Numerous high-profile cybersecurity events in recent years, such as the Colonial Pipeline and SolarWinds attacks, spurred the US government to implement new legislation. In response to the growing threat, President Biden signed the Cyber Incident Reporting for Critical Infrastructure Act of 2022 (CIRCIA) in March 2022.

While the law has passed, many healthcare organizations remain uncertain about how it will directly affect them. If your organization has questions about what steps to take and what the law means for your processes, you are not alone. Here is what you need to know about how to comply with CIRCIA’s new requirements.

Who Does the Law Affect?

For the purposes of the law, critical infrastructure refers to any agency, organization or business whose service disruption would impact economic security or public health and safety. Examples include financial services, energy companies and transportation organizations.

Because healthcare organizations directly impact public health and safety, they also fall into this category. This law also defines single-provider offices for large healthcare systems as critical infrastructure.

If your organization has questions about whether you are required to report, then you should contact CISA. 

What Does the Law Require?

While some specific details are in flux, the legislation lays out the framework for future incident reporting for healthcare industries. CIRCIA will require:

• Organizations falling under critical infrastructure report substantial cybersecurity incidents to the Cybersecurity and Infrastructure Security Agency (CISA)
• Covered cybersecurity incidents must be reported within 72 hours
• Paying a ransom must be reported within 24 hours.

The law will require that the organization report information in the following even areas:

1. Description of the incident
2. Description of the vulnerability
3. Security defenses maintained
4. Tactics, techniques and procedures used by a threat actor
5. Identifying information for a threat actor
6. Information compromised during an incident
7. Contact information for a covered entity.

What Counts as Significant Cybersecurity Events?

Many chief information security officers (CISOs) at critical infrastructure organizations are asking the same questions. While a ransomware attack that shuts down the entire hospital is obviously a significant event, many leaders wonder about lesser events, such as phishing emails or a short denial of service attack. However, CISA defines a significant event as one that causes any of the following three results:

• Substantial loss of confidentiality, integrity or availability
• Disruption of business or industrial operations
• Unauthorized access or disruption of business or industrial operations.

Because these guidelines are a bit vague and open to interpretation, CISA provided specific events considered “substantial.” If your healthcare organization experiences one of the following, you must report the event once the Final Rule is published:

• Unauthorized access to your system
• Denial of Service (DOS) attacks that last more than 12 hours
• Malicious code on your systems, including variants if known
• Targeted and repeated scans against services on your systems
• Repeated attempts to gain unauthorized access to your system
• Email or mobile messages associated with phishing attempts or successes
• Ransomware against critical infrastructure, including variant and ransom details, if known.

What are My Current Requirements for Reporting?

Reporting is not currently mandatory for the CIRCIA requirements. However, CISA asks for voluntary reporting. CISA says that when they know about events, they can help your organization and provide warnings to other at-risk entities. It also uses the reports to help with proactive prevention to protect the country’s critical infrastructure. While CISA will share information, all details will be anonymized at this time.

Enacting new legislation is time-consuming and a multi-year process. Currently, CISA is working to publish a Notice of Proposed Rulemaking (NPRM), which must be completed by March 2024. The next step will be issuing the Final Rule, which will set the regulatory requirements within 18 months of NPRM publication.

However, as a CISO, you have many ways to participate in the process. You or a team member can attend one of the many listening sessions held around the country to gather information from stakeholders like yourself. The moderators at the sessions take all feedback back to CISA to incorporate into the Final Rule. By participating in the process, you not only get your organization’s needs considered in the law but can gain a full understanding of the bill so you can easily stay compliant when it becomes final.

When dealing with an event, your first task should be to contain the threat and reduce the damage. You should also work with local authorities as needed. If you are going to report the incident voluntarily, you should email [email protected] or call 888-282-0870. Reporting is available 24 hours a day, seven days a week. If you email, be sure to include as much detail as possible as well as contact information so CISA can follow up for more information.

Why CIRCIA Matters to CISOs

As a CISO, you need to understand your responsibility under the new law. However, because the details are still being finalized, it’s important to know where the law currently stands. You should stay on top of changes as the processes are ironed out and implemented. Once mandatory reporting begins, your organization could face penalties for not staying compliant.

The patients at your healthcare organization have a choice about where they get care, and trust plays a large part in their decision. Additionally, your healthcare organization has a large amount of personal and sensitive data about each patient, which they trust you to keep secure. Every cybersecurity event can cause patients to lose trust in your organization, in addition to costly financial setbacks which further impact patient care.

While reporting the incident may seem likely to reduce patient trust, the impact will be greater if you are fined for not reporting. When patients feel that you have not been transparent about the event, then you lose even more trust than from the original incident. By proactively reporting and working with authorities, you can help regain trust and also help other organizations.