Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION
Chapter 120 - RELEASE OF DATA TO THE PUBLIC
Section 590-120-3 - GENERAL PROVISIONS APPLICABLE TO ALL MHDO DATA
Universal Citation: 90 ME Code Rules ยง 590-120-3
Current through 2024-38, September 18, 2024
1. Confidentiality of Data
A. MHDO data may be released only in
accordance with this chapter and rules. MHDO may designate certain reports or
data as open to public inspection by publishing them on the MHDO public website
(Public Data).
B. MHDO Data and
records or documents containing PHI are confidential, may not be open to public
inspection, are not public records for purposes of any state or federal freedom
of access laws and may not be examined in any judicial, executive, legislative,
administrative or other proceeding as to the existence or content of any
individual's identifying health information , except that an individual's
identifying health information may be used to the extent necessary to prosecute
civil or criminal violations regarding information in the MHDO
database.
C. Decisions of the MHDO
or employees and subcommittees of MHDO denying or limiting data release are not
reviewable externally.
D. Data
elements related to health care facility or practitioner charges (total
charges, line-item charges, charge amount) for services rendered shall only be
released by MHDO in the average or aggregate in a manner which will prevent a
charge/paid ratio to be computed for each type of service rendered for any
individual health care claims processor, health care facility, or health care
practitioner. All other data related to payment of claims
contained in the appendices is publicly available contingent upon MHDO approval
of the data request.
E. Any data
that directly identifies or would lead to the indirect identification of
practitioners performing abortions as defined by 22 M.R.S. § 1596,
including a practitioner's tax identification number, or a practitioner's Drug
Enforcement Administration (DEA) registration number, or National Provider
Identifier (NPI) are deemed to be confidential and shall not be
released.
F. HIV Tests and status.
Level III Data shall not be released, nor shall any data released by MHDO be
used, to individually identify any person's HIV status, including the results
of an HIV test, except to the Maine Center for Disease Control on appropriate
application and with a MHDO DUA, to fulfill its statutory duties under 22
M.R.S.A. Chapters 250 and 251. 5 M.R.S. §§ 19203 & 19203-
D.
G. Psychiatric treatment
records. Level III Data shall not be released, nor shall any MHDO Data be used
to individually identify any patient receiving mental health services including
treatment from licensed psychiatric in-patient treatment facilities. 34-B
M.R.S. § 1207.
H. Substance
abuse treatment. Level III Data shall not be released, nor shall any MHDO Data
be used to individually identify any patient regarding receipt of substance
abuse treatment by a licensed substance abuse treatment provider. 42 CFR §
2.13(2015).
2. All data, which are not public data, must be requested by application made to the MHDO, by completing application forms prescribed by MHDO. Data applications shall at a minimum:
A. Identify the name and address
of the person and/or company requesting the data, and identify professional
qualifications and affiliations;
B.
identify the specific level of data requested;
C. describe how any Level II or Level III
Data requested meets the standard of "minimum necessary";
D. the purpose for which the data will be
used;
E. whether or not an
Institutional review board is to be utilized;
F. the ultimate recipient or user of the
data;
G. specify security and
privacy measures that will be taken in order to safeguard patient privacy; and
H. describe how, or if, the
results of the Applicant's analysis will be published and made publicly
accessible.
3. All uses of released data are governed by the following principles of release:
A. Level I and Level II Data releases may
include MHDO replacement numbers to distinguish individual subjects so long as
those individuals remain unidentified and anonymous to the data recipient and
anyone obtaining information or reports from the data recipient.
B. Level III Data requests shall be reviewed
and must be approved by the MHDO Data Release Subcommittee before release.
Level III Data may be linked and identified only as specified in the MHDO
DUA.
C. All data releases shall be
limited to information that is necessary for the stated purpose of the release
(minimum necessary).
D.
Supplemental data may only be requested with Level I, Level II, or Level III
Data, and is subject to the same limitations and requirements that are
associated with the level of data it supplements. In addition, supplemental
data element "Payer Assigned Group ID Number" shall be subject to the following
conditions:
1. In order for the MHDO to
consider releasing a payer assigned group ID number the affected employer must
have at least 500 covered employees on their health plan. The` Data Applicant
must obtain written authorization from the affected health plan and employer
and/ or plan sponsor.
2. Written
authorization must include a detailed description of the use of this level of
information. The written authorization must also include a statement from the
employer certifying that the data will not be used to identify employees and/or
dependents.
3. Written
authorization must be included with the submission of the data request to the
MHDO.
4. Before the release of data
including the payer assigned group ID can occur the data applicant will provide
the MHDO with the affected payer assigned Group ID Numbers.
E. All data releases will be
governed by a MHDO DUA that provides adequate privacy and security measures
including accountability and breach notification requirements similar to those
required in business associate agreements under HIPAA. Standard MHDO DUA's
shall be published on the MHDO Public Website.
F. The MHDO Executive Director and the Data
Release Subcommittee have the authority to deny any request for data. A
decision to deny or limit a request for data is not reviewable outside the
MHDO.
G. MHDO Data recipients must
demonstrate levels of security and privacy practices commensurate with health
industry standards for PHI, and with data encrypted at rest and in transit.
Data recipients must be able to demonstrate their ability to meet privacy and
security requirements. Data releases may be made available to authorized users
via an encrypted secure download process.
H. Data elements related to payment may be
arrayed or displayed publicly in a way that shows payments for specific health
care services by individual health care claims processors and health care
facilities or practitioners only by MHDO. Data recipients may not publicly
array or display MHDO Data in this way.
I. A data recipient may not sell, re-package
or in any way make MHDO Data available at the individual element level, unless
the ultimate viewers of that data have applied to MHDO for this data, been
approved for such access and signed an MHDO DUA.
J. Data Ownership. MHDO shall maintain
ownership of all data elements and sets it releases including any MHDO
generated numbers or identifiers therein. MHDO ownership of the data and the
laws controlling MHDO Data survive the expiration of any DUA or Agreement
regarding MHDO Data. MHDO reserves the authority to stop access to MHDO Data
without notice, and demand the return or destruction of MHDO Data. MHDO Data
recipients acquire no enforceable property rights to MHDO Data or access to
MHDO Data. Data Recipients must submit a written certification to the MHDO
verifying destruction of the MHDO data within five business days of the
completion of the data recipients stated purpose of the data use, or demand by
the MHDO Executive Director.
K. The
Executive Director reserves the right to stop access to Data even after
approval; and/or demand and secure the destruction or return of all MHDO Data,
when the Executive Director concludes that is necessary to protect the privacy,
integrity or security of MHDO Data.
L. Data Recipients are prohibited from
computing or trying to compute any charge/paid ratio for a type of service
rendered for any individual health care claims processor, health care facility,
or health care practitioner.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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