In the complex landscape of healthcare privacy law, few documents carry as much practical and legal significance as the Notice of Privacy Practices (NPP). For compliance attorneys advising healthcare providers, understanding the NPP’s requirements, strategic implications, and potential pitfalls is essential to protecting both patient rights and organizational interests. For those who need a template to use see the end of this article and for those who want help with a comprehensive privacy notice register to use our adaptive privacy notice generator.
A HIPAA NPP Guide for Compliance Attorneys
The NPP represents more than a regulatory checkbox—it serves as the primary communication vehicle between covered entities and patients regarding how protected health information (PHI) will be used, disclosed, and safeguarded. As enforcement actions and private litigation increasingly scrutinize privacy practices, the NPP has evolved from a simple notice requirement into a critical component of a comprehensive compliance strategy.
Legal Foundation and Regulatory Framework
The NPP requirement flows directly from the HIPAA Privacy Rule, codified at 45 CFR § 164.520. Congress enacted HIPAA in 1996 with the dual purpose of improving healthcare system efficiency and protecting the privacy of health information. The Privacy Rule, which became effective in 2003, operationalized these privacy protections by establishing national standards for how covered entities handle PHI.
The NPP serves as the transparency mechanism within this framework. Rather than allowing healthcare organizations to operate under opaque privacy policies, the Privacy Rule mandates that covered entities provide clear, accessible information about their privacy practices. This requirement reflects a fundamental principle: patients have a right to know how their sensitive health information will be treated before they entrust it to providers.
Three categories of entities must comply with the NPP requirement: health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically. Business associates, despite their significant role in the HIPAA ecosystem, are not required to provide NPPs, though they must comply with other Privacy Rule obligations.
Core Content Requirements
The Privacy Rule specifies mandatory content that every NPP must include. Compliance attorneys should view these requirements as the minimum threshold, not the ceiling, for effective privacy communication.
Uses and Disclosures
The NPP must describe how the covered entity may use and disclose PHI. The Privacy Rule organizes these into three categories, each requiring different treatment in the notice.
First, the NPP must explain uses and disclosures for treatment, payment, and healthcare operations (TPO). These activities form the core business functions of healthcare delivery and generally do not require patient authorization. However, the notice must provide sufficient detail that patients understand what these terms mean in practical terms. Simply stating that PHI may be used for “treatment” provides little meaningful information to patients who may not understand that this includes consultations with specialists, pharmacy communications, and care coordination activities.
Second, the NPP must address uses and disclosures that the covered entity is required or permitted to make without authorization under specific Privacy Rule provisions. These include disclosures required by law, public health activities, health oversight activities, judicial and administrative proceedings, law enforcement purposes, coroner and medical examiner functions, organ donation, research under certain conditions, serious threats to health or safety, essential government functions, and workers’ compensation.
Third, the NPP must describe other uses and disclosures that require patient authorization. This category serves as the catch-all: if a use or disclosure doesn’t fall within TPO or another specified exception, authorization is required. The notice must make clear that patients can revoke authorizations and that refusal to authorize generally cannot be used as grounds to deny treatment.
Individual Rights
The NPP must provide a clear statement of patient rights under HIPAA, including the right to request restrictions on uses and disclosures, the right to receive confidential communications, the right to inspect and copy PHI, the right to amend PHI, the right to receive an accounting of disclosures, and the right to receive a paper copy of the notice.
Each right comes with specific procedural requirements and limitations that should be explained in plain language. For instance, while patients have the right to request restrictions, covered entities generally are not required to agree to such restrictions except in one specific circumstance: when the patient pays out of pocket in full and requests that information not be disclosed to a health plan for payment or healthcare operations purposes.
Duties and Complaint Procedures
The NPP must articulate the covered entity’s legal duties, including the duty to maintain PHI privacy, provide the notice, and abide by the terms currently in effect. It must also explain how individuals can file complaints with both the covered entity and the Office for Civil Rights (OCR), including contact information for both.
Effective Date and Revision Information
Every NPP must display its effective date prominently. When revisions occur, the covered entity must explain how changes will be communicated and made available. For entities that maintain websites, posting the current NPP online has become standard practice and is required if the site provides information about services or benefits.
Distribution Requirements and Timing
The Privacy Rule establishes specific distribution requirements that vary by type of covered entity. For healthcare providers with direct treatment relationships, the covered entity must provide the NPP no later than the first service delivery date and make a good faith effort to obtain written acknowledgment of receipt. If acknowledgment cannot be obtained, the provider must document the reason.
This “good faith effort” standard provides some flexibility in emergency situations or when patients refuse to sign, but it requires documented attempts. Compliance attorneys should ensure their clients maintain clear policies about what constitutes a good faith effort and how failed attempts are recorded.
Health plans must provide the NPP at enrollment and at least once every three years thereafter, even if the notice hasn’t changed. Plans must also provide the notice upon request within 30 days. For electronic plans, the notice must be prominently posted on the website.
The requirement to redistribute even unchanged notices every three years reflects the regulatory philosophy that privacy information bears repeating—people forget, circumstances change, and regular reminders serve an important function in maintaining privacy awareness.
Material Changes and Revisions
Covered entities may revise their NPPs, but material changes trigger new distribution requirements. Determining what constitutes a “material change” requires judgment and legal analysis. Generally, changes that affect how PHI may be used or disclosed, that limit patient rights, or that modify the covered entity’s legal duties or complaint procedures qualify as material.
When material changes occur, the revised NPP must be distributed promptly. For providers, this means making the new notice available at the facility and providing it to individuals upon request. For health plans, the new notice must be provided within 60 days of the revision.
Some organizations adopt a practice of routinely reviewing and updating their NPPs annually, even without material changes. This proactive approach can ensure that the notice accurately reflects current practices and incorporates any regulatory developments.
Common Compliance Pitfalls
Compliance attorneys frequently encounter several recurring issues in NPP compliance. Understanding these pitfalls can help prevent violations before they occur.
Generic Templates Without Customization
Many organizations download generic NPP templates without adequately customizing them to reflect their actual privacy practices. While templates provide a useful starting point, they must be tailored to describe the specific uses, disclosures, and procedures of the organization. An NPP that describes practices the organization doesn’t engage in, or fails to describe practices it does engage in, creates both compliance gaps and potential liability.
Failure to Update for Practice Changes
Healthcare organizations evolve—they adopt new technologies, enter into new business relationships, implement new procedures. When these changes affect privacy practices, the NPP should be evaluated for necessary updates. A common scenario involves organizations implementing new health information exchanges or patient portals without considering whether these developments require NPP revisions.
Inadequate Distribution Documentation
The good faith effort to obtain acknowledgment requires documentation. Organizations that fail to maintain records of NPP distribution, acknowledgment attempts, and reasons for non-acknowledgment face difficulties demonstrating compliance during audits or investigations.
Ignoring Accessibility Requirements
The Privacy Rule requires that NPPs be written in plain language. Yet many NPPs remain dense, legalistic documents that fail to communicate effectively with patients. Organizations serving populations with limited English proficiency or disabilities must also consider translation and format accessibility.
Strategic Considerations Beyond Compliance
While ensuring technical compliance with the Privacy Rule requirements is essential, sophisticated compliance attorneys recognize that the NPP presents strategic opportunities beyond mere regulatory adherence.
Building Trust Through Transparency
An effective NPP can strengthen the patient-provider relationship by demonstrating a commitment to privacy and transparency. Organizations that view the NPP as a communication tool rather than a legal obligation often produce notices that are clearer, more user-friendly, and more effective at building patient confidence.
Coordinating with Broader Privacy Programs
The NPP should align with and reinforce the organization’s broader privacy and security initiatives. If an organization promotes specific privacy protections or security measures in its marketing or patient communications, these should be reflected consistently in the NPP.
Preparing for Breach Response
The NPP’s explanation of how privacy complaints are handled and what patients can expect from the organization becomes particularly important following a breach. Organizations that have clearly communicated their privacy practices and complaint procedures are often better positioned to manage patient and regulatory responses when incidents occur.
Enforcement Landscape
OCR enforces HIPAA Privacy Rule requirements, including NPP obligations, through complaint investigations, compliance reviews, and enforcement actions. While NPP violations alone rarely result in significant penalties, they frequently appear alongside other Privacy Rule violations in enforcement actions.
The civil monetary penalty structure under HIPAA provides for penalties ranging from $100 to $50,000 per violation, with annual maximums reaching $1.5 million for violations of an identical provision. NPP failures typically fall into the lower penalty ranges, but repeated or systematic failures can accumulate significant exposure.
Beyond regulatory enforcement, NPP failures can also create private litigation risks. While HIPAA itself does not create a private right of action, NPP deficiencies may support state law claims or serve as evidence of negligence in privacy-related litigation.
Practical Guidance for Compliance Attorneys
Attorneys advising healthcare organizations on NPP compliance should implement several practical strategies. First, conduct regular NPP audits to ensure that the notice accurately reflects current practices and remains compliant with regulatory requirements. These audits should occur at least annually and whenever significant practice changes occur.
Second, develop clear protocols for NPP distribution, acknowledgment, and documentation. Staff training on these protocols is essential—the most compliant NPP is worthless if it isn’t properly distributed.
Third, consider patient perspectives when drafting or revising the NPP. Patient advisory groups or readability testing can provide valuable feedback on whether the notice effectively communicates privacy information.
Fourth, maintain version control and documentation of all NPP revisions, distribution efforts, and material changes. This documentation proves invaluable during audits or investigations.
Finally, integrate NPP compliance into broader privacy and compliance programs. The NPP should not exist in isolation but should be part of a comprehensive approach to privacy protection that includes policies, procedures, training, risk assessment, and ongoing monitoring.
The Notice of Privacy Practices represents a critical intersection of legal obligation, patient communication, and organizational risk management. For compliance attorneys, thorough understanding of NPP requirements provides the foundation for advising healthcare organizations on privacy compliance.
As healthcare continues evolving with new technologies, payment models, and care delivery approaches, the NPP remains a constant—a fundamental commitment to transparency about how patient information will be handled. Organizations that view the NPP as an opportunity to build trust and demonstrate their privacy commitment, rather than merely checking a regulatory box, position themselves for both compliance success and stronger patient relationships.
The complexity of HIPAA compliance can seem daunting, but the NPP provides a concrete, actionable starting point. By ensuring that this foundational document is comprehensive, accurate, accessible, and properly distributed, compliance attorneys help their healthcare clients meet legal obligations while advancing the broader goal of protecting patient privacy in an increasingly complex healthcare environment.
HIPAA Notice of Privacy Practices Template
[ORGANIZATION NAME] NOTICE OF PRIVACY PRACTICES
Effective Date: [INSERT DATE]
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
[Organization Name] is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices regarding your PHI, and follow the terms of the Notice currently in effect.
How We May Use and Disclose Your Health Information
For Treatment. We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This includes consultation with other healthcare providers regarding your treatment and referral to another provider. For example, your primary care physician may share your health information with a specialist to coordinate your care.
For Payment. We may use and disclose your health information to obtain payment for services we provide. This includes billing activities, claims management, and collection activities. For example, we may send claims to your health insurance company containing certain health information to obtain payment for services we provided.
For Healthcare Operations. We may use and disclose your health information for our healthcare operations, which include internal administration and planning and various activities that improve the quality and cost-effectiveness of care. For example, we may use health information to evaluate the performance of our staff, assess the quality of care, or conduct training programs.
Other Uses and Disclosures We May Make Without Your Authorization:
- As Required by Law. We may disclose health information when required by federal, state, or local law.
- Public Health Activities. We may disclose health information to public health authorities for activities such as preventing or controlling disease, injury, or disability, or reporting vital events such as births or deaths.
- Health Oversight Activities. We may disclose health information to health oversight agencies for activities authorized by law, including audits, investigations, inspections, and licensure.
- Judicial and Administrative Proceedings. We may disclose health information in response to a court order, subpoena, discovery request, or other lawful process.
- Law Enforcement. We may disclose health information to law enforcement officials for law enforcement purposes as permitted by law.
- Coroners, Medical Examiners, and Funeral Directors. We may disclose health information to coroners, medical examiners, and funeral directors to carry out their duties.
- Organ and Tissue Donation. We may disclose health information to organizations involved in the procurement, banking, or transplantation of organs, eyes, or tissue.
- Research. We may use or disclose health information for research purposes when an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of your information.
- To Avert a Serious Threat to Health or Safety. We may use or disclose health information when necessary to prevent a serious threat to the health or safety of you, another person, or the public.
- Specialized Government Functions. We may disclose health information for military, national security, protective services, or correctional institution purposes as authorized by law.
- Workers’ Compensation. We may disclose health information as authorized by workers’ compensation laws.
Uses and Disclosures That Require Your Written Authorization:
We will obtain your written authorization before using or disclosing your health information for purposes other than those described above. Specifically, we will obtain your authorization before using or disclosing:
- Psychotherapy notes (with limited exceptions)
- Health information for marketing purposes
- Health information in a manner that constitutes a sale of PHI
You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on your authorization.
Your Rights Regarding Your Health Information
Right to Inspect and Copy. You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your care, including medical and billing records. To inspect or copy your health information, submit a written request to our Privacy Officer. We may charge a reasonable fee for copying and mailing costs.
Right to Amend. If you believe that information in your record is incorrect or incomplete, you may request that we amend it. To request an amendment, submit a written request to our Privacy Officer that includes the reason for your request. We may deny your request in certain circumstances, and if we do, we will provide you with a written explanation.
Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures we have made of your health information. To request an accounting, submit a written request to our Privacy Officer specifying the time period for which you want the accounting (not to exceed six years). The first accounting in a 12-month period will be provided free of charge; subsequent requests may incur a reasonable fee.
Right to Request Restrictions. You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations, or to restrict disclosures to family members or others involved in your care. We are not required to agree to your request except in one situation: if you pay for a service or item out of pocket in full, you can ask us not to share information about that service or item with your health insurer for payment or healthcare operations purposes, and we will honor that request.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. To request confidential communications, submit a written request to our Privacy Officer specifying how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically. To obtain a paper copy, contact our Privacy Officer.
Right to Be Notified of a Breach. You have the right to be notified in the event that we discover a breach of your unsecured health information.
Changes to This Notice
We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information we maintain. If we make material changes to our privacy practices, we will post the revised Notice in our office and on our website (if applicable), and we will provide you with a copy of the revised Notice [specify method: upon request, at your next service appointment, by mail, etc.].
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer at the address and phone number below. You will not be retaliated against for filing a complaint.
Contact Information
Privacy Officer: [Name]
Address: [Street Address, City, State, ZIP]
Phone: [Phone Number]
Email: [Email Address]
To File a Complaint with HHS:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/
ACKNOWLEDGMENT OF RECEIPT
I acknowledge that I have received a copy of [Organization Name]’s Notice of Privacy Practices.
Patient Name (Print): __________________________________
Patient Signature: ____________________________________
Date: ____________________
If signed by personal representative, please describe relationship to patient and authority to act on patient’s behalf:
____________________________________________________
FOR OFFICE USE ONLY
If acknowledgment not obtained, document reason:
☐ Emergency situation
☐ Patient refused to sign
☐ Other: __________________________________________
Staff Initials: _______ Date: ______________
