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Chapter 350-5 DISCLOSURE OF INFORMATION ON MEDICAID APPLICANTS, RECIPIENTS AND PROVIDERS

Rule 350-5-.01 Types of Applicant and Recipient Information to be Safeguarded

Any information which could be connected to an individual applicant or recipient in such a way as to disclose the individual's identity is confidential and shall be safeguarded. Such information includes:

(a) names, addresses, and all types of identification numbers;
(b) medical services proposed or provided to the individual;
(c) social and economic conditions or circumstances of the individual;
(d) agency evaluation of the individual's personal information; and
(e) medical data about the individual, including diagnosis and past history of disease or disability.

Rule 350-5-.02 Use of Applicant and Recipient Information

The types of information specified in Section .01 shall be used only for purposes directly connected with the administration of the State Plan. Such purposes include, but shall not be limited to:

(a) establishing eligibility;
(b) determining the amount of medical assistance;
(c) providing services for recipients; and
(d) conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the Plan.

Rule 350-5-.03 Access to Applicant and Recipient Information

(1) Access to the types of information specified in Section .01 shall be restricted to Department representatives or other persons, agencies, or organizations that are subject to standards of confidentiality comparable to those of the Department. Such persons, agencies, and organizations shall include providers of medical assistance and other entities contracting with the Department or otherwise authorized by law to perform one or more of the functions delineated in Section .02. Such access is available without the permission of the applicant or recipient, but shall be granted only where the entity seeking the information is performing one of the functions enumerated in Section .02, above.
(2) Before responding to a request for information from any person, agency, or organization that is not performing one or more of the functions delineated in Section .02, the Department must obtain written permission from the individual or the person legally responsible for the individual whenever possible. Confidential information about applicants or recipients shall be released without the individual's written permission only under the following conditions:
(a) An emergency situation exists in which:
1. prior attempts to contact the individual or legally responsible person for permission has been unsuccessful; or
2. a court of competent jurisdiction has ordered or subpoenaed information and the Department does not have sufficient time to notify the individual or legally responsible person before responding to the order or subpoena; or
3. release of such information is necessary to prevent loss of or risk to life or health; and
4. such release is not otherwise prohibited by law or regulation; and
5. written notification of the release is sent to the individual or the legally responsible person immediately after disclosure.
(b) An order has been issued by a court of competent jurisdiction in a case to which the Department is not a party. Before releasing the information in compliance with the court order, the Department shall:
1. attempt to obtain permission for such disclosure from the individual or the legally responsible person by means calculated to be the most effective to achieve meaningful contact with that person; and
2. notify the Law Department so that it may petition the court for appropriate relief such as a motion for reconsideration or in camera inspection of the confidential information if necessary, and notify the court of the applicable statutory provisions, policies, and regulations restricting disclosure of information.
(3) The Department shall not publish or otherwise release any names or list of names of applicants or recipients of medical assistance.

Rule 350-5-.04 Disclosure of Provider Information

Information maintained by the Department regarding providers may be disclosed to anyone who submits a written request therefor in accordance with all applicable federal and state laws and regulations, including but not limited to those concerning open records and trade secrets.