hipaa-compliance

What this skill does

# HIPAA Compliance

Implement HIPAA Security Rule, Privacy Rule, and Breach Notification Rule requirements for systems that create, receive, maintain, or transmit electronic Protected Health Information (ePHI).

## When to Use

- Building or operating systems that handle electronic Protected Health Information
- Configuring cloud infrastructure for HIPAA-eligible workloads
- Establishing Business Associate Agreements with vendors
- Implementing technical safeguards for PHI protection
- Preparing for HIPAA compliance audits or OCR investigations

## HIPAA Rules and Safeguards

```yaml
security_rule:
  administrative_safeguards:
    164.308_a_1: "Security Management Process"
    actions:
      - Conduct risk analysis (required)
      - Implement risk management program (required)
      - Apply sanction policy for violations (required)
      - Review information system activity (required)

    164.308_a_3: "Workforce Security"
    actions:
      - Authorization/supervision procedures (addressable)
      - Workforce clearance procedure (addressable)
      - Termination procedures (addressable)

    164.308_a_4: "Information Access Management"
    actions:
      - Access authorization policies (addressable)
      - Access establishment and modification (addressable)
      - Isolate healthcare clearinghouse functions (required)

    164.308_a_5: "Security Awareness and Training"
    actions:
      - Security reminders (addressable)
      - Protection from malicious software (addressable)
      - Log-in monitoring (addressable)
      - Password management (addressable)

    164.308_a_6: "Security Incident Procedures"
    actions:
      - Response and reporting procedures (required)

    164.308_a_7: "Contingency Plan"
    actions:
      - Data backup plan (required)
      - Disaster recovery plan (required)
      - Emergency mode operation plan (required)
      - Testing and revision procedures (addressable)
      - Applications and data criticality analysis (addressable)

    164.308_a_8: "Evaluation"
    actions:
      - Periodic technical and nontechnical evaluation (required)

  physical_safeguards:
    164.310_a: "Facility Access Controls"
    164.310_b: "Workstation Use"
    164.310_c: "Workstation Security"
    164.310_d: "Device and Media Controls"

  technical_safeguards:
    164.312_a: "Access Control"
    actions:
      - Unique user identification (required)
      - Emergency access procedure (required)
      - Automatic logoff (addressable)
      - Encryption and decryption (addressable)

    164.312_b: "Audit Controls"
    actions:
      - Implement hardware/software/procedural mechanisms to record and examine access (required)

    164.312_c: "Integrity"
    actions:
      - Mechanism to authenticate ePHI (addressable)

    164.312_d: "Person or Entity Authentication"
    actions:
      - Verify identity of person/entity seeking access (required)

    164.312_e: "Transmission Security"
    actions:
      - Integrity controls (addressable)
      - Encryption (addressable)

privacy_rule:
  minimum_necessary: "Limit PHI use, disclosure, and requests to minimum necessary"
  individual_rights: "Access, amendment, accounting of disclosures, restrictions"
  notice_of_practices: "Provide notice of privacy practices to individuals"

breach_notification_rule:
  individual_notification: "Within 60 days of discovery"
  hhs_notification: "Annual for <500 records; within 60 days for 500+"
  media_notification: "Required when 500+ individuals in a state/jurisdiction"
```

## Technical Safeguards Implementation Checklist

```yaml
encryption_requirements:
  at_rest:
    standard: AES-256
    aws_services:
      - [ ] RDS encryption enabled (KMS managed key)
      - [ ] S3 bucket default encryption (SSE-KMS)
      - [ ] EBS volume encryption enabled
      - [ ] DynamoDB table encryption (KMS)
      - [ ] ElastiCache encryption at rest enabled
      - [ ] Redshift cluster encryption enabled
      - [ ] EFS encryption enabled
    azure_services:
      - [ ] Azure SQL TDE enabled (customer-managed key)
      - [ ] Storage Account encryption (CMK)
      - [ ] Managed Disk encryption (SSE with CMK)
      - [ ] Cosmos DB encryption at rest
    gcp_services:
      - [ ] Cloud SQL encryption (CMEK)
      - [ ] Cloud Storage encryption (CMEK)
      - [ ] BigQuery encryption (CMEK)
      - [ ] Persistent Disk encryption (CMEK)

  in_transit:
    standard: TLS 1.2 or higher
    checks:
      - [ ] TLS 1.2+ enforced on all load balancers
      - [ ] HTTP-to-HTTPS redirect enabled
      - [ ] Internal service-to-service mTLS configured
      - [ ] Database connections use SSL/TLS
      - [ ] API gateways enforce TLS minimum version
      - [ ] Email encryption for PHI (S/MIME or TLS)
      - [ ] VPN or private connectivity for admin access

  key_management:
    - [ ] Customer-managed KMS keys for PHI data stores
    - [ ] Key rotation enabled (annual minimum)
    - [ ] Key access restricted to authorized roles only
    - [ ] Key usage audited via CloudTrail / audit logs
    - [ ] Key deletion protection enabled

access_control:
  unique_user_identification:
    - [ ] Individual user accounts (no shared credentials)
    - [ ] MFA enforced for all users accessing PHI systems
    - [ ] Service accounts with unique identities and audited usage
    - [ ] Federated identity with SSO (SAML/OIDC)

  role_based_access:
    - [ ] Least privilege roles defined per job function
    - [ ] PHI access restricted to need-to-know
    - [ ] Separate roles for data access vs. administration
    - [ ] Privileged access requires just-in-time approval

  session_management:
    - [ ] Automatic session timeout (15 minutes idle for workstations)
    - [ ] Re-authentication for sensitive operations
    - [ ] Concurrent session limits
    - [ ] Session tokens secured (HttpOnly, Secure, SameSite)

  emergency_access:
    - [ ] Break-glass procedure documented and tested
    - [ ] Emergency access credentials stored securely
    - [ ] All emergency access usage audited and reviewed
    - [ ] Emergency access automatically expires

audit_controls:
  logging_requirements:
    - [ ] All PHI access logged (read, write, delete)
    - [ ] User authentication events logged
    - [ ] Administrative actions logged
    - [ ] Failed access attempts logged
    - [ ] Log integrity protection (hash chaining or WORM storage)
    - [ ] Logs retained for minimum 6 years
    - [ ] Regular log review process documented

  monitoring:
    - [ ] Real-time alerting on unauthorized PHI access attempts
    - [ ] Anomaly detection for unusual data access patterns
    - [ ] Privileged action monitoring
    - [ ] Data export/download alerting
```

## AWS HIPAA-Eligible Architecture

```bash
# Verify you are using only HIPAA-eligible AWS services
# Reference: https://aws.amazon.com/compliance/hipaa-eligible-services-reference/

# Create a dedicated VPC for PHI workloads
aws ec2 create-vpc --cidr-block 10.100.0.0/16 \
  --tag-specifications 'ResourceType=vpc,Tags=[{Key=Name,Value=phi-vpc},{Key=Compliance,Value=HIPAA}]'

# Enable VPC flow logs for network auditing
aws ec2 create-flow-log \
  --resource-type VPC \
  --resource-ids vpc-XXXXXXXX \
  --traffic-type ALL \
  --log-destination-type cloud-watch-logs \
  --log-group-name /vpc/phi-flow-logs \
  --deliver-logs-permission-arn arn:aws:iam::123456789012:role/VPCFlowLogsRole

# Create encrypted RDS instance for PHI
aws rds create-db-instance \
  --db-instance-identifier phi-database \
  --db-instance-class db.r6g.large \
  --engine postgres \
  --master-username admin \
  --master-user-password "USE_SECRETS_MANAGER" \
  --storage-encrypted \
  --kms-key-id arn:aws:kms:us-east-1:123456789012:alias/phi-rds-key \
  --vpc-security-group-ids sg-XXXXXXXX \
  --db-subnet-group-name phi-subnet-group \
  --backup-retention-period 35 \
  --multi-az \
  --deletion-protection \
  --enable-cloudwatch-logs-exports '["postgresql","upgrade"]' \
  --tags Key=Compliance,Value=HIPAA Key=DataC