Code of Massachusetts Regulations
258 CMR - BOARD OF REGISTRATION OF SOCIAL WORKERS
Title 258 CMR 22.00 - Confidentiality of Client Communications and Records
Section 22.04 - Limitations and Exceptions to Client Confidentiality

Universal Citation: 258 MA Code of Regs 258.22

Current through Register 1531, September 27, 2024

(1) Disclosure to Colleagues or Employees Providing Services to Client. A social worker may disclose client communications, information or records to his or her employee or agent, an administrative or clinical supervisor, or a professional colleague who is licensed under the applicable laws of the Commonwealth of Massachusetts or any other jurisdiction, without the written consent of the client if:

(a) The client has been informed in advance of the nature of the disclosure to be made, the purpose for which it will be made, and the provisions of 258 CMR 22.04(1);

(b) The client has not objected to such disclosure;

(c) The individual to whom the communications, information or records are disclosed is responsible for ensuring the adequacy and/or continuity of professional services for that client;

(d) The disclosure of such communications, information or records is reasonably necessary to ensure the adequacy and/or continuity of professional services to that client;

(e) The extent of the disclosure is limited to that which is reasonably necessary to ensure the adequacy and/or continuity of professional services for that client; and

(f) The individual to whom the communications, information or records are disclosed is required to keep such information confidential to the extent required by 258 CMR 22.00 or any other applicable state or federal laws or regulations.

(2) Disclosure Necessary to Prevent Harm to Client.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(2)(b) and (c), if:
1. The client's behavior creates a clear and present danger of harm to the client himself or herself;

2. The client has explicitly refused to voluntarily accept further appropriate treatment or services;

3. Disclosure of the communications, information or records is reasonably necessary to protect the safety of the client; and

4. The disclosure of client communications, information or records is limited to that authorized by 258 CMR 22.04(2)(b) and (c).

(b) In any situation where disclosure of client communications, information or records without the written consent of the client is authorized by 258 CMR 22.04(2)(a), if the social worker has a reasonable basis to believe that the client can be committed involuntarily to a hospital or other health care facility for appropriate treatment or services pursuant to M.G.L. c. 123, § 12, that social worker shall take all appropriate actions which are within the lawful scope of practice for his or her licensure level, as set forth in 258 CMR 12.00: Scope of Practice, to initiate proceedings for involuntary hospitalization of that client. In so doing, the social worker may disclose any and all client communications, information or records reasonably necessary to carry out his or her obligations under 258 CMR 22.04(2)(b).

(c) In any situation where disclosure of client communications, information or records without the written consent of the client is authorized by 258 CMR 22.04(2)(a), and whether or not the social worker has a reasonable basis to believe that the client can be committed involuntarily to a hospital or other health care facility for appropriate treatment or services pursuant to M.G.L. c. 123, § 12, the social worker may disclose client communications, information or records to members of the client's family or other individuals if, in the reasonable exercise of his or her professional judgment, the social worker believes that disclosure of the particular communications, information or records in question would assist in protecting the safety of the client.

(3) Disclosure Necessary to Prevent Client from Harming Others.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(3)(b) and (c), if:
1. The client has communicated to the social worker an explicit threat to kill or inflict serious bodily injury upon a reasonably identified or identifiable victim or victims, and the client has the apparent intent and ability to carry out that threat; or

2. The client has a history of physical violence which is known to the social worker and the social worker has a reasonable basis to believe that there is a clear and present danger that the client will attempt to kill or inflict serious bodily injury upon a reasonably identified or identifiable victim or victims.

(b) In any situation described in 258 CMR 22.04(3)(a), the social worker shall take one or more of the following actions:
1. The social worker shall make reasonable efforts to communicate the threat of death or serious bodily injury made by the client to the identified or identifiable victim or victims;

2. The social worker shall make reasonable efforts to notify an appropriate law enforcement agency, either in the city or town in which the client resides, or the cities or towns in which the identified or identifiable victims reside;

3. The social worker shall make reasonable efforts to arrange for voluntary hospitalization of the client at a hospital or other health care facility for appropriate treatment or services; or

4. The social worker shall take all appropriate steps which are within the lawful scope of practice for his or her level of licensure, as set forth in 258 CMR 12.00: Scope of Practice, to initiate proceedings for involuntary hospitalization of the client. Nothing in 258 CMR 22.03(3)(b) shall require a social worker to take any actions which, in the reasonable exercise of sound professional judgment, would endanger the health or safety of the social worker or increase the danger to any potential victim or victims. (c) In carrying out his or her obligations under 258 CMR 22.04(3)(b), the social worker may disclose client communications, information or records only if, and only to the extent that, disclosure of the specific communications, information or records in question is reasonably necessary to protect the identified or identifiable victim or victims.

(4) Disclosure To Comply with Statutory Abuse Reporting Obligations.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(4)(b), if such disclosure is made for the purpose of:
1. Complying with his or her statutory obligation to report suspected abuse or neglect of a child pursuant to M.G.L. c. 119, § 51A;

2. Complying with his or her statutory obligation to report suspected abuse of an elderly person pursuant to M.G.L. c. 19A, § 15;

3. Complying with his or her statutory obligation to report suspected abuse, neglect or mistreatment of a long term care facility resident pursuant to M.G.L. c. 111, § 72G; or

4. Complying with his or her statutory obligation to report suspected abuse, neglect or mistreatment of a person receiving hospice or home health agency services pursuant to M.G.L. c. 111, § 72G.

(b) In any situation in which disclosure of client communications, information or records without the prior written consent of the client is authorized by 258 CMR 22.04(4)(a), the social worker shall disclose such communications, information or records only to the extent that disclosure is reasonably necessary to provide the information required by the applicable reporting statute or cooperate with a governmental investigation into that report.

(5) Disclosure in Connection with Elderly Protective Services Investigations.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(5)(b), if:
1. The communication, information or record in question was made, acquired by, or revealed to that social worker while the social worker was acting as an elder protective services worker for a designated elder protective services agency, as defined in M.G.L. c. 19A, § 14; and

2. The communication, information or record in question was made, acquired by, or revealed to that social worker while the social worker was conducting an elder protective services assessment pursuant to M.G.L. c. 19A, § 18.

(b) In any situation in which disclosure of client communications, information or records without the prior written consent of the client is authorized by 258 CMR 22.04(5)(a), the social worker shall disclose such communications, information or records only to the extent that disclosure is reasonably necessary to carry out his or her obligations under M.G.L. c. 19A, § 18 or is otherwise authorized by the applicable regulations of the Department of Elder Affairs (651 CMR).

(6) Disclosure in Connection with Disabled Persons Protective Services Investigations.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(6)(b), if the communication, information or record in question was made, acquired by, or revealed to, that social worker while the social worker was conducting an investigation of alleged abuse of a disabled person pursuant to M.G.L. c. 19C, § 4(b), 4(c), or (5).

(b) In any situation in which disclosure of client communications, information or records without the prior written consent of the client is authorized by 258 CMR 22.04(6)(a), the social worker shall disclose such communications, information or records only to the extent that disclosure is reasonably necessary to carry out his or her obligations under M.G.L. c. 19C or is otherwise authorized by the applicable regulations of the Disabled Persons Protection Commission.

(7) Disclosure In Connection with Certain Child Custody or Protection Proceedings.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(7)(b), if:
1. The disclosure is made for the purpose of initiating, or giving testimony in connection with, probate court proceedings for placement of a child in foster care pursuant to M.G.L. c. 119, § 23(C);

2. The disclosure is made for the purpose of initiating, or giving testimony in connection with, juvenile court proceedings regarding protective custody and care for children pursuant to M.G.L. c. 119, § 24; or

3. The disclosure is made for the purpose of initiating, or giving testimony in connection with, court proceedings to dispense with parental consent to adoption pursuant to M.G.L. c. 210, § 3.

(b) In any situation in which disclosure of client communications, information or records without the prior written consent of the client is authorized by 258 CMR 22.04(7)(a), the social worker may disclose such client communications, information or records only if, and only to the extent that:
1. Disclosure of the communication, information or record in question is reasonably necessary to initiate, or give complete and accurate testimony in, the court proceeding; or

2. Disclosure of the communication, information or record in question has been ordered by a court of competent jurisdiction.

(8) Disclosure for Purposes of Collection of Payment for Services Rendered.

(a) A social worker may disclose client communications, information or records without the prior written consent of the client, to the extent authorized by 258 CMR 22.04(8)(b), if the disclosure is made solely for the purpose of collecting amounts owed to that social worker by that client for professional services rendered by that social worker or by the social worker's agents or employees.

(b) In any situation in which disclosure of client communications, information or records without the prior written consent of the client is authorized by 258 CMR 22.04(8)(a), such disclosure shall be limited to:
1. A description of the nature of the services provided to the client for which amounts are owed;

2. The dates on which such services were provided; and

3. The amounts owed to the social worker by the client for such services and any other related financial information.

If the client in question has made substantive assertions about the competence of the social worker or the quality of the services provided, the social worker may also disclose any and all information which is reasonably necessary to refute such claims.

(9) Disclosure to Third Party Payors.

(a) A social worker may disclose client communications, information or records to an insurance company, nonprofit hospital service corporation, medical service corporation, or health maintenance organization, without the prior written consent of the client, if:
1. The communications, information or records being disclosed relate to the diagnosis, treatment or other services provided to a client for which insurance coverage, benefits or reimbursement has been claimed, even if the client is a minor or is incompetent;

2. The insurance policy or certificate under which the claim for coverage, benefits or reimbursement is made authorizes the corporation to access the records in question for this purpose; and

3. The communications, information or records being disclosed are limited to that reasonably necessary for:
a. determining eligibility for, or entitlement to, such coverage, benefits or reimbursement;

b. administering or providing benefits for expenses arising from outpatient diagnosis and/or treatment of that client's mental, emotional or behavioral disorders, conditions or addictions; or

c. applying or implementing benefits coordination, benefits management, subrogation, workers' compensation, peer review or utilization review procedures in good faith.

(b) Whenever a client's clinical treatment record, or a portion of that record is made available to an insurance company, nonprofit hospital service organization or medical service organization pursuant to 258 CMR 22.04(9)(a), the social worker shall inform the client of the nature of the information contained in that clinical treatment record which is being or will be disclosed to the insurance company, nonprofit hospital service corporation, medical service corporation or health maintenance organization in question.

(10) Parental Access to Clinical Treatment Records of Minor Clients.

(a) Except as provided in 258 CMR 22.03(2)(b)2. or 22.04(10)(b), a social worker shall, upon the request of a parent or legal guardian of a minor client or prospective minor client, provide a copy of that minor client's clinical treatment record to that parent or legal guardian. The social worker may charge a reasonable fee, not to exceed the actual costs of reproducing that clinical treatment record, for this service.

(b) If a parent or legal guardian of a minor client or prospective minor client requests client communications, information or records pertaining to that minor client or prospective minor client which are protected by 258 CMR 22.03(1) from a social worker, and the minor client or prospective minor client expressly objects to disclosure of those communications, information or records to that parent or legal guardian, the social worker shall:
1. Provide the requesting parent or legal guardian with a treatment summary, as defined in 258 CMR 8.03: Definitions, regarding the services provided to that minor client or prospective minor client, instead of the communications, information or records actually requested, unless the social worker determines, in the reasonable exercise of his or her professional judgment, that disclosure of even a treatment summary would result in identifiable physical or emotional harm to that minor client or prospective minor client.

2. If the social worker determines, in the reasonable exercise of his or her professional judgment, that disclosure of even a treatment summary, as defined in 258 CMR 8.03: Definitions, to that parent or legal guardian would result in identifiable physical or emotional harm to that minor client or prospective minor client, the social worker may decline to provide any of the communications, information or records requested by that parent or legal guardian which pertain to that minor client or prospective minor client until he or she is ordered by a court of competent jurisdiction to do so.

Disclaimer: These regulations may not be the most recent version. Massachusetts 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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