The confidentiality provisions of the Health Insurance Portability and Accountability Act (PubLNo 104-191) (HIPAA) and the Medicaid Act do not prohibit a state hospital and state training school from disclosing protected health information to a state protection and advocacy system (P&A) as long as the disclosure complies with the requirements of the Protection and Advocacy for Individuals with Mental Illness Act (PAIMI) and other related acts, according to the U.S. District Court for the District of Wyoming. Therefore, the agreement for access to medical records between the state hospital, state training school, and the P&A could be implemented.
P&A access to medical records. The P&A requested medical information from a state hospital and a state training school as part of its federal mandate to protect and advocate for the rights of persons with disabilities. PAIMI, the Developmental Disabilities Assistance and Bill of Rights Act, and the Protection and Advocacy for Individual Rights Act (collectively P&A Acts) authorize the P&A to access medical records of disabled patients without their consent in certain circumstances. These circumstances include occasions when the P&A has received a complaint regarding the treatment of an individual in a facility and the individual either has no legal guardian or the legal guardian has chosen not to act on behalf of the disabled individual. The P&A also has authorization to access records when probable cause exists to believe an individual in a facility was subject to abuse or neglect.
Limits on release of medical records. After the state hospital and state training school denied the P&A's request to access the medical records of its disabled patients, both sides sought guidance on the extent to which HIPAA and the Medicaid Act affected the disclosure requirements of the P&A Acts. The court determined that the limits on the release of protected health information found in HIPAA and the Medicaid Act do not prevent the P&A from accessing protected health information. Under HIPAA, medical records may be released when required by another law. The P&A Acts require the release of medical records in certain circumstances, satisfying requirements for release of the information under HIPAA.
The Medicaid Act allows the release of medical records in several situations, including when conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the Medicaid plan. Because, as part of its procedures, the P&A requests records when investigating whether or not facilities provided adequate services or safeguards for Medicaid clients, the P&A meets the requirements for release of protected health information under the Medicaid Act. Because HIPAA and the Medicaid Act authorize the release of records to the P&A, the agreement between the P&A, state hospital, and state training facility for access to medical records could be implemented.
Source: Protection & Advocacy System, Inc. v. Freudenthal, D. Wyo., Jan. 5, 2006.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide..
Visit our News Library to read more news stories.
