Standards for Privacy of Individually Identifiable Health Information. Final Privacy Rule Preamble.. Health Care Provider.


We proposed to define health care provider to mean a provider of services as defined in section 1861(u) of the Act, a provider of medical or health services as defined in section 1861(s) of the Act, and any other person or organization who furnishes, bills, or is paid for health care services or supplies in the normal course of business.

In the final rule, we delete the term "services and supplies," in order to eliminate redundancy within the definition. The definition also reflects the addition of the applicable U.S.C. citations (42 U.S.C. 1395x(u) and 42 U.S.C. 1395x(s), respectively) for the referenced provisions of the Act that were promulgated in the Transactions Rule.

To assist the reader, we also provide here excerpts from the relevant sections of the Act. (Refer to the U.S.C. sections cited above for complete definitions in sections 1861(u) and 1861(s).) Section 1861(u) of the Act defines a "provider of services," to include, for example,

a hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program, or, for purposes of section 1814(g) [42 U.S.C. 1395f(g)] and section 1835(e) [42 U.S.C. 1395n(e)], a fund." Section 1861(s) of the Act defines the term, "medical and other health services," and includes a list of covered items or services, as illustrated by the following excerpt:

(s) Medical and other health services. The term "medical and other health services" means any of the following items or services:

(1) physicians' services;

(2) (A) services and supplies…furnished as an incident to a physician's professional service, or kinds which are commonly furnished in physicians' offices and are commonly either rendered without charge or included in the physicians' bills;

(B) hospital services…incident to physicians' services rendered to outpatients and partial hospitalization services incident to such services;

(C)diagnostic services which are-

(i) furnished to an individual as an outpatient by a hospital or by others under arrangements with them made by a hospital, and

(ii) ordinarily furnished by such hospital (or by others under such arrangements) to its outpatients for the purpose of diagnostic study;

(D) outpatient physical therapy services and outpatient occupational therapy services;

(E) rural health clinic services and federally qualified health center services;

(F) home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies;

(G) antigens…prepared by a physician…for a particular patient, including antigens so prepared which are forwarded to another qualified person…for administration to such patient,…by or under the supervision of another such physician;

(H) (i) services furnished pursuant to a contract under section 1876 [42 U.S.C. 1395mm] to a member of an eligible organization by a physician assistant or by a nurse practitioner…and such services and supplies furnished as an incident to his service to such a member…and

(ii) services furnished pursuant to a risk-sharing contract under section 1876(g) [42 U.S.C. 1395mm(g)] to a member of an eligible organization by a clinical psychologist…or by a clinical social worker…[and] furnished as an incident to such clinical psychologist's services or clinical social worker's services…;

(I) blood clotting factors, for hemophilia patients…;

(J) prescription drugs used in immunosuppressive therapy furnished, to an individual who receives an organ transplant for which payment is made under this title [42 U.S.C. 1395 et seq.], but only in the case of [certain] drugs furnished…

(K) (i) services which would be physicians' services if furnished by a physician…and which are performed by a physician assistant…;and

(ii) services which would be physicians' services if furnished by a physician…and which are performed by a nurse…;

(L) certified nurse-midwife services;

(M) qualified psychologist services;

(N) clinical social worker services…;

(O) erythropoietin for dialysis patients…;

(P) prostate cancer screening tests…;

(Q) an oral drug (which is approved by the federal Food and Drug Administration) prescribed for use as an anti-cancer chemotherapeutic agent for a given indication, and containing an active ingredient (or ingredients)…;

(R) colorectal cancer screening tests…;

(S) diabetes outpatient self-management training services…; and

(T) an oral drug (which is approved by the federal Food and Drug Administration) prescribed for use as an acute anti-emetic used as part of an anti-cancer chemotherapeutic regimen…

(3) diagnostic X-ray tests…furnished in a place of residence used as the patient's home…;

(4) X-ray, radium, and radioactive isotope therapy, including materials and services of technicians;

(5) surgical dressings, and splints, casts, and other devices used for reduction of fractures and dislocations;

(6) durable medical equipment;

(7) ambulance service where the use of other methods of transportation is contraindicated by the individual's condition…;

(8) prosthetic devices (other than dental) which replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care),…and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery…[;]

(9) leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements if required…;

(10) (A) pneumococcal vaccine and its administration…; and

(B) hepatitis B vaccine and its administration…, and

(11) services of a certified registered nurse anesthetist…;

(12) …extra-depth shoes with inserts or custom molded shoes with inserts for an individual with diabetes, if…;

(13) screening mammography…;

(14) screening pap smear and screening pelvic exam; and

(15) bone mass measurement…. (etc.)