Updates

January 23, 2025 The HIPAA Security Rule went into effect in 2003, and it’s an understatement to say that technology has changed quite a bit since then. The Office for Civil Rights has released proposed updates for the HIPAA Security Rule. After a historic year of breaches, this legislation comprehensively strengthens the current Rule. This is the first update of the legislation in a decade. Many of the new requirements simply reinforce existing recommendations within the Security Rule, which now makes best practices mandatory. This legislation is the result of the significant rise in cyber attacks and the OCR’s continuous noncompliant findings when investigating Covered Entities and Business Associates. Although the proposed rule has not yet been finalized, legislation will likely be enacted within the next year, given bipartisan support for protecting patient data. What is the HIPAA Security Rule? The Security Rule, a critical component of HIPAA, centers on stringent guidelines for managing electronic Protected Health Information (ePHI). These guidelines encompass a wide range of safeguards—including physical, administrative, and technical—all designed to ensure the protection of sensitive patient data. One of the most significant components of the Security Rule is completing a Security Risk Analysis (SRA). The SRA sets a benchmark for your practice and assesses what your practice currently does to protect patient data. This analysis includes safeguards ranging from physical measures, like door alarms, to technical precautions, like properly encrypting files. This analysis is a yearly procedure for the OCR and continues to be emphasized in this proposal. In this new proposal, the OCR strictly defines the SRA as a yearly requirement with more guidelines on specific questions. The OCR has introduced eight implementation specifications for risk analysis. This also includes a thorough analysis of potential natural disasters and the consequences if a Business Associate was breached. In fact, the government has introduced a Risk Analysis Initiative, fining practices and businesses that do not complete this analysis. While this assessment is a major component of this rule, once vulnerabilities are identified, it’s up to your practice to implement these safeguards to protect your patients. What’s Changing? This proposed rule mandates that Covered Entities and their Business Associates implement certain proactive measures that were previously only strongly recommended, such as multi-factor authentication. As technology has greatly advanced since the introduction of this rule, there are also more requirements focused on system management, including required anti-malware protection, disabling unused network ports, and a network map, highlighting what devices are connected to specific networks in an organization. Network segmentation is another advancement of the rule, requiring practices to use different networks based on access to specific information. New policies and procedures will also be required if this proposal goes into effect. For instance, contingency plans will be required, showing what a practice or business plans to do if it is breached within 72 hours. Additionally, practices need to have a transition plan when staff leaves, and they need to notify other regulated entities when a staff member’s access to ePHI is changed or terminated. Business Associates (BAs) will also face stricter requirements when working with Covered Entities. If breached, BAs must notify their Covered Entities within 24 hours. BAs will also now have to have their compliance program certified by a Subject Matter Expert in cybersecurity on a yearly basis, ensuring that the business is taking the right steps to protect patient data. What Can I Do? While this rule is still within its comment period until early March, it could be enacted this year. Being aware of upcoming HIPAA legislation and preparing your practice is vital. Working with a smart compliance solution can take the pressure off, with compliance experts updating their systems to ensure their users will be compliant with new laws. Looking to understand HIPAA compliance for your practice before new laws take effect? Schedule a consultation with one of our experts today.