Adult Medicaid Manual MA-300 CONFIDENTIALITY

VI. RELEASE OF INFORMATION TO OTHER SOURCES WITHOUT CONSENT

A. Information may be disclosed without the consent of the applicant/recipient or his authorized representative in these situations:

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(VI.A)

1. To employees of the county DSS or another county DSS for administration of the programs of public assistance or social services;

Note: Child and Adult Protective Services can be considered “social service programs.” However, information should be released to Child or Adult Protective Service on a case-by-case basis. In assessing the appropriateness of releasing the information, the need for the information must be balanced against the risks involved in releasing it. Contact your Medicaid Program Representative if you have any questions about releasing the information.

2. To Medicaid program staff in other states when a client moves or when there is a question of dual participation, or to verify the status of Medicaid assistance in North Carolina for applicants in another state;

3. Between county Departments of Social Services and the Division of Medical Assistance for the purposes of supervision and reporting;

4. To federal, state and county employees for the purposes of auditing, monitoring and evaluation of the programs of public assistance and social services (federal CMS employees, state DSS or DMA employees or field staff, financial auditors, monitors, etc.). The need for disclosure of confidential information must be justifiable for the purpose and adequate safeguards must be maintained to protect the information from re-disclosure;

5. For the purpose of complying with other state and federal statutes or regulations;

6. For the purpose of complying with a subpoena or court order. The subpoena or court order must have been signed by a judge in order to release information from the Medicaid eligibility case file. If you have a questionable situation regarding a court order or subpoena requesting Medicaid client information, contact the Division of Medical Assistance, Medicaid Eligibility Section at (919) 855-4000 and your county attorney for guidance regarding Medicaid regulations and legal issues.

7. To other states for matching purposes (For example, DMA has signed agreements with other states for the quarterly interstate and VA matches.)

See VIII: “Release of Information without Client Consent Chart.”

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(VI.B.1.a.)

B. When Release of Information Without Consent to Outside Sources Is Permissible

There are strictly limited outside sources to which DSS may disclose information without the consent of the applicant/recipient. The kind of information disclosed is limited

1. Medicaid Enrolled Providers

a. Medicaid enrolled providers may be given certain information about the applicant/recipient's Medicaid status. This includes:

(1) Medicaid identification number

(2) Prior approval information

b. Some schools are enrolled as Medicaid providers to bill for covered services they provide. When acting in the role of Medicaid provider, schools have the same access to eligibility information as other providers. There are no provisions to allow schools greater access than other providers.

c. Medical providers who are not currently enrolled in the Medicaid program do not have access to information regarding Medicaid applicant/ recipients.

2. Referral for Medicaid

The DMA-5020, Notice of Case Status, serves as a referral for Medicaid from providers of inpatient care and as a notice of case status from the county dss. The form must state that the patient gives his consent for a referral to Medicaid and it must contain the signature of the patient or his authorized representative and a date. The only exception is for automatic newborn coverage and to verify dates of authorization for an individual who is already authorized for Medicaid. If these requirements are not met, the county dss cannot respond to the DMA-5020, Notice of Case Status referral.

NOTE: Some hospital admission forms state that the patient gives his consent for a referral to Medicaid. If a copy of this signed admission form accompanies a DMA-5020, Notice of Case Status, consider the DMA-5020 as signed.

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(VI.B.)

3. Health Check Coordinators and Community Care of North Carolina Case Managers (CCNC)

Health Check coordinators at the county health departments and CCNC case managers frequently request information about Medicaid recipients which they use to schedule services for recipients. For Health Check and CCNC activities involving outreach and follow-up, the county dss may release the recipient's name, address, phone number, and Medicaid ID number and authorization data. No other information may be released without client consent.

4. Social Security Administration and SSI Recipients

The Division has an agreement with the Social Security Administration to share information regarding SSI recipients because SSA determines Medicaid eligibility for SSI recipients. This includes reporting to SSA any information that would affect Medicaid eligibility (such as income and resources) if it is not reported to SSA by the recipient. The information is reported on the DMA-5049, Referral to Local Social Security Office.

This agreement applies only to SSI recipients. Information regarding Medicaid recipients who do not receive SSI cannot be released to SSA without a signed consent.

5. Agencies With Agreements

The State has signed agreements with certain agencies to facilitate administration of the Medicaid program. These agreements pertain to specific types of information and state the manner in which information is shared. The exchange of information in many cases is an electronic process. Safeguards are in place to ensure that client confidentiality is protected and that only information necessary in the administration of the program is exchanged. These agreements do not affect the release of applicant/recipient information by the county dss.

For example, EIS eligibility information is matched with Internal Revenue Service data for leads on income. Other On Line Verification (OLV) examples are SOLQ, BENDEX and SDX information from Social Security Administration, and unemployment and wage information from ESC.

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(VI.B)

6. Study and Research Projects

The State has on occasion entered into agreements with agencies to conduct approved study projects. For example, the Division recently received a grant from the National Academy for State Health Policy to evaluate child development services for Medicaid children under age 3 in Access II and III sites. A sample of parents were notified by mail and asked to participate in a telephone survey. This type of project must be evaluated and approved by the Division.

7. Hospitals Acting for Deceased Applicants

Under limited circumstances, a hospital may request an appeal for a deceased applicant and have access to that applicant’s case file without having a signed authorization from the deceased applicant. This can only occur when there is no known authorized representative or family member to act on the decedent’s behalf.

See: VIII “Release of Information without Client Consent Chart” on page 12.

C. Release of Information to Other Agencies Without Consent

Information from the applicant/recipient's Medicaid eligibility case record may not be released to other agencies, such as public housing agencies, legal services, private organizations, the United States Citizenship and Immigration Service (USCIS), Employment Security Commission (ESC), school lunch programs, health departments or elected officials without the client's consent.

These agencies frequently contact the Division of Medical Assistance (DMA) or the county Department of Social Services (DSS) for information regarding applicants/recipients. Some agencies request a list of recipients and their addresses for outreach purposes. This information cannot be released without the signed consent of the applicant/recipient.

The exception is agencies with whom the Division of Medical Assistance (DMA) has an agreement for specific types of sharing of information, such as on-line wage information from ESC and the Systematic Alien Verification for Entitlements (SAVE) verification system with the United States Citizenship and Immigration Service (USCIS). Only the information needed to complete the request for the agreed-upon information may be released.

In some cases these agencies are Medicaid enrolled providers, such as local health departments and mental health agencies. Release of information to those agencies is limited to that available to other Medicaid enrolled providers, as specified in B.1., above.

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(VI.D.)

D. Release of Information to WIC Agencies and Maternity Care Coordinators

1. WIC agencies have requested the release of information on Medicaid eligible pregnant women and young children for outreach for the WIC program. Confidentiality rules do not allow the release of information to WIC agencies without the client's consent. The county dss must explain the WIC program and make a referral for women who are pregnant, breastfeeding or within 6 months of postpartum, or who have children under the age of 5.

2. Health departments have also requested information on Medicaid eligible pregnant women to release to maternity care coordinators for follow-up on prenatal care and health needs. If the initiation of this service comes from the recipient and she has selected a maternity care coordinator, the information may be released to that provider. It is not allowable to release the names of Medicaid eligible pregnant women for the purpose of marketing the maternity care coordinator's services, even though those services may be of benefit.