Organized Health Care Arrangement


  1. A clinically integrated care setting in which individuals typically receive health care from more than one health care provider; 

  2. An organized system of health care in which more than one covered entity participates, and in which the participating covered entities: 

    1. Hold themselves out to the public as participating in a joint arrangement; and 

    2. Participate in joint activities that include at least one of the following: 

      1. Utilization review, in which health care decisions by participating covered entities are reviewed by other participating covered entities or by a third party on their behalf; 

      2. Quality assessment and improvement activities, in which treatment provided by participating covered entities is assessed by other participating covered entities or by a third party on their behalf; or 

      3. Payment activities, if the financial risk for delivering health care is shared, in part or in whole, by participating covered entities through the joint arrangement and if protected health information created or received by a covered entity is reviewed by other participating covered entities or by a third party on their behalf for the purpose of administering the sharing of financial risk.


  3. A group health plan and a health insurance issuer or HMO with respect to such group health plan, but only with respect to protected health information created or received by such health insurance issuer or HMO that relates to individuals who are or who have been participants or beneficiaries in such group health plan; 

  4. A group health plan and one or more other group health plans each of which are maintained by the same plan sponsor; or 

  5. The group health plans described in paragraph (4) of this definition and health insurance issuers or HMOs with respect to such group health plans, but only with respect to protected health information created or received by such health insurance issuers or HMOs that relates to individuals who are or have been participants or beneficiaries in any of such group health plans.

The Office of Civil Rights offered this clarification:

The Privacy Rule identifies relationships in which participating covered entities share protected health information to manage and benefit their common enterprise as “organized health care arrangements.” Covered entities in an organized health care arrangement can share protected health information with each other for the arrangement’s joint health care operations. 


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