?

HIPAA Weekly Advisor, July 18, 2003

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Q: If a provider offers services to patients over the Internet, is that considered a direct or indirect treatment relationship?

A: Covered health care providers that provide services to individuals over the Internet have direct treatment relationships with those individuals, the HHS commentary in the privacy rule states.

Providers that have direct treatment relationships with patients must provide notices of privacy practices to their patients as of the first service delivery date after April 14, 2003, the HIPAA privacy rule compliance deadline. This notice requirement applies whether the first service is delivered electronically or in person. If the first service delivery to an individual is delivered electronically, the covered health care provider must provide an electronic notice of privacy practices automatically and contemporaneously in response to the individual's first request for service.

For example, the first time an individual requests to fill a prescription through a covered Internet pharmacy, the pharmacy must automatically and contemporaneously provide the individual with the pharmacy's notice of privacy practices, the HHS commentary states. The rules require that the recipient of an electronic notice retain the right to obtain a paper copy upon request.

The rules state that a covered entity may satisfy the applicable distribution requirements by providing the notice to the individual electronically, if he or she agrees to receive materials from the covered entity electronically and has not withdrawn his or her agreement. The HHS does not require any particular form of agreement. For example, a covered provider could ask an individual at the time the individual requests a copy of the notice whether he or she prefers to receive it in hard copy or electronic form.

A health plan could ask an individual applying for coverage to provide an e-mail address where the health plan can send the individual information. If the individual provides an e-mail address, the health plan can infer agreement to obtain information electronically. In addition, if the covered entity knows that the electronic transmission has failed, the covered entity must provide a paper copy of the notice to the individual. The recipient of an e-mail notice still has the right to request a paper copy.

Covered health care providers (including clinical laboratories) that have indirect treatment relationships with individuals are only required to produce the notice upon request.

Editor's note: Brought to you by attorneys Marty Baxter and Gretchen McBeath at Bricker and Eckler, LLP and The Quality Management Consulting Group, Ltd.. E-mail: mbaxter@bricker.com or gmcbeath@bricker.com

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