C.F.R. » Title 45 » SUBCHAPTER C—ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS › PART 160—GENERAL ADMINISTRATIVE REQUIREMENTS › Subpart B—Preemption of State Law

45 C.F.R. § 160.203

General rule and exceptions

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A standard, requirement, or implementation specification adopted under this subchapter that is contrary to a provision of State law preempts the provision of State law. This general rule applies, except if one or more of the following conditions is met:

(a) A determination is made by the Secretary under § 160.204 that the provision of State law:

(1) Is necessary:

(i) To prevent fraud and abuse related to the provision of or payment for health care;

(ii) To ensure appropriate State regulation of insurance and health plans to the extent expressly authorized by statute or regulation;

(iii) For State reporting on health care delivery or costs; or

(iv) For purposes of serving a compelling need related to public health, safety, or welfare, and, if a standard, requirement, or implementation specification under part 164 of this subchapter is at issue, if the Secretary determines that the intrusion into privacy is warranted when balanced against the need to be served; or

(2) Has as its principal purpose the regulation of the manufacture, registration, distribution, dispensing, or other control of any controlled substances (as defined in 21 U.S.C. 802), or that is deemed a controlled substance by State law.

(b) The provision of State law relates to the privacy of individually identifiable health information and is more stringent than a standard, requirement, or implementation specification adopted under subpart E of part 164 of this subchapter.

(c) The provision of State law, including State procedures established under such law, as applicable, provides for the reporting of disease or injury, child abuse, birth, or death, or for the conduct of public health surveillance, investigation, or intervention.

(d) The provision of State law requires a health plan to report, or to provide access to, information for the purpose of management audits, financial audits, program monitoring and evaluation, or the licensure or certification of facilities or individuals.

[65 FR 82798, Dec. 28, 2000, as amended at 67 FR 53266, Aug. 14, 2002]
Notes of Decisions
Cited in 105 cases (12 in the last 5 years), 2003–2025 · leading case: Samuel Zean v. Fairview Health Services
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Samuel Zean v. Fairview Health Services (2017) ca8 · cites it 2× “On appeal, Zean first argues the district court erred in concluding, contrary to governing FCC rulings, that lack of “prior express consent” is an element of his prima facie TCPA case, rather than an affirmative defense that Fairview must plead and prove.”
Allen v. Wright (2007) ga · cites it 6× “45 CFR § 160.203 . A HIPAA standard will be deemed "contrary to" a state law if it would be "impossible to comply with both the [s]tate and federal requirements" or "[t]he provision of [s]tate law stands as an obstacle to the accomplishment and execution of the full purposes and…”
Northlake Medical Center, LLC v. Queen (2006) gactapp · cites it 8× “2 is contrary to HIPAA and none of the exceptions contained in 45 C.F.R. § 160.203 applies, [20] it is preempted by HIPAA.”
Holman v. RASAK (2010) mich · cites it 4× “45 CFR 160.203 (emphasis added). "Contrary" means either that "[a] covered entity would find it impossible to comply with both the State and federal requirements" or that "[t]he provision of State law stands as an obstacle to the accomplishment and execution of the full purposes…”
Wipf v. Altstiel (2016) sd · cites it 8× “114-248 ); 45 C.F.R. § 160.203 . However, there are several exceptions to this general preemption rule.”
Law v. Zuckerman (2004) mdd · cites it 3× “C § 1320d — 2); 45 C.F.R. § 160.203 . Defendant’s counsel has argued that the Maryland Confidentiality of Medical Records Act, Md.”
Haage v. Zavala (2021) ill · cites it 2× “” Summary of the HIPAA Privacy Rule, supra, at 17; 45 C.F.R. § 160.203 (2018). A state law is “contrary” to HIPAA if a “covered entity or business associate would find it impossible to comply with both the State and Federal requirements” or if the “provision of State law stands…”
In the Interest of A.M., Minor Child. Heather Thomas, Subpoenaed Witness (2014) iowa · cites it 2× “See 45 C.F.R. § 160.203 (b); Holman v. Rasak, 486 Mich.”
Pacific Radiation Oncology, LLC v. The Queen's Medical Center. (2016) haw · cites it 4× “18 *** FOR PUBLICATION IN WEST’S HAWAII REPORTS AND PACIFIC REPORTER *** We acknowledge that Cohan also stated the following: Once health information has been de-identified, it is no longer protected by HIPAA. Further, because HIPAA allows “more stringent” state law to preempt…”
Menorah Park Ctr. for Senior Living v. Rolston (Slip Opinion) (2020) ohio · cites it 2× “” 45 C.F.R. 160.203. State law is contrary to HIPAA when (1) it is “impossible to comply with both the State and Federal requirements” or (2) “[s]tate law stands as an obstacle to the accomplishment and execution” of the act.”
Giangiulio v. Ingalls Memorial Hospital (2006) illappct · cites it 2× “45 C.F.R. § 160.203 (2005). However, HIPAA does not preempt state laws that are more stringent.”
Northwestern Memorial Hospital v. John Ashcroft, Attorney General of the United States (2004) ca7 “” See also 45 C.F.R. § 160.203 (b). A standard is “more stringent” if it “provides greater privacy protection for the individual who is the subject of the individually identifiable health information” than the standard in the regulation.”
Show all 105 citing cases →
— 45 C.F.R. § 160.203(a) — 1 case
Quentin White v. Henry Ford MacOmb Hospital Corporation (2023) michctapp
— 45 C.F.R. § 160.203(b) — 2 cases
Menorah Park Ctr. for Senior Living v. Rolston (Slip Opinion) (2020) ohio “” 45 C.F.R. 160.203. State law is contrary to HIPAA when (1) it is “impossible to comply with both the State and Federal requirements” or (2) “[s]tate law stands as an obstacle to the accomplishment and execution” of the act.”
Quentin White v. Henry Ford MacOmb Hospital Corporation (2023) michctapp
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