Current through November, 2024
(a) The use or
disclosure of any of the information specified in section 17-1702-4(a) shall be
limited to the persons or purposes stipulated in this section and, unless
otherwise stated, this excludes inspection of the entire case record.
(b) Disclosure for purposes directly
connected with the administration of the medical assistance program shall be
allowed:
(1) To an employee of the DHS and
the U.S. government in the performance of the employee's official duties, who
shall have access to the entire case record;
(2) To the extent necessary to provide
services and to determine eligibility or the amount of medical assistance for
applicants or beneficiaries;
(3) To
the following, who shall be subject to the standards of confidentiality that
are comparable to those of the Medicaid agency:
(B) Other individuals contracted by the
Medicaid agency to provide a service;
(C) Medicaid providers who require
eligibility, cost share or TPL information for billing or recovery
purposes;
(D) Participating health
plans that require eligibility, co-payment, or TPL information for billing or
recovery purposes;
(E) Private
social service agencies, including purchase of service (POS) providers, from
which a beneficiary receives services; and
(F) Agencies administering programs under the
Social Security Act under such titles as XVI-SSI (
42 U.S.C.
§§1381 -
1383
), IV-A AFDC ( 42 U.S.C. §§630 - 644), or XX-Social Services (
42 U.S.C.
§1397) .
(c) Disclosure for purposes
directly connected with any investigation, prosecution, or criminal or civil
proceedings conducted in connection with the administration of medical
assistance program shall be permitted:
(1) To
police departments, prosecutors' offices, the attorney general's office, the
ombudsman's office, or any other state or federal agency; and
(2) For such purposes as:
(A) The detection, investigation, or
prosecution of violations of applicable state and federal laws of regulations
in connection with these programs, including any and all aspects of theft,
fraud, deception, or overpayment;
(B) DHS' claims against estates of deceased
recipients, or initiation of paternity and nonsupport actions by DHS under
Title IV-D of the Social Security Act (
42 U.S.C.
§§651 - 662);
(C) Responding to requests for information in
connection with lawsuits challenging the administration of the medical
assistance program; and
(D)
Providing information to the ombudsman's office investigating complaints about
the administration of the medical assistance program.
(d) Disclosure may be allowed for
purposes of the administration of other federal or federally assisted programs
which provide assistance, in cash or in kind, or services directly to
individuals on the basis of need. Disclosure shall be permitted for purposes of
administering programs such as:
(1) Social
security - supplemental security income; and
(2) Hawaii housing authority for the section
8 programs and the low income housing projects.
(e) Disclosure may be allowed for purposes of
an audit or similar activity, such as a financial review or review of
expenditure reports, conducted in connection with the administration of the
public assistance programs by any governmental entity which is authorized by
law to conduct the audit or activity.
