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Re: WA State bill & "Uniform Health Care Info. Act"
To Peter Marshall:
Any idea where this bill is? Alive or dead or passed?
Twila Brase, R.N.
President, CCHC
>>HOUSE BILL 2032 (2/12/99)
>
>>{+ NEW SECTION. +} Sec. 4. HEALTH INFORMATION PRIVACY.
>
> (1) Each
>>health carrier shall develop and implement policies and procedures
>>governing the collection, use, and disclosure of health information.
>>These policies and procedures shall include methods for enrollees to
>>access information and amend incorrect information, for enrollees to
>>restrict the disclosure of sensitive information, and for enrollees to
>>obtain information about the carrier's health information policies.
>
>In
>>addition, these policies and procedures shall include methods for
>>carrier oversight and enforcement of information policies, for carrier
>>storage and disposal of health information, and for carrier conformance
>>to state and federal laws governing the collection, use, and disclosure
>>of personally identifiable health information. Each carrier shall
>>provide a summary notice of its health information policies to
>>enrollees, including the enrollee's right to restrict the collection,
>>use, and disclosure of health information.
>
>
> (2) Except as otherwise required by statute or rule, a health
>>carrier is, and all persons acting at the direction of or on behalf of
>>a carrier or in receipt of an enrollee's personally identifiable health
>>information are, prohibited from collecting, using, or disclosing
>>personally identifiable health information unless authorized in writing
>>by the person who is the subject of the information. At a minimum,
>>such authorization shall be valid for a limited time and purpose; shall
>>be specific as to purpose and type of information to be collected,
>>used, or disclosed; and shall identify the persons who will be
>>receiving the information.
>> (3) Any person who is the subject of an unauthorized collection,
>>use, or disclosure of personally identifiable health information is
>>entitled to the remedies provided under RCW 9.73.060 governing
>>violations of the right to privacy.
>> (4) The commissioner shall adopt rules to implement this section
>>and shall take into consideration health information privacy standards
>>recommended by the national association of insurance commissioners and
>>other related professional organizations.
>
>------
>
>
>CHAPTER 70.02 MEDICAL RECORDS--HEALTH CARE INFORMATION
>ACCESS AND DISCLOSURE
>
>
>
> 70.02.005 Findings.
> 70.02.010 Definitions.
> 70.02.020 Disclosure by health care provider.
> 70.02.030 Patient authorization of disclosure.
> 70.02.040 Patient's revocation of authorization for
> disclosure.
> 70.02.050 Disclosure without patient's authorization.
> 70.02.060 Discovery request or compulsory process.
> 70.02.070 Certification of record.
> 70.02.080 Patient's examination and copying--Requirements.
> 70.02.090 Patient's request--Denial of examination and
> copying.
> 70.02.100 Correction or amendment of record.
> 70.02.110 Correction or amendment or statement of
> disagreement--Procedure.
> 70.02.120 Notice of information practices--Display
> conspicuously.
> 70.02.130 Consent by others--Health care representatives.
> 70.02.140 Representative of deceased patient.
> 70.02.150 Security safeguards.
> 70.02.160 Retention of record.
> 70.02.170 Civil remedies.
> 70.02.900 Conflicting laws.
> 70.02.901 Application and construction--1991 c 335.
>
>RCW 70.02.005 Findings.
>
>
> The legislature finds that:
> (1) Health care information is personal and sensitive
>information that if improperly used or released may do
>significant harm to a patient's interests in privacy, health
>care, or other interests.
> (2) Patients need access to their own health care
>information as a matter of fairness to enable them to make
>informed decisions about their health care and correct
>inaccurate or incomplete information about themselves.
> (3) In order to retain the full trust and confidence of
>patients, health care providers have an interest in assuring
>that health care information is not improperly disclosed and
>in having clear and certain rules for the disclosure of
>health care information.
> (4) Persons other than health care providers obtain, use,
>and disclose health record information in many different
>contexts and for many different purposes. It is the public
>policy of this state that a patient's interest in the proper
>use and disclosure of the patient's health care information
>survives even when the information is held by persons other
>than health care providers.
> (5) The movement of patients and their health care
>information across state lines, access to and exchange of
>health care information from automated data banks, and the
>emergence of multistate health care providers creates a
>compelling need for uniform law, rules, and procedures
>governing the use and disclosure of health care information.
>
>RCW 70.02.010 Definitions.
>
> As used in this chapter, unless the context otherwise
>requires:
> (1) "Audit" means an assessment, evaluation,
>determination, or investigation of a health care provider by
>a person not employed by or affiliated with the provider to
>determine compliance with:
> (a) Statutory, regulatory, fiscal, medical, or scientific
>standards;
> (b) A private or public program of payments to a health
>care provider; or
> (c) Requirements for licensing, accreditation, or
>certification.
> (2) "Directory information" means information disclosing
>the presence, and for the purpose of identification, the
>name, residence, sex, and the general health condition of a
>particular patient who is a patient in a health care
>facility or who is currently receiving emergency health care
>in a health care facility.
> (3) "General health condition" means the patient's health
>status described in terms of "critical," "poor," "fair,"
>"good," "excellent," or terms denoting similar conditions.
> (4) "Health care" means any care, service, or procedure
>provided by a health care provider:
> (a) To diagnose, treat, or maintain a patient's physical
>or mental condition; or
> (b) That affects the structure or any function of the
>human body.
> (5) "Health care facility" means a hospital, clinic,
>nursing home, laboratory, office, or similar place where a
>health care provider provides health care to patients.
> (6) "Health care information" means any information,
>whether oral or recorded in any form or medium, that
>identifies or can readily be associated with the identity of
>a patient and directly relates to the patient's health care.
>The term includes any record of disclosures of health care
>information.
> (7) "Health care provider" means a person who is licensed,
>certified, registered, or otherwise authorized by the law of
>this state to provide health care in the ordinary course of
>business or practice of a profession.
> (8) "Institutional review board" means any board,
>committee, or other group formally designated by an
>institution, or authorized under federal or state law, to
>review, approve the initiation of, or conduct periodic
>review of research programs to assure the protection of the
>rights and welfare of human research subjects.
> (9) "Maintain," as related to health care information,
>means to hold, possess, preserve, retain, store, or control
>that information.
> (10) "Patient" means an individual who receives or has
>received health care. The term includes a deceased
>individual who has received health care.
> (11) "Person" means an individual, corporation, business
>trust, estate, trust, partnership, association, joint
>venture, government, governmental subdivision or agency, or
>any other legal or commercial entity.
> (12) "Reasonable fee" means the charges for duplicating or
>searching the record, but shall not exceed sixty-five cents
>per page for the first thirty pages and fifty cents per page
>for all other pages. In addition, a clerical fee for
>searching and handling may be charged not to exceed fifteen
>dollars. These amounts shall be adjusted biennially in
>accordance with changes in the consumer price index, all
>consumers, for Seattle-Tacoma metropolitan statistical area
>as determined by the secretary of health. However, where
>editing of records by a health care provider is required by
>statute and is done by the provider personally, the fee may
>be the usual and customary charge for a basic office visit.
> (13) "Third-party payor" means an insurer regulated under
> Title 48 RCW authorized to transact business in this state
>or other jurisdiction, including a health care service
>contractor, and health maintenance organization; or an
>employee welfare benefit plan; or a state or federal health
>benefit program.
>
>
>
>RCW 70.02.020 Disclosure by health care provider.
>
> Except as authorized in RCW 70.02.050 , a health care
>provider, an individual who assists a health care provider
>in the delivery of health care, or an agent and employee of
>a health care provider may not disclose health care
>information about a patient to any other person without the
>patient's written authorization. A disclosure made under a
>patient's written authorization must conform to the
>authorization.
> Health care providers or facilities shall chart all
>disclosures, except to third-party payors, of health care
>information, such chartings to become part of the health
>care information.
>
>RCW 70.02.030 Patient authorization of disclosure.
>
> (1) A patient may authorize a health care provider to
>disclose the patient's health care information. A health
>care provider shall honor an authorization and, if
>requested, provide a copy of the recorded health care
>information unless the health care provider denies the
>patient access to health care information under RCW
> 70.02.090.
> (2) A health care provider may charge a reasonable fee for
>providing the health care information and is not required to
>honor an authorization until the fee is paid.
> (3) To be valid, a disclosure authorization to a health
>care provider shall:
> (a) Be in writing, dated, and signed by the patient;
> (b) Identify the nature of the information to be
>disclosed;
> (c) Identify the name, address, and institutional
>affiliation of the person to whom the information is to be
>disclosed;
> (d) Except for third-party payors, identify the provider
>who is to make the disclosure; and
> (e) Identify the patient.
> (4) Except as provided by this chapter, the signing of an
>authorization by a patient is not a waiver of any rights a
>patient has under other statutes, the rules of evidence, or
>common law.
> (5) A health care provider shall retain each authorization
>or revocation in conjunction with any health care
>information from which disclosures are made. This
>requirement shall not apply to disclosures to third-party
>payors.
> (6) Except for authorizations given pursuant to an
>agreement with a treatment or monitoring program or
>disciplinary authority under chapter 18.71 or 18.130 RCW or
>to provide information to third-party payors, an
>authorization may not permit the release of health care
>information relating to future health care that the patient
>receives more than ninety days after the authorization was
>signed. Patients shall be advised of the period of validity
>of their authorization on the disclosure authorization form.
>If the authorization does not contain an expiration date, it
>expires ninety days after it is signed.
>
>RCW 70.02.040 Patient's revocation of authorization for
>disclosure.
> A patient may revoke in writing a disclosure authorization
>to a health care provider at any time unless disclosure is
>required to effectuate payments for health care that has
>been provided or other substantial action has been taken in
>reliance on the authorization. A patient may not maintain
>an action against the health care provider for disclosures
>made in good-faith reliance on an authorization if the
>health care provider had no actual notice of the revocation
>of the authorization.
>
>RCW 70.02.050 Disclosure without patient's authorization.
>
> (1) A health care provider may disclose health care
>information about a patient without the patient's
>authorization to the extent a recipient needs to know the
>information, if the disclosure is:
> (a) To a person who the provider reasonably believes is
>providing health care to the patient;
> (b) To any other person who requires health care
>information for health care education, or to provide
>planning, quality assurance, peer review, or administrative,
>legal, financial, or actuarial services to the health care
>provider; or for assisting the health care provider in the
>delivery of health care and the health care provider
>reasonably believes that the person:
> (i) Will not use or disclose the health care information
>for any other purpose; and
> (ii) Will take appropriate steps to protect the health
>care information;
> (c) To any other health care provider reasonably believed
>to have previously provided health care to the patient, to
>the extent necessary to provide health care to the patient,
>unless the patient has instructed the health care provider
>in writing not to make the disclosure;
> (d) To any person if the health care provider reasonably
>believes that disclosure will avoid or minimize an imminent
>danger to the health or safety of the patient or any other
>individual, however there is no obligation under this
>chapter on the part of the provider to so disclose;
> (e) Oral, and made to immediate family members of the
>patient, or any other individual with whom the patient is
>known to have a close personal relationship, if made in
>accordance with good medical or other professional practice,
>unless the patient has instructed the health care provider
>in writing not to make the disclosure;
> (f) To a health care provider who is the successor in
>interest to the health care provider maintaining the health
>care information;
> (g) For use in a research project that an institutional
>review board has determined:
> (i) Is of sufficient importance to outweigh the intrusion
>into the privacy of the patient that would result from the
>disclosure;
> (ii) Is impracticable without the use or disclosure of the
>health care information in individually identifiable form;
> (iii) Contains reasonable safeguards to protect the
>information from redisclosure;
> (iv) Contains reasonable safeguards to protect against
>identifying, directly or indirectly, any patient in any
>report of the research project; and
> (v) Contains procedures to remove or destroy at the
>earliest opportunity, consistent with the purposes of the
>project, information that would enable the patient to be
>identified, unless an institutional review board authorizes
>retention of identifying information for purposes of another
>research project;
> (h) To a person who obtains information for purposes of an
>audit, if that person agrees in writing to:
> (i) Remove or destroy, at the earliest opportunity
>consistent with the purpose of the audit, information that
>would enable the patient to be identified; and
> (ii) Not to disclose the information further, except to
>accomplish the audit or report unlawful or improper conduct
>involving fraud in payment for health care by a health care
>provider or patient, or other unlawful conduct by the health
>care provider;
> (i) To an official of a penal or other custodial
>institution in which the patient is detained;
> (j) To provide directory information, unless the patient
>has instructed the health care provider not to make the
>disclosure;
> (k) In the case of a hospital or health care provider to
>provide, in cases reported by fire, police, sheriff, or
>other public authority, name, residence, sex, age,
>occupation, condition, diagnosis, or extent and location of
>injuries as determined by a physician, and whether the
>patient was conscious when admitted.
> (2) A health care provider shall disclose health care
>information about a patient without the patient's
>authorization if the disclosure is:
> (a) To federal, state, or local public health authorities,
>to the extent the health care provider is required by law to
>report health care information; when needed to determine
>compliance with state or federal licensure, certification or
>registration rules or laws; or when needed to protect the
>public health;
> (b) To federal, state, or local law enforcement
>authorities to the extent the health care provider is
>required by law;
> (c) To county coroners and medical examiners for the
>investigations of deaths;
> (d) Pursuant to compulsory process in accordance with RCW
> 70.02.060.
> (3) All state or local agencies obtaining patient health
>care information pursuant to this section shall adopt rules
>establishing their record acquisition, retention, and
>security policies that are consistent with this chapter.
>
>RCW 70.02.060 Discovery request or compulsory process.
>
> (1) Before service of a discovery request or compulsory
>process on a health care provider for health care
>information, an attorney shall provide advance notice to the
>health care provider and the patient or the patient's
>attorney involved through service of process or first class
>mail, indicating the health care provider from whom the
>information is sought, what health care information is
>sought, and the date by which a protective order must be
>obtained to prevent the health care provider from complying.
>Such date shall give the patient and the health care
>provider adequate time to seek a protective order, but in no
>event be less than fourteen days since the date of service
>or delivery to the patient and the health care provider of
>the foregoing. Thereafter the request for discovery or
>compulsory process shall be served on the health care
>provider.
> (2) Without the written consent of the patient, the health
>care provider may not disclose the health care information
>sought under subsection (1) of this section if the requestor
>has not complied with the requirements of subsection (1) of
>this section. In the absence of a protective order issued
>by a court of competent jurisdiction forbidding compliance,
>the health care provider shall disclose the information in
>accordance with this chapter. In the case of compliance,
>the request for discovery or compulsory process shall be
>made a part of the patient record.
> (3) Production of health care information under this
>section, in and of itself, does not constitute a waiver of
>any privilege, objection, or defense existing under other
>law or rule of evidence or procedure.
>
>RCW 70.02.070 Certification of record.
>
> Upon the request of the person requesting the record, the
>health care provider or facility shall certify the record
>furnished and may charge for such certification in
>accordance with RCW 36.18.016 (5). No record need be
>certified until the fee is paid. The certification shall be
>affixed to the record and disclose:
> (1) The identity of the patient;
> (2) The kind of health care information involved;
> (3) The identity of the person to whom the information is
>being furnished;
> (4) The identity of the health care provider or facility
>furnishing the information;
> (5) The number of pages of the health care information;
> (6) The date on which the health care information is
>furnished; and
> (7) That the certification is to fulfill and meet the
>requirements of this section.
>
>RCW 70.02.080 Patient's examination and copying--
>Requirements.
>
> (1) Upon receipt of a written request from a patient to
>examine or copy all or part of the patient's recorded health
>care information, a health care provider, as promptly as
>required under the circumstances, but no later than fifteen
>working days after receiving the request shall:
> (a) Make the information available for examination during
>regular business hours and provide a copy, if requested, to
>the patient;
> (b) Inform the patient if the information does not exist
>or cannot be found;
> (c) If the health care provider does not maintain a record
>of the information, inform the patient and provide the name
>and address, if known, of the health care provider who
>maintains the record;
> (d) If the information is in use or unusual circumstances
>have delayed handling the request, inform the patient and
>specify in writing the reasons for the delay and the
>earliest date, not later than twenty-one working days after
>receiving the request, when the information will be
>available for examination or copying or when the request
>will be otherwise disposed of; or
> (e) Deny the request, in whole or in part, under RCW
> 70.02.090 and inform the patient.
> (2) Upon request, the health care provider shall provide
>an explanation of any code or abbreviation used in the
>health care information. If a record of the particular
>health care information requested is not maintained by the
>health care provider in the requested form, the health care
>provider is not required to create a new record or
>reformulate an existing record to make the health care
>information available in the requested form. The health
>care provider may charge a reasonable fee for providing the
>health care information and is not required to permit
>examination or copying until the fee is paid.
>
>RCW 70.02.090 Patient's request--Denial of examination
>and copying.
>
> (1) Subject to any conflicting requirement in the public
>disclosure act, chapter 42.17 RCW, a health care provider
>may deny access to health care information by a patient if
>the health care provider reasonably concludes that:
> (a) Knowledge of the health care information would be
>injurious to the health of the patient;
> (b) Knowledge of the health care information could
>reasonably be expected to lead to the patient's
>identification of an individual who provided the information
>in confidence and under circumstances in which
>confidentiality was appropriate;
> (c) Knowledge of the health care information could
>reasonably be expected to cause danger to the life or safety
>of any individual;
> (d) The health care information was compiled and is used
>solely for litigation, quality assurance, peer review, or
>administrative purposes; or
> (e) Access to the health care information is otherwise
>prohibited by law.
> (2) If a health care provider denies a request for
>examination and copying under this section, the provider, to
>the extent possible, shall segregate health care information
>for which access has been denied under subsection (1) of
>this section from information for which access cannot be
>denied and permit the patient to examine or copy the
>disclosable information.
> (3) If a health care provider denies a patient's request
>for examination and copying, in whole or in part, under
>subsection (1) (a) or (c) of this section, the provider
>shall permit examination and copying of the record by
>another health care provider, selected by the patient, who
>is licensed, certified, registered, or otherwise authorized
>under the laws of this state to treat the patient for the
>same condition as the health care provider denying the
>request. The health care provider denying the request shall
>inform the patient of the patient's right to select another
>health care provider under this subsection. The patient
>shall be responsible for arranging for compensation of the
>other health care provider so selected.
>
>RCW 70.02.100 Correction or amendment of record.
>
> (1) For purposes of accuracy or completeness, a patient
>may request in writing that a health care provider correct
>or amend its record of the patient's health care information
>to which a patient has access under RCW 70.02.080.
> (2) As promptly as required under the circumstances, but
>no later than ten days after receiving a request from a
>patient to correct or amend its record of the patient's
>health care information, the health care provider shall:
> (a) Make the requested correction or amendment and inform
>the patient of the action;
> (b) Inform the patient if the record no longer exists or
>cannot be found;
> (c) If the health care provider does not maintain the
>record, inform the patient and provide the patient with the
>name and address, if known, of the person who maintains the
>record;
> (d) If the record is in use or unusual circumstances have
>delayed the handling of the correction or amendment request,
>inform the patient and specify in writing, the earliest
>date, not later than twenty-one days after receiving the
>request, when the correction or amendment will be made or
>when the request will otherwise be disposed of; or
> (e) Inform the patient in writing of the provider's
>refusal to correct or amend the record as requested and the
>patient's right to add a statement of disagreement.
>
>RCW 70.02.110 Correction or amendment or statement of
>disagreement--Procedure.
>
> (1) In making a correction or amendment, the health care
>provider shall:
> (a) Add the amending information as a part of the health
>record; and
> (b) Mark the challenged entries as corrected or amended
>entries and indicate the place in the record where the
>corrected or amended information is located, in a manner
>practicable under the circumstances.
> (2) If the health care provider maintaining the record of
>the patient's health care information refuses to make the
>patient's proposed correction or amendment, the provider
>shall:
> (a) Permit the patient to file as a part of the record of
>the patient's health care information a concise statement of
>the correction or amendment requested and the reasons
>therefor; and
> (b) Mark the challenged entry to indicate that the patient
>claims the entry is inaccurate or incomplete and indicate
>the place in the record where the statement of disagreement
>is located, in a manner practicable under the circumstances.
>
>RCW 70.02.120 Notice of information practices--Display
>conspicuously.
>
> (1) A health care provider who provides health care at a
>health care facility that the provider operates and who
>maintains a record of a patient's health care information
>shall create a "notice of information practices" that
>contains substantially the following:
>
> NOTICE
>
> "We keep a record of the health care services we provide
> you. You may ask us to see and copy that record. You
> may also ask us to correct that record. We will not
> disclose your record to others unless you direct us to
> do so or unless the law authorizes or compels us to do
> so. You may see your record or get more information
> about it at . . . . . ."
>
> (2) The health care provider shall place a copy of the
>notice of information practices in a conspicuous place in
>the health care facility, on a consent form or with a
>billing or other notice provided to the patient.
>
>
>RCW 70.02.130 Consent by others--Health care
>representatives.
>
> (1) A person authorized to consent to health care for
>another may exercise the rights of that person under this
>chapter to the extent necessary to effectuate the terms or
>purposes of the grant of authority. If the patient is a
>minor and is authorized to consent to health care without
>parental consent under federal and state law, only the minor
>may exercise the rights of a patient under this chapter as
>to information pertaining to health care to which the minor
>lawfully consented. In cases where parental consent is
>required, a health care provider may rely, without incurring
>any civil or criminal liability for such reliance, on the
>representation of a parent that he or she is authorized to
>consent to health care for the minor patient regardless of
>whether:
> (a) The parents are married, unmarried, or separated at
>the time of the representation;
> (b) The consenting parent is, or is not, a custodial
>parent of the minor;
> (c) The giving of consent by a parent is, or is not, full
>performance of any agreement between the parents, or of any
>order or decree in any action entered pursuant to chapter
> 26.09 RCW.
> (2) A person authorized to act for a patient shall act in
>good faith to represent the best interests of the patient.
>
>RCW 70.02.140 Representative of deceased patient.
>
> A personal representative of a deceased patient may
>exercise all of the deceased patient's rights under this
>chapter. If there is no personal representative, or upon
>discharge of the personal representative, a deceased
>patient's rights under this chapter may be exercised by
>persons who would have been authorized to make health care
>decisions for the deceased patient when the patient was
>living under RCW 7.70.065.
>
>RCW 70.02.150 Security safeguards.
>
> A health care provider shall effect reasonable safeguards
>for the security of all health care information it
>maintains.
>
>RCW 70.02.160 Retention of record.
>
> A health care provider shall maintain a record of existing
>health care information for at least one year following
>receipt of an authorization to disclose that health care
>information under RCW 70.02.040 , and during the pendency of
>a request for examination and copying under RCW 70.02.080 or
>a request for correction or amendment under RCW 70.02.100.
>
>RCW 70.02.170 Civil remedies.
>
> (1) A person who has complied with this chapter may
>maintain an action for the relief provided in this section
>against a health care provider or facility who has not
>complied with this chapter.
> (2) The court may order the health care provider or other
>person to comply with this chapter. Such relief may include
>actual damages, but shall not include consequential or
>incidental damages. The court shall award reasonable
>attorneys' fees and all other expenses reasonably incurred
>to the prevailing party.
> (3) Any action under this chapter is barred unless the
>action is commenced within two years after the cause of
>action is discovered.
> (4) A violation of this chapter shall not be deemed a
>violation of the consumer protection act, chapter 19.86 RCW.
>
>RCW 70.02.900 Conflicting laws.
>
> (1) This chapter does not restrict a health care provider
>from complying with obligations imposed by federal or state
>health care payment programs or federal or state law.
> (2) This chapter does not modify the terms and conditions
>of disclosure under Title 51 RCW and chapters 13.50 ,
> 26.09 , 70.24 , 70.39, 70.96A , 71.05 , and 71.34 RCW and rules
>adopted under these provisions.
>
>
>RCW 70.02.901 Application and construction--1991 c 335.
>
> This act shall be applied and construed to effectuate its
>general purpose to make uniform the law with respect to the
>subject of this act among states enacting it.
>
>[1991 c 335 § 903.]
>
> This act may be cited as the uniform health care
>information act.
Twila Brase, R.N.
President
Citizens' Council on Health Care
1954 University Ave., Suite 8
St. Paul, MN 55104
651-646-8935ph
651-646-0100fx
http://www.cchc-mn.org