Current through Register Vol. 30, No. 38, September 20, 2024
A. The Administration, contractors,
providers, and noncontracting providers shall limit the release of safeguarded
information to persons or agencies for the following purposes in accordance
with 45 CFR 160 and 45 CFR 164, October 1, 2004, and
42 CFR 431.300
through
431.307,
October 1, 2004, incorporated by reference, on file with the Administration and
available from the U.S. Government Printing Office, 732 N. Capitol St., N.W.,
Washington, D.C. 20401. This incorporation by reference contains no future
editions or amendments:
1. Official purposes
directly related to the administration of the AHCCCS program including:
a. Establishing eligibility and
post-eligibility treatment of income, as applicable;
b. Determining the amount of medical
assistance;
c. Providing services
for members;
d. Performing
evaluations and analysis of AHCCCS operations;
e. Filing liens on property as
applicable;
f. Filing claims on
estates, as applicable; and
g.
Filing, negotiating, and settling medical liens and claims.
2. Law enforcement. The
Administration may release safeguarded information without the applicant's or
member's written or verbal consent, for the purpose of conducting or assisting
an investigation, prosecution, or criminal or civil proceeding related to the
administration of the AHCCCS program.
3. The Administration may release safeguarded
member information to a review committee in accordance with the provisions of
A.R.S. §
36-2917,
without the consent of the applicant or member.
B. Except as provided in subsection (A), the
Administration, contractors, providers, and noncontracting providers shall
disclose safeguarded information only to:
1.
An applicant;
2. A
member;
3. An unemancipated minor,
with written permission of a parent, custodial relative, or designated
representative, if:
a. An Administration
employee, authorized representative, or responsible caseworker is present
during the examination of the safeguarded information; or
b. After written notification to the
provider, and at a reasonable time and place.
4. Persons authorized by the applicant or
member; or
5. A court order or
subpoena compliant with
45
CFR 164.512(e), October 1,
2004, incorporated by reference, on file with the Administration and available
from the U.S. Government Printing Office, 732 N. Capitol St., N.W., Washington,
D.C. 20401. This incorporation by reference contains no future editions or
amendments.
C. The
Administration, contractors, providers, and noncontracting providers shall
safeguard identifiable information, protected health information as specified
in 45 CFR 160, and information obtained in the course of application for or
redetermination of eligibility concerning an applicant or member, that
includes, but is not limited to the following:
1. Name and address;
2. Social Security number;
3. Social and economic conditions or
circumstances;
4. Agency evaluation
of personal information;
5. Medical
data and information concerning medical services received, including diagnosis
and history of disease or disability;
6. State Data Exchange (SDX) tapes, and other
types of information received from outside sources for the purpose of verifying
income eligibility and amount of medical assistance payments; and
7. Any information received in connection
with the identification of legally liable third-party resources.
D. The restriction upon disclosure
of information in this Section does not apply to:
1. De-identified information as described by
45
CFR 164.514, October 1, 2004, incorporated by
reference in subsection (A); or
2.
A disclosure, in response to a request for information, that complies with 45
CFR 160 and 45 CFR 164, October 1, 2004, and
42 CFR 431.300
through
431.307,
October 1, 2004, incorporated by reference in subsection (A).
E. A provider shall furnish
records requested by the Administration or a contractor to the Administration
or the contractor at no charge.
