Adult Medicaid Manual MA-300 CONFIDENTIALITY

V. CLIENT ACCESS AND RELEASE OF INFORMATION

A. For purposes of access to client information in the county dss, the applicant/recipient is:

1. The individual who is the applicant/recipient

2. The parent/legal guardian of a minor applicant/recipient

NOTE: A non-custodial parent has the same legal access to the child's eligibility record as the custodial parent. However, if releasing information to a non-custodial parent appears to pose a threat to the safety and well-being of the child, the county dss should contact their county attorney for assistance.

REVISED 10/01/11 CHANGE NO. 18-11

(V.A.)

3. Court appointed guardian of a mentally incompetent applicant/recipient

4. Duly appointed executor for a deceased applicant/recipient

5. Guardian Ad Litem of an applicant/recipient

6. Any representative authorized in writing by the applicant/recipient to have access to the applicant/recipient's eligibility file. The applicant/recipient must state the name of the representative, give right to access, sign and date the statement. If the client is a minor in the custody of the Department of Social Services, the DSS may give consent. See DMA-5018 Designation of Authorized Representative, for a suggested form.

B. Right to Access

1. An applicant/recipient or his authorized representative has the right to review the Medicaid eligibility case file upon request. The Director or his delegated representative must be present when the applicant/recipient reviews the record and must document in the case file the review of the record by the client. The applicant/recipient or his authorized representative may obtain without charge, a copy of the information in the eligibility case file. The information must be provided as promptly as possible but not more than five workdays after receipt of the request. There are exceptions to this requirement.

2. The Exceptions to the applicant/recipient or authorized representative’s right to view case information include:

a. Confidential third party information which may not be released to the applicant/recipient or his authorized representative includes:

(1) Information that the agency is required by law to keep confidential, such as adoption records

(2) Information originating from another agency, medical provider or other source that is identified as “Confidential” or “Do Not Release”

(3) Information that would breach another individual's right to confidentiality, such as the identity of an individual who reports fraud and requests anonymity

(4) Documents and/or informational matches that originate from ESC and SSA, such as printouts of OLV and SOLQ. The applicant/recipient or his authorized representative may obtain this information from ESC and SSA.

REVISED 10/01/11 – CHANGE NO. 18-11

(V.B.2.a. (4))

NOTE: ESC and SSA information verified through OLV cannot be released from the Medicaid eligibility case record even if the Medicaid applicant/recipient or his authorized representative gives consent.

NOTE: Documentation in the eligibility case record of how the ESC benefits or SSA benefits were verified such as, "The recipient and the amount of SSA, (ESC) benefits were verified on mm/dd/yy by OLV dated, mm/dd/yy" may remain in the eligibility case record.

b. Document the Medicaid eligibility case record and notify the applicant/recipient or his authorized representative that information is being withheld and which of the exceptions specified above supports the decision to withhold information. If confidential information originating from another agency is being withheld, refer the applicant/recipient or his authorized representative to the appropriate originating source for the information withheld.

3. Appeals

The applicant/recipient or his authorized representative has the right to examine the contents of the eligibility case records pertaining to the matter under appeal. The county DSS must allow the applicant/recipient or his authorized representative to examine any reports or documents of evidence being used in the hearing. If the applicant/recipient is represented by an attorney, the attorney has the same rights of access to eligibility records as the applicant/recipient.

NOTE: When the applicant/recipient or his authorized representative's right to view evidence for a hearing involves confidential information from a third party as described in B.2., contact the county attorney or the Division of Medical Assistance for guidance.

4. Contested Information

The a/r may contest the accuracy, completeness or relevancy of the information in his record. When the county DSS concurs that a correction of the contested information is justified, insert the correction in the record. Do not delete the original information if it is required to support receipt of state or federal financial participation. When the county DSS does not concur, allow the a/r to enter a statement in the record.

REISSUED 10/01/11 – CHANGE NO. 18-11

(V.C.1.)

C. Client‘s Consent to Release Information

1. Do not request or require that the applicant/recipient or the authorized representative sign a blank consent form for release of information for future use. If the applicant/recipient or his authorized representative gives consent to release information, a valid consent form must contain all of the following:

a. Name of the person, provider or agency to whom the information is being released

b. Extent of information to be released

c. Name and dated signature of the applicant/recipient

d. A statement that the consent is subject to revocation at any time

e. Length of time the consent is valid.

2. Do not request or require that the applicant/recipient or the authorized representative disclose the applicant/recipient’s PIN number or password for verification of checking or saving accounts or any other accounts. The financial information must be obtained from the banking institution by using a DSS-3431, Request for Financial Information, valid consent form. See 1 above.

3. The applicant/recipient or his authorized representative must be informed of the information to be released, the need for the release of information, and that there are statutes that protect his confidentiality.

4. The applicant/recipient or his authorized representative has the right to revoke his consent at any time. A verbal declaration is legally acceptable, but it is advisable to obtain a written statement revoking consent whenever possible.

5. See V. B 2. above for guidance regarding confidential information that may not be released even with the consent of the applicant/recipient or his authorized representative.