The Department of Health and Human Services, in accordance
with Federal Regulation (
42 CFR
431.306) and State statutes, must maintain
the individual's information in a manner which will ensure that this
information is restricted to persons or agency representatives who are subject
to standards of confidentiality comparable to those of the Department.
Section 2.1: Release of
Information
Information from the case record will be released under the
following circumstances:
I. The
individual has the right to review information in their case record at any
time. When the medical source requests that the medical information be kept
confidential, that information may not be reviewed by the individual.
II. All information pertaining to a decision
of eligibility for assistance, including medical and social data for
preparation of an Administrative Hearing will be made available to the
individual or the individual's representative. If the individual is being
represented by an attorney, permission to release information to the attorney
must be obtained in writing from the individual.
III. Financial information relating to
eligibility will be given to general assistance administrators if necessary for
making a determination of granting general assistance.
IV. Information relating to whether an
individual is a recipient in a particular month will be given to hospitals,
physicians, pharmacists, and other medical providers inquiring in order to
determine whether to provide their service under MaineCare. The address of the
individual is not to be released.
V. Information necessary for other Offices
within the Department to administer their programs may be given. These Offices
include Office of Child and Family Services (OCFS) - Child Protective Services,
Office of Aging and Disability Services (OADS) - Adult Protective Services,
Division of Support Enforcement and Recovery (DSER), Fraud Investigation and
Recovery Unit (FIRU), the Preventive Health Program (PHP), and the Division of
Administrative Hearings. Information may also be provided to other Offices
within DHHS if there is a written Memorandum of Understanding between OFI and
that Office.
VI. For those agencies
having a contract with the Department information may be released that is
needed for the agency to fulfill the terms of the contract. Agencies include
Home and Community Based Waiver agencies and Community Action
Programs.
VII. In the event of the
issuance of a subpoena or order from the court for the case record or for any
agency representative to testify concerning an applicant or recipient, the
Department's attorneys will call the Court's attention to the statutory
provisions and the regulations against disclosure of information. The decision
in regard to release of information will be with the presiding judge.
VIII. Pursuant to
42
CFR §
435.1200, for Members or
individuals who have been determined not eligible for Medicaid, the Department
will transfer via secure electronic interface, the individual's electronic
account to other insurance affordability programs, such as the federally
facilitated marketplace.
Section
2.2
: Written Release of Information
With all other requests, a written release from the
individual is required prior to sharing the information. Unless otherwise
specified any written release of information is valid for one year from the
date of signature by the individual. The release of information must specify
the information to be released and to whom.
I. Release of medical reports to general
assistance administrators will be made only if the individual has signed a
written release.
II. Information
will be made available upon receipt of written authorization from the
individual (or adult family head in the case of children) giving the Department
authorization to release information to the following:
A. Federal and State legislators;
B. attorneys;
C. social or financial service agencies
requesting information beyond eligibility dates, or, if under contract with the
Department, information beyond that necessary to administer their
program.
III.
Information about whether the individual is receiving MaineCare, the number of
children in the assistance unit and the address of the children will be made
available to absent parents inquiring about the status of the family only with
written permission of the caretaker relative.
Section 2.3
: Information from an
external source
For DHHS to obtain information:
I. the Eligibility Specialists must inform
the individual of the Department's need for collateral information;
and
II. receive a signed release
form from the individual identifying the information being requested and from
whom.
Information in case records and computer files will be used
only for Department business, never for obtaining information about friends,
relatives or neighbors. Employees of the Department are not permitted to
determine their own eligibility or that of their immediate family.
The names of individuals supplying information who wish to
remain anonymous will not be kept in the case
record.
