Section .0100 ‑ General

Link to law: http://reports.oah.state.nc.us/ncac/title 10a - health and human services/chapter 23 - medical assistance administration/subchapter h/subchapter h rules.html
Published: 2015

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subchapter 23H – Confidentiality and access to client

records

 

SECTION .0100 ‑ General

 

10A NCAC 23H .0101       SCOPE

The rules of this Subchapter protect the client's right to

confidentiality.  Non-identifying statistical information, general information about

the scope of any programs administered by the agency, and any written policy

relevant to the administration of the Medicaid program, are not confidential

information.

 

History Note:        Authority G.S. 108A-54; 108A-80;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0401 Eff. May 1, 2012.

10A NCAC 23H .0102       INFORMATION FROM

OTHER AGENCIES

If the agency receives information from another agency or

individual, that information shall be treated as any other information

generated by the Division of Medical Assistance or the county department of

social services, and disclosure thereof will be governed by any condition

imposed by the furnishing agency or individual.

 

History Note:        Authority G.S. 108A-54; 108A-80;

Eff. September 1, 1984;

Transferred from 10A NCAC 21A .0402 Eff. May 1, 2012.

 

10A NCAC 23H .0103       CONFIDENTIALITY

(a)  Except as otherwise provided in these Rules it shall be

unlawful for any person to obtain, disclose or use, or to authorize, permit or

acquiesce to the use of any list of names or other information concerning any client

applying for or receiving Medicaid that may be directly or indirectly derived

from the records, files, or communications of the agency, or acquired in the

course of performing official duties except for purposes directly connected

with the administration of the Medicaid program.

(b)  Whenever federal or state statutes or regulations

specifically address confidentiality issues, the agency shall disclose or keep

confidential client information in accordance with those federal or state

statutes or regulations.

(c)  Whenever there is inconsistency between federal or

state statutes or regulations specifically addressing confidentiality issues,

the agency shall abide by the statute or regulation which provides more

protection for the client.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.302;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0403 Eff. May 1, 2012.

 

10A NCAC 23H .0104       OWNERSHIP OF RECORDS

(a)  All client information contained in any records of the

agency is the property of the agency, and employees of the agency shall protect

and preserve such information from dissemination except as provided by the rules

of this Subchapter.

(b)  Original client records may not be removed from the

premises by individuals other than authorized staff of the agency, except by a

court order.

(c)  The agency shall be allowed to destroy records in

accordance with record retention schedules promulgated by the Division of

Archives and History, rules of the Division of Medical Assistance, and state

and federal statutes and regulations.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.306;

Eff. September 1, 1984;

Transferred from 10A NCAC 21A .0404 Eff. May 1, 2012.

 

10A NCAC 23H .0105       SECURITY OF RECORDS

(a)  The agency shall provide a secure place or places with

controlled access for the storage of records.  Only individuals who must access

client information in order to carry out duties assigned or approved by the agency

shall be authorized access to the storage area or areas.

(b)  Only authorized individuals may remove a record from

the storage area or areas and the authorizing individual shall be responsible

for the security of the record until it is returned to the storage area or

areas.

(c)  The agency shall establish procedures to prevent

accidental disclosure of client information from automated data processing

systems.

(d)  The director shall assure that all authorized

individuals are informed of the confidential nature of client information and

shall disseminate written policy to and provide training for all persons with

access to client information.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.306;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0405 Eff. May 1, 2012.

 

10a NCAC 23H .0106       LIABILITY OF PERSONS WITH ACCESS

(a)  Failure to comply with the rules in this Subchapter may

constitute a misdemeanor and be punishable by fine or imprisonment as provided

by North Carolina General Statute 108A-80.

(b)  Individuals employed by the agency and governed by the

State Personnel Act are subject to suspension, dismissal or disciplinary action

for failure to comply with these Rules.

(c)  Individuals other than employees but including

volunteers and students who are agents of the Department of Health and Human

Services and who have access to client information shall be liable in the same

manner as employees.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.304;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0406 Eff. May 1, 2012.

 

10A NCAC 23H .0107       RIGHT OF ACCESS

(a)  An individual has the right to obtain data about his

own case. Upon written or verbal request the client shall be able to review or

obtain without charge a copy of the information in his records with the

following exceptions:

(1)           Information that the agency is required to

keep confidential by state or federal statutes or regulations;

(2)           Confidential information originating from

another agency as provided for in Rule .0104 of this Section.

(3)           Information that would breach another

individual's right to confidentiality.

(b)  The agency shall provide access as promptly as feasible

but not more than five working days after receipt of the request.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.306;

Eff. September 1, 1984;

Transferred from 10A NCAC 21A .0407 Eff. May 1, 2012.

 

10A NCAC 23H .0108       WITHHOLDING INFORMATION FROM THE CLIENT

(a)  When the director or a delegated representative

determines on the basis of the exceptions in Rule .0107 of this Section to

withhold information from the client, this reason shall be documented in the

client record.

(b)  The director or delegated representative must inform

the client that information is being withheld, and upon which of the exceptions

specified in Rule .0107 of this Section the decision to withhold the

information is based.  If confidential information originating from another

agency is being withheld, the client shall be referred to that agency for

access to the information.

(c)  When a delegated representative determines to withhold

client information, the decision to withhold shall be reviewed by the

supervisor of the person making the initial determination.

 

History Note:        Authority G.S. 108A-54; 108A-80;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0408 Eff. May 1, 2012.

 

10A NCAC 23H .0109       PROCEDURE FOR REVIEW OF RECORDS

(a)  The director or his delegated representative shall be

present when the client reviews the record.  The director or his delegated

representative must document in the client record the review of the record by

the client.

(b)  A client may contest the accuracy, completeness or

relevancy of the information in his record.  Correction of the contested

information, but not the deletion of the original information if it is required

to support receipt of state or federal participation, shall be inserted in the

record when the director or his delegated representative concurs that such

correction is justified.  When the director or his delegated representative

does not concur, the client shall be allowed to enter a statement in the

record.  Such corrections and statements shall be made a permanent part of the

record and shall be disclosed to any recipient of the disputed information.  If

a delegated representative decides not to correct contested information, the

decision not to correct shall be reviewed by the supervisor of the person

making the initial decision.

(c)  Upon written request from the client, his personal

representative, including an attorney, may have access to review or obtain

without charge, a copy of the information in his record.  The client may permit

the personal representative to have access to his entire record or may restrict

access to certain portions of the record.  Rules .0107 and .0108 of this Section

shall apply.

 

History Note:        Authority G.S. 108A-54; 108A-80;

Eff. September 1, 1984;

Transferred from 10A NCAC 21A .0409 Eff. May 1, 2012.

 

10A NCAC 23H .0110       CONSENT FOR RELEASE

(a)  As a part of the application process for Medicaid, the

client shall be informed of the need for and give consent to release of

information necessary to verify statements to establish eligibility.

(b)  No individual shall release any client information

which is owned by the Division of Medical Assistance or the county departments

of social services, or request the release of information regarding the client

from other agencies or individuals without obtaining a signed consent for

release of information.  Disclosure without obtaining consent shall be in

accordance with Rule .0111 of this Section.

(c)  The consent for release of information shall be on a

form provided by the Division of Medical Assistance or shall contain the

following:

(1)           Name of the provider and the recipient of

the information;

(2)           The extent of information to be released;

(3)           The name and dated signature of the client;

(4)           A statement that the consent is subject to

revocation at any time except to the extent that action has been taken in

reliance on the consent;

(5)           Length of time the consent is valid.

(d)  The client may alter the form to contain other

information which may include but need not be limited to:

(1)           A statement specifying the date, event or

condition upon which the consent may expire even if the client does not

expressly revoke the consent;

(2)           Specific purpose for the release.

(e)  The following persons may consent to the release of

information:

(1)           The client;

(2)           The legal guardian if the client has been

judged incompetent;

(3)           The county department of social services if

the client is a minor and in the custody of the county department of social

services.

(f)  Prior to obtaining a consent for release of

information, the delegated representative shall explain the meaning of informed

consent.  The client shall be told the following:

(1)           Contents to be released;

(2)           That there is a definite need for the

information;

(3)           That the client can give or withhold the

consent and the consent is voluntary;

(4)           That there are statutes and regulations

protecting the confidentiality of the information.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.304; 42 C.F.R. 431.306;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0410 Eff. May 1, 2012.

 

10A NCAC 23H .0111       DISCLOSURE WITHOUT CLIENT CONSENT

(a)  Client information from the Medicaid record may be

disclosed without the consent of the client under the following circumstances:

(1)           To other employees of the county department

of social services for purpose of making referrals, supervision, consultation

or determination of eligibility;

(2)           To other county departments of social

services when the client moves to that county and requests Medicaid;

(3)           Between the county departments of social

services and the Division of Medical Assistance for purposes of supervision and

reporting.

(b)  Client information may be disclosed without consent to

individuals requesting approval to conduct studies of client records, provided

such approval is requested in writing and the written request will specify and

be approved on the basis of:

(1)           An explanation of how the findings of the

study have potential for expanding knowledge and improving professional

practices;

(2)           A description of how the study will be

conducted and how the findings will be used;

(3)           A presentation of the individual's

credentials in the area of investigation;

(4)           A description of how the individual will

safeguard the information;

(5)           An assurance that no report will contain

the names of individuals or other information that makes individuals

identifiable.

(c)  Client information may be disclosed without consent to

federal, state, or county employees for the purpose of monitoring, auditing,

evaluation, or to facilitate the administration of other state and federal

programs, provided that the need for the disclosure of confidential information

is justifiable for the purpose and that adequate safeguards are maintained to

protect the information from re-disclosure.

(d)  Client information may be disclosed without consent for

purposes of complying with other state and federal statutes and regulations and

court orders.

(e)  When information is released without the client's

consent, the client shall be informed to the extent possible, of the

disclosure.  The method of informing the client of the disclosure shall be

documented in the appropriate record.

 

History Note:        Authority G.S. 108A-54; 108A-80; 42

C.F.R. 431.306;

Eff. September 1, 1984;

Transferred from 10A NCAC 21A .0411 Eff. May 1, 2012.

 

10A NCAC 23H .0112       DOCUMENTATION OF CONSENT OR DISCLOSURE

Whenever client information is disclosed in accordance with

rules of this Subchapter, the director or delegated representative shall insure

that documentation of the disclosure is placed in the appropriate client

record.

 

History Note:        Authority G.S. 108A-54; 108A-80;

Eff. September 1, 1984;

Transferred from 10A NCAC 21A .0412 Eff. May 1, 2012.

 

10A NCAC 23H .0113       PERSONS DESIGNATED TO DISCLOSE

INFORMATION

Only directors of county departments of social services and

their designated representatives may disclose client information in accordance

with rules of this Subchapter.

 

History Note:        Authority G.S. 108A-54; 108A-80;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0413 Eff. May 1, 2012.