HIPAA Compliance Guide

HIPAA Overview & Regulations

HIPAA Compliance Guide
What is HIPAA? What is a HIPAA BAA?
Regulations
General Administrative Requirements
Subpart A
General Provisions
Subpart B
Preemption Of State Law
Subpart C
Compliance and Investigations
Subpart D
Imposition of Civil Money Penalties
Subpart E
Procedures for Hearings
Administrative Requirements
Subpart A
General Provisions
Subpart D
Standard Unique Health Identifier For Health Care Providers
Subpart E
Standard Unique Health Identifier For Health Plans
Subpart F
Standard Unique Employer Identifier
Subpart I
General Provisions For Transactions
Subpart J
Code Sets
Subpart K
Health Care Claims Or Equivalent Encounter Information
Subpart L
Eligibility For A Health Plan
Subpart M
Referral Certification And Authorization
Subpart N
Health Care Claim Status
Subpart O
Enrollment And Disenrollment In A Health Plan
Subpart P
Health Care Electronic Funds Transfers (EFT) And Remittance Advice
Subpart Q
Health Plan Premium Payments
Subpart R
Coordination Of Benefits
Subpart S
Medicaid Pharmacy Subrogation
Security and Privacy
Subpart A
General Provisions
Subpart C
Security Standards For The Protection Of Electronic Protected Health Information
Subpart D
Notification In The Case Of Breach Of Unsecured Protected Health Information
Subpart E
Privacy Of Individually Identifiable Health Information

General Administrative Requirements   >   Procedures for Hearings

§ 160.504 Hearing before an ALJ

(a) A respondent may request a hearing before an ALJ. The parties to the hearing proceeding consist of–

(1) The respondent; and

(2) The officer(s) or employee(s) of HHS to whom the enforcement authority involved has been delegated.

(b) The request for a hearing must be made in writing signed by the respondent or by the respondent’s attorney and sent by certified mail, return receipt requested, to the address specified in the notice of proposed determination. The request for a hearing must be mailed within 90 days after notice of the proposed determination is received by the respondent. For purposes of this section, the respondent’s date of receipt of the notice of proposed determination is presumed to be 5 days after the date of the notice unless the respondent makes a reasonable showing to the contrary to the ALJ.

(c) The request for a hearing must clearly and directly admit, deny, or explain each of the findings of fact contained in the notice of proposed determination with regard to which the respondent has any knowledge. If the respondent has no knowledge of a particular finding of fact and so states, the finding shall be deemed denied. The request for a hearing must also state the circumstances or arguments that the respondent alleges constitute the grounds for any defense and the factual and legal basis for opposing the penalty, except that a respondent may raise an affirmative defense under § 160.410(b)(1) at any time.

(d) The ALJ must dismiss a hearing request where–

(1) On motion of the Secretary, the ALJ determines that the respondent’s hearing request is not timely filed as required by paragraphs (b) or does not meet the requirements of paragraph (c) of this section;

(2) The respondent withdraws the request for a hearing;

(3) The respondent abandons the request for a hearing; or

(4) The respondent’s hearing request fails to raise any issue that may properly be addressed in a hearing.

HIPAA Regulations

§ 160.502: Definitions

HIPAA Regulations

§ 160.506: Rights of the parties