The definition of HIPAA compliance is the documented implementation and ongoing operation of policies, procedures, safeguards, agreements, and workforce controls required to meet federal obligations under the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations for protected health information. HIPAA compliance applies to HIPAA Covered Entities and, through required agreements and direct regulatory duties, Business Associates that create, receive, maintain, or transmit protected health information. HIPAA compliance requires demonstrable adherence to use and disclosure requirements, security safeguards for electronic protected health information, and breach evaluation and notification duties.
HIPAA compliance includes meeting requirements under the HIPAA Privacy Rule for permitted uses and disclosures, individual rights, notice obligations, complaint processes, mitigation, and workforce sanctions for violations of policies and procedures. HIPAA compliance also includes meeting requirements under the HIPAA Security Rule for administrative, physical, and technical safeguards that protect the confidentiality, integrity, and availability of electronic protected health information. Risk analysis and risk management activities support implementation decisions for security measures and support documentation of security posture over time.
HIPAA compliance also includes meeting requirements under the HIPAA Breach Notification Rule for identifying and responding to impermissible uses or disclosures and other security incidents involving unsecured protected health information, including required notifications to affected individuals and specified government entities, and in certain cases the media. Organizational compliance programs manage Business Associate agreements, apply the HIPAA Minimum Necessary Rule where the standard applies, and maintain records that demonstrate compliance activities during audits, investigations, and internal reviews. Operational controls include access management, secure communications practices, device and media handling, retention and disposal practices, and incident response documentation.
HIPAA staff training supports HIPAA compliance by providing workforce members with a foundation in HIPAA rules and regulations before internal policies and procedures are addressed. All workforce members must receive HIPAA training if they have access to PHI, including workforce members whose duties involve viewing, handling, documenting, transmitting, or storing protected health information in any format. HIPAA staff training should be provided during onboarding and reinforced through refreshers, with annual HIPAA training as industry best practice. Online training can be used to deliver comprehensive instruction on the HIPAA Privacy Rule, HIPAA Security Rule, HIPAA Breach Notification Rule, and the HIPAA Minimum Necessary Rule, including permissible uses and disclosures, safeguards, incident reporting pathways, and individual rights. The HIPAA Journal Training is online, comprehensive, and suitable for onboarding and annual refresher training, and training records support compliance oversight and audit documentation.