2017 -- S 0486 SUBSTITUTE A AS AMENDED

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO HEALTH AND SAFETY - DEPARTMENT OF HEALTH

     Introduced By: Senators McCaffrey, Lombardi, Conley, Nesselbush, and Archambault

     Date Introduced: March 02, 2017

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 23-1-48 of the General Laws in Chapter 23-1 entitled "Department

of Health" is hereby amended to read as follows:

     23-1-48. Reimbursement for medical record copies.

     (a) The director shall promulgate rules and regulations which establish reasonable

charges for expenses incurred in responding to requests for copies of medical records by

physicians pursuant to § 5-37-22(c) and (d), and by any health care provider as defined in §5-

37.3-3 ("health care provider"). The director may utilize data provided by the Rhode Island health

information management association or other similar local professional organization in his or her

determination as to the amount of the charges permitted by this section.

     (b) A patient or a patient's authorized representative, as defined in §5-37.3-3 ("patient or

a patient's authorized representative"), or a third-party requestor, also as defined in §5-37.3-3

("third-party requestor"), shall have the right to request a patient's medical records.

     (c) If the health care provider, utilizes patient's medical records, an electronic health

records system or database:

     (1) Any patient or any patient's authorized representative or any third-party requestor

shall have a right to obtain from any health care provider a copy of their records in an electronic

format;

     (2) Notwithstanding the provisions of subsection (a) of this section, the charges for

responding to requests for copies of medical records in electronic format shall not exceed a fee

for clerical services, research, and handling of twenty-five dollars ($25.00), inclusive of shipping

costs and the costs of data retrieval and/or the data storage device used to transport the medical

records. Provided, however, that fifty cents ($.50) per page for the first one hundred (100) pages

and twenty-five cents ($.25) per page for all pages thereafter may be charged. In no event shall

the charge for pages exceed one hundred dollars ($100).

     (d) If the health care provider does not utilize an electronic health records system or

database, the charges for responding to requests for copies of medical records shall not exceed a

fee for clerical services, research, and handling of twenty-five dollars ($25.00), inclusive of

retrieval costs, provided, however, that fifty cents ($.50) per page for the first one hundred (100)

pages and twenty-five cents ($.25) per page for all pages thereafter may be charged. In addition,

the requestor shall pay for the actual shipping costs incurred.

     (e) Copies of X-rays or films not reproducible by photocopy shall be provided at the

health care provider's actual cost for materials and supplies. In addition, the requestor shall pay

reasonable fees for clerical services, research, and handling, not to exceed twenty-five dollars

($25.00), plus actual shipping costs incurred.

     (f) A special handling fee of ten dollars ($10.00) may be charged if the records must be

delivered to the patient or authorized representative or third-party requestor within forty-eight

(48) hours of the request.

     (g) The health care provider shall not charge a fee for copying medical records if the

record is requested by the applicant or beneficiary:

     (1) For proof of immunization records required for school admission;

     (2) For the purposes of supporting a claim or an appeal under the provision of the Social

Security Act or any federal or state needs-based benefit program such as, medical assistance, RIte

Care, temporary disability insurance, and unemployment compensation;

     (3) For benefits in connection with a civil court certification proceeding;

     (4) To support a claim under the workers' compensation act §28-29-38 as reflected in

§23-17-19.1(16); or

     (5) To be sent to another consulting provider.

     SECTION 2. Section 5-37.3-3 of the General Laws in Chapter 5-37.3 entitled

"Confidentiality of Health Care Communications and Information Act" is hereby amended to read

as follows:

     5-37.3-3. Definitions.

     As used in this chapter:

     (1) "Authorized representative" means:

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     (i) A person empowered by the patient/client to assert or to waive the confidentiality, or

to disclose or consent to the disclosure of confidential information, as established by this chapter.

That person is not, except by explicit authorization, empowered to waive confidentiality or to

disclose or consent to the disclosure of confidential information;

     (ii) A guardian or conservator, if the person whose right to confidentiality is protected

under this chapter is incompetent to assert or waive that right; or

     (iii) If the patient/client is deceased, his or her personal representative or, in the absence

of that representative, his or her heirs-at-law.

     (2) "Board of medical licensure and discipline" means the board created under chapter 37

of this title.

     (3) (i) "Confidential health care communication" means a communication of health care

information by an individual to a health care provider, including a transcription of any

information, not intended to be disclosed to third persons except if those persons are:

     (A) Present to further the interest of the patient in the consultation, examination or

interview;

     (B) Reasonably necessary for the transmission of the communication; or

     (C) Participating in the diagnosis and treatment under the direction of the health care

provider, including members of the patient's family.

     (ii) "Confidential health care information" means all information relating to a patient's

health care history, diagnosis, condition, treatment, or evaluation obtained from a health care

provider who has treated the patient.

     (4) "Health care provider" means any person licensed by this state to provide or lawfully

providing health care services, including, but not limited to, a physician, hospital, intermediate

care facility or other health care facility, dentist, nurse, optometrist, podiatrist, physical therapist,

psychiatric social worker, pharmacist or psychologist, and any officer, employee, or agent of that

provider acting in the course and scope of his or her employment or agency related to or

supportive of health services.

     (5) "Health care services" means acts of diagnosis, treatment, medical evaluation, or

counseling or any other acts that may be permissible under the health care licensing statutes of

this state.

     (6) "Managed care contractor" means a person that:

     (i) Establishes, operates, or maintains a network of participating providers;

     (ii) Conducts or arranges for utilization review activities; and

     (iii) Contracts with an insurance company, a hospital or medical service plan, an

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employer, an employee organization, or any other entity providing coverage for health care

services to operate a managed care plan.

     (7) "Managed care entity" includes a licensed insurance company, hospital or medical

service plan, health maintenance organization, an employer or employee organization, or a

managed care contractor as described in subdivision (6) of this section, that operates a managed

care plan.

     (8) "Managed care plan" means a plan operated by a managed care entity as described in

subdivision (7) of this section, that provides for the financing and delivery of health care services

to persons enrolled in the plan through:

     (i) Arrangements with selected providers to furnish health care services;

     (ii) Explicit standards for the selection of participating providers;

     (iii) Organizational arrangements for ongoing quality assurance, utilization review

programs, and dispute resolution; and

     (iv) Financial incentives for persons enrolled in the plan to use the participating providers

and procedures provided for by the plan.

     (9) "Medical peer review board" means a peer review board under chapter 37 of this title.

     (10) "Nurse" means a registered nurse or licensed practical nurse licensed to practice

nursing in the state.

     (11) "Participating provider" means a physician, hospital, pharmacy, laboratory, dentist,

or other state licensed or other state recognized provider of health care services or supplies, that

has entered into an agreement with a managed care entity to provide any services or supplies to a

patient enrolled in a managed care plan.

     (12) "Patient" means a person who receives health care services from a health care

provider.

     (13) "Personally identifiable confidential health care information" means confidential

health care information, which explicitly or by implication identifies a particular patient.

     (14) "Physician" means a person registered or licensed to practice allopathic or

osteopathic medicine in this state under Rhode Island general laws.

     (15) "Psychiatric social worker" means a person holding a Master's or further advanced

degree from a school of social work accredited by the council of social work education.

     (16) "Psychologist" means a certified psychologist under chapter 44 of this title.

     (17) "Qualified personnel" means persons whose training and experience are appropriate

to the nature and level of the work in which they are engaged and who, when working as part of

an organization, are performing that work with published and adequate administrative safeguards

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against disclosure unauthorized under this chapter.

     (18) "Third party" means a person other than the patient to whom the confidential health

care information relates and other than a health care provider.

     (19) "Third-party requestor" means any person or entity representing a patient signed

Health Insurance Portability and Accountability Act (HIPAA)-compliant authorization allowing

them to obtain a copy of the patient's medical records or reports.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - DEPARTMENT OF HEALTH

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     This act would determine reimbursement rates for medical records copies from health

care providers including those that utilize an electronic health records system. This act would also

add a patient's attorney to the definition of "authorized representative" for purposes of receiving

and obtaining confidential health care communications and information.

     This act would take effect upon passage.

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