Standards for Privacy of Individually Identifiable Health Information. Final Privacy Rule Preamble.. Section 164.522(b) - Confidential Communications Requirements


In the NPRM, we did not directly address the issue of whether an individual could request that a covered entity restrict the manner in which it communicated with the individual. As described above, the NPRM would have provided individuals with the right to request that health care providers restrict uses and disclosures of protected health information for treatment, payment and health care operations, but would not have required providers to agree to such a restriction.

In the final rule, we require covered entities to permit individuals to request that the covered entity provide confidential communications of protected health information about the individual. The requirement applies to communications from the covered entity to the individual, and also communications from the covered entity that would otherwise be sent to the named insured of an insurance policy that covers the individual as a dependent of the named insured. Individuals may request that the covered entity send such communications by alternative means or at alternative locations. For example, an individual who does not want his or her family members to know about a certain treatment may request that the provider communicate with the individual about that treatment at the individual's place of employment, by mail to a designated address, or by phone to a designated phone number. Similarly, an individual may request that the provider send communications in a closed envelope rather than a post card, as an "alternative means." Covered health care providers must accommodate all reasonable requests. Health plans must accommodate all reasonable requests, if the individual clearly states that the disclosure of all or part of the protected health information could endanger the individual. For example, if an individual requests that a health plan send explanations of benefits about particular services to the individual's work rather than home address because the individual is concerned that a member of the individual's household (e.g., the named insured) might read the explanation of benefits and become abusive towards the individual, the health plan must accommodate the request.

The reasonableness of a request made under this paragraph must be determined by a covered entity solely on the basis of the administrative difficulty of complying with the request and as otherwise provided in this section. A covered health care provider or health plan cannot refuse to accommodate a request based on its perception of the merits of the individual's reason for making the request. A covered health care provider may not require the individual to provide a reason for the request as a condition of accommodating the request. As discussed above, a health plan is not required to accommodate a request unless the individual indicates that the disclosure could endanger the individual. If the individual indicates such endangerment, however, the covered entity cannot further consider the individual's reason for making the request in determining whether it must accommodate the request.

A covered health care provider or health plan may refuse to accommodate a request, however, if the individual has not provided information as to how payment, if applicable, will be handled, or if the individual has not specified an alternative address or method of contact.