Beyond the B.A.S.I.C.S. Blog
ABA and HIPPA
January 20, 2012
What is HIPPA?
HIPPA, or the Health Insurance Portability and Accountability Act (1996), is a law consisting of a set of rules designed to protect and keep private individuals’ health care information.
What information is protected?
Any information that can specifically identify your client is protected under this act, including: patient demographics, past/present/future medical or mental health diagnoses or treatments, the provision of health care, health care payment information, names, addresses, birthdays, and social security numbers. Any information that can reasonably be used to identify your client is also protected (ex: via an internet search engine), so be careful about how specific you are.
How specific can I be without breaking the law?
OK: I have a 3 year old client in Del Ray (there are likely several 3 year olds in Del Ray, so the information you gave cannot specifically identify your client).
Not OK: I see a 3 year old boy on Mt. Vernon Avenue twice a week (there are likely very few 3 year old boys on any specific street, so someone could reasonably and easily discover the identity of your client with this information).
Can my partner/significant other drive me to work?
Not if you work at a client’s home; divulging your client’s address is a violation of HIPPA law.
Can a taxi drive me to work?
As long as you do not tell the taxi driver why you are going to a specific location, you may take a taxi to work.
Can I leave my Autism Awareness bumper sticker on my car when I’m at work?
Unless you also identify yourself as an ABA therapist (via a uniform, etc), neighbors have no way of knowing why your car is at your client’s home. Some clients prefer not to have any identifying objects visible in or around their home, so although your bumper sticker is legal, it may not be in your client’s best interest. If you have highly visible Autism Awareness paraphernalia, talk to your client about his/her preferences.
My client’s grandmother is babysitting during my session and she’s asking a ton of questions about the curriculum. Can I answer her?
According to HIPPA, if your client has identified grandma as family AND if you think that sharing information with her is in the best interest of your client, then YES, you may answer grandma’s question. For example, if you see grandma giving your client raisins but know that raisins are a very special reinforce reserved for a specific task, you should probably tell her. She does not, however, need to know how your last team meeting went or how your client’s sessions are submitted to insurance. When in doubt, tell grandma you’re not allowed to discuss program information and refer her to your Program Consultant.
KEEP IN MIND that although you are legally allowed to share relevant information with grandma, your client may not want you to do so. Ask your client if and what you are allowed to discuss with other family members, and if you have doubts, refer grandma to her son or daughter.
You can often side-step the issue by offering general information about autism treatment. Most of the time family members want to understand more but don’t know the right questions to ask. So, instead of telling grandma which programs your client is running, tell her that ABA programs try to teach from several different angles, and that we ask the same question several different ways to make sure our kids know and understand the answers. Instead of trying to answer her query of whether or not her grandchild will ever live an independent adult life, offer her examples of adults on the spectrum who do fabulous things.
KEEP IN MIND ALSO that the above strategy ONLY WORKS with identified family members. If you encounter a stranger or a neighbor on the street who asks you a similar question, discussing even general facts about autism will reveal to that person that you treat people on the autism spectrum, which will in turn “out” your client if she is with you, and you could go to jail. WHEN IN DOUBT, SAY NOTHING.
My client’s neighbor approached us at the park and asked how my client was doing. I know she is friends with my client and knows all about his diagnosis and treatment program. What can I tell her?
Legally, you can’t tell her anything. Answer her questions as honestly as possible without offering any treatment-specific information. For example:
Q: You’re one of Johnny’s therapists, right? A: I’m (insert name here).
Q: How’s he doing today? A: We’re having fun!
Q: Jane was telling me he’s working on potty training. How’s that going? A: We’re swinging right now.
Q: Do you know if his OT is canceled this week? I was supposed to babysit. A: I don’t know.
Q: When is his next psych evaluation? A: His mom knows his schedule better than I do!
Most of the time friends and neighbors will realize you are dodging their questions, and most of the time they’ll figure out why rather quickly. Occasionally you will come across someone who does not understand. DO NOT tell this person you’re not allowed to discuss it with them – you are implying that the information is medically related and you may be inadvertently violating HIPPA law. If you can’t think of a good answer, or you’re confused about what you’re allowed to say, simply leave the situation. Talk to your Program Consultant about what you can do in the future.
What if I run into a client at the mall? Am I allowed to say hello?
If you are off work and see one of your clients in a public place, it is a good idea to let your client make the first move. If you are with other people, allow your client to make the introductions and follow her lead – DO NOT tell anyone how you know your client unless your client offers the information first. It may be obvious to the people you are with (your friends likely know your career and could easily figure it out), but confirming your friends’ suspicions is a HIPPA violation.
I’m trying to teach my client to grocery shop, but people ask me a lot of questions when I’m at the store. What should I do?
Say as little as possible and be as honest as possible. Don’t offer any information. Don’t be rude and don’t lie, but get out of the conversation as quickly as you can. Here are some examples:
Q: Are you his therapist? A: I’m helping him right now.
Q: What’s wrong with him? A: He can’t find the spaghetti sauce.
Q: Does he have autism? A: I’m sorry, we don’t talk to strangers.
Q: Why does he have that book thing/talking device/computer/helmet? A: He’s using it.
Q: Why isn’t he talking? A: He’s trying to shop.
I know that teachers and doctors are legally obligated to report suspected child abuse and/or neglect. Am I?
Yes. Start by discussing your concerns with your Program Consultant.
Where can I find more information about HIPPA and Mandated Reporting?
Melissa Ruiz, BCaBA
BASICS ABA Therapy, LLC