2019 -- H 5383

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LC001121

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING

     

     Introduced By: Representatives Edwards, Bennett, Chippendale, Canario, and Mendez

     Date Introduced: February 14, 2019

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17.26-3 of the General Laws in Chapter 23-17.26 entitled

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"Comprehensive Discharge Planning" is hereby amended to read as follows:

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     23-17.26-3. Comprehensive discharge planning.

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     (a) On or before January 1, 2017, each hospital and freestanding, emergency-care facility

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operating in the state of Rhode Island shall submit to the director a comprehensive discharge plan

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that includes:

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     (1) Evidence of participation in a high-quality, comprehensive discharge-planning and

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transitions-improvement project operated by a nonprofit organization in this state; or

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     (2) A plan for the provision of comprehensive discharge planning and information to be

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shared with patients transitioning from the hospital's or freestanding, emergency-care facility's

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care. Such plan shall contain the adoption of evidence-based practices including, but not limited

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to:

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     (i) Providing education in the hospital or freestanding, emergency-care facility prior to

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discharge;

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     (ii) Ensuring patient involvement such that, at discharge, patients and caregivers

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understand the patient's conditions and medications and have a point of contact for follow-up

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questions;

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     (iii) With patient consent, attempting to notify the person(s) listed as the patient's

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emergency contacts and recovery coach before discharge. If the patient refuses to consent to the

 

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notification of emergency contacts, such refusal shall be noted in the patient's medical record

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Encouraging notification of the person(s) listed as the patient's emergency contacts and certified

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peer recovery specialist to the extent permitted by lawful patient consent or applicable law,

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including but not limited to the Federal Health Insurance Portability and Accountability Act of

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1996, as amended and 42 CFR Part 2, as amended. The policy shall also require all such attempts

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at notification to be noted in the patient’s medical record;

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     (iv) Attempting to identify patients' primary care providers and assisting with scheduling

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post-discharge follow-up appointments prior to patient discharge;

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     (v) Expanding the transmission of the department of health's continuity-of-care form, or

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successor program, to include primary care providers' receipt of information at patient discharge

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when the primary care provider is identified by the patient; and

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     (vi) Coordinating and improving communication with outpatient providers.

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     (3) The discharge plan and transition process shall include recovery planning tools for

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patients with substance-use disorders, opioid overdoses, and chronic addiction, which plan and

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transition process shall include the elements contained in subsections (a)(1) or (a)(2), as

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applicable. In addition, such discharge plan and transition process shall also include:

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     (i) That, with patient consent, each patient presenting to a hospital or freestanding,

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emergency-care facility with indication of a substance-use disorder, opioid overdose, or chronic

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addiction shall receive a substance-abuse use evaluation, in accordance with the standards in

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subsection (a)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection

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(a)(4)(ii), with patient consent, each patient presenting to a hospital or freestanding, emergency-

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care facility with indication of a substance-use disorder, opioid overdose, or chronic addiction

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shall receive a substance-abuse use evaluation, in accordance with best practices standards, before

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discharge;

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     (ii) That if, after the completion of a substance-abuse use evaluation, in accordance with

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the standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services

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for the treatment of substance-use disorders, opioid overdose, or chronic addiction contained in

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subsection (a)(3)(iv) are not immediately available, the hospital or freestanding, emergency-care

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facility shall provide medically necessary and appropriate services with patient consent, until the

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appropriate transfer of care is completed;

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     (iii) That, with patient consent, pursuant to 21 C.F.R. § 1306.07, a physician in a hospital

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or freestanding, emergency-care facility, who is not specifically registered to conduct a narcotic

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treatment program, may administer narcotic drugs, including buprenorphine, to a person for the

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purpose of relieving acute, opioid-withdrawal symptoms, when necessary, while arrangements

 

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are being made for referral for treatment. Not more than one day's medication may be

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administered to the person or for the person's use at one time. Such emergency treatment may be

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carried out for not more than three (3) days and may not be renewed or extended;

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     (iv) That each patient presenting to a hospital or freestanding, emergency-care facility

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with indication of a substance-use disorder, opioid overdose, or chronic addiction, shall receive

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information, made available to the hospital or freestanding, emergency-care facility in accordance

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with subsection (a)(4)(v), about the availability of clinically appropriate inpatient and outpatient

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services for the treatment of substance-use disorders, opioid overdose, or chronic addiction,

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including:

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     (A) Detoxification;

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     (B) Stabilization;

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     (C) Medication-assisted treatment or medication-assisted maintenance services, including

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methadone, buprenorphine, naltrexone, or other clinically appropriate medications;

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     (D) Inpatient and residential treatment;

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     (E) Licensed clinicians with expertise in the treatment of substance-use disorders, opioid

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overdoses, and chronic addiction;

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     (F) Certified peer recovery coaches specialists; and

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     (v) That, when the real-time patient-services database outlined in subsection (a)(4)(vi)

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becomes available, each patient shall receive real-time information from the hospital or

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freestanding, emergency-care facility about the availability of clinically appropriate inpatient and

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outpatient services.

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     (4) On or before January 1, 2017, the director of the department of health, with the

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director of the department of behavioral healthcare, developmental disabilities and hospitals,

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shall:

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     (i) Develop and disseminate, to all hospitals and freestanding, emergency-care facilities, a

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regulatory standard for the early introduction of a certified peer recovery coach specialist during

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the pre-admission and/or admission process for patients with substance-use disorders, opioid

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overdose, or chronic addiction;

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     (ii) Develop and disseminate, to all hospitals and freestanding, emergency-care facilities,

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substance-abuse use evaluation standards for patients with substance-use disorders, opioid

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overdose, or chronic addiction;

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     (iii) Develop and disseminate, to all hospitals and freestanding, emergency-care facilities,

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pre-admission, admission, and discharge regulatory standards, a recovery plan, and voluntary

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transition process for patients with substance-use disorders, opioid overdose, or chronic addiction.

 

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Recommendations from the 2015 Rhode Island governor's overdose prevention and intervention

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task force strategic plan may be incorporated into the standards as a guide, but may be amended

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and modified to meet the specific needs of each hospital and freestanding, emergency-care

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facility;

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     (iv) Develop and disseminate best practices standards for health care clinics, urgent-care

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centers, and emergency-diversion facilities regarding protocols for patient screening, transfer, and

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referral to clinically appropriate inpatient and outpatient services contained in subsection

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(a)(3)(iv);

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     (v) Develop regulations for patients presenting to hospitals and freestanding, emergency-

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care facilities with indication of a substance-use disorder, opioid overdose, or chronic addiction to

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ensure prompt, voluntary access to clinically appropriate inpatient and outpatient services

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contained in subsection (a)(3)(iv);

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     (vi) Develop a strategy to assess, create, implement, and maintain a database of real-time

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availability of clinically appropriate inpatient and outpatient services contained in subsection

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(a)(3)(iv) of this section on or before January 1, 2018.

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     (b) Nothing contained in this chapter shall be construed to limit the permitted disclosure

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of confidential health care information and communications permitted in § 5-37.3-4(b)(4)(i) of

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the Confidentiality of Health Care Communications Act.

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     (5) On or before September 1, 2017, each hospital and freestanding, emergency-care

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facility operating in the state of Rhode Island shall submit to the director a discharge plan and

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transition process that shall include provisions for patients with a primary diagnosis of a mental

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health disorder without a co-occurring substance use disorder.

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     (6) On or before January 1, 2018, the director of the department of health, with the

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director of the department of behavioral healthcare, developmental disabilities and hospitals, shall

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develop and disseminate mental health best practices standards for health care clinics, urgent care

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centers, and emergency diversion facilities regarding protocols for patient screening, transfer, and

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referral to clinically appropriate inpatient and outpatient services. The best practice standards

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shall include information and strategies to facilitate clinically appropriate prompt transfers and

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referrals from hospitals and freestanding, emergency-care facilities to less intensive settings.

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     SECTION 2. Section 5-37.3-4 of the General Laws in Chapter 5-37.3 entitled

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

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as follows:

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     5-37.3-4. Limitations on and permitted disclosures.

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     (a)(1) Except as provided in subsection (b) of this section, or as specifically provided by

 

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the law, a patient's confidential health care information shall not be released or transferred

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without the written consent of the patient, or his or her authorized representative, on a consent

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form meeting the requirements of subsection (d) of this section. A copy of any notice used

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pursuant to subsection (d) of this section, and of any signed consent shall, upon request, be

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provided to the patient prior to his or her signing a consent form. Any and all managed care

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entities and managed care contractors writing policies in the state shall be prohibited from

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providing any information related to enrollees that is personal in nature and could reasonably lead

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to identification of an individual and is not essential for the compilation of statistical data related

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to enrollees, to any international, national, regional, or local medical information database. This

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provision shall not restrict or prohibit the transfer of information to the department of health to

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carry out its statutory duties and responsibilities.

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     (2) Any person who violates the provisions of this section may be liable for actual and

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punitive damages.

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     (3) The court may award a reasonable attorney's fee at its discretion to the prevailing

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party in any civil action under this section.

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     (4) Any person who knowingly and intentionally violates the provisions of this section

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shall, upon conviction, be fined not more than five thousand ($5,000) dollars for each violation,

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or imprisoned not more than six (6) months for each violation, or both.

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     (5) Any contract or agreement that purports to waive the provisions of this section shall

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be declared null and void as against public policy.

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     (b) No consent for release or transfer of confidential health care information shall be

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required in the following situations:

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     (1) To a physician, dentist, or other medical personnel who believes, in good faith, that

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the information is necessary for diagnosis or treatment of that individual in a medical or dental

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emergency;

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     (2) To medical and dental peer review boards, or the board of medical licensure and

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discipline, or board of examiners in dentistry;

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     (3) To qualified personnel for the purpose of conducting scientific research, management

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audits, financial audits, program evaluations, actuarial, insurance underwriting, or similar studies;

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provided, that personnel shall not identify, directly or indirectly, any individual patient in any

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report of that research, audit, or evaluation, or otherwise disclose patient identities in any manner;

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     (4)(i) By a health care provider to appropriate law enforcement personnel, or to a person

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if the health care provider believes that person, or his or her family, is in danger from a patient; or

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to appropriate law enforcement personnel if the patient has, or is attempting to obtain, narcotic

 

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drugs from the health care provider illegally; or to appropriate law enforcement personnel, or

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appropriate child protective agencies, if the patient is a minor child or the parent or guardian of

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said child and/or the health care provider believes, after providing health care services to the

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patient, that the child is, or has been, physically, psychologically, or sexually abused and

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neglected as reportable pursuant to § 40-11-3; or to appropriate law enforcement personnel or the

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division of elderly affairs if the patient is an elder person and the healthcare provider believes,

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after providing healthcare services to the patient, that the elder person is, or has been, abused,

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neglected, or exploited as reportable pursuant to § 42-66-8; or to law enforcement personnel in

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the case of a gunshot wound reportable under § 11-47-48, or to patient emergency contacts and

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certified peer recovery specialists notified in the case of an opioid overdose reportable under §

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23-17.26-3;

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     (ii) A health care provider may disclose protected health information in response to a law

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enforcement official's request for such information for the purpose of identifying or locating a

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suspect, fugitive, material witness, or missing person, provided that the health care provider may

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disclose only the following information:

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     (A) Name and address;

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     (B) Date and place of birth;

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     (C) Social security number;

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     (D) ABO blood type and rh factor;

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     (E) Type of injury;

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     (F) Date and time of treatment;

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     (G) Date and time of death, if applicable; and

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     (H) A description of distinguishing physical characteristics, including height, weight,

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gender, race, hair and eye color, presence or absence of facial hair (beard or moustache), scars,

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and tattoos.

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     (I) Except as permitted by this subsection, the health care provider may not disclose for

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the purposes of identification or location under this subsection any protected health information

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related to the patient's DNA or DNA analysis, dental records, or typing, samples, or analysis of

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body fluids or tissue.

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     (iii) A health care provider may disclose protected health information in response to a law

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enforcement official's request for such information about a patient who is, or is suspected to be, a

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victim of a crime, other than disclosures that are subject to subsection (b)(4)(vii) of this section,

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if:

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     (A) The patient agrees to the disclosure; or

 

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     (B) The health care provider is unable to obtain the patient's agreement because of

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incapacity or other emergency circumstances provided that:

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     (1) The law enforcement official represents that such information is needed to determine

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whether a violation of law by a person other than the victim has occurred, and such information is

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not intended to be used against the victim;

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     (2) The law enforcement official represents that immediate law enforcement activity that

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depends upon the disclosure would be materially and adversely affected by waiting until the

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patient is able to agree to the disclosure; and

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     (3) The disclosure is in the best interests of the patient as determined by the health care

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provider in the exercise of professional judgment.

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     (iv) A health care provider may disclose protected health information about a patient who

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has died to a law enforcement official for the purpose of alerting law enforcement of the death of

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the patient if the health care provider has a suspicion that such death may have resulted from

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criminal conduct.

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     (v) A health care provider may disclose to a law enforcement official protected health

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information that the health care provider believes in good faith constitutes evidence of criminal

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conduct that occurred on the premises of the health care provider.

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     (vi)(A) A health care provider providing emergency health care in response to a medical

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emergency, other than such emergency on the premises of the covered health care provider, may

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disclose protected health information to a law enforcement official if such disclosure appears

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necessary to alert law enforcement to:

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     (1) The commission and nature of a crime;

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     (2) The location of such crime or of the victim(s) of such crime; and

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     (3) The identity, description, and location of the perpetrator of such crime.

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     (B) If a health care provider believes that the medical emergency described in subsection

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(b)(4)(vi)(A) of this section is the result of abuse, neglect, or domestic violence of the individual

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in need of emergency health care, subsection (b)(4)(vi)(A) of this section does not apply and any

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disclosure to a law enforcement official for law enforcement purposes is subject to subsection

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(b)(4)(vii) of this section.

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     (vii)(A) Except for reports permitted by subsection (b)(4)(i) of this section, a health care

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provider may disclose protected health information about a patient the health care provider

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reasonably believes to be a victim of abuse, neglect, or domestic violence to law enforcement or a

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government authority, including a social service or protective services agency, authorized by law

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to receive reports of such abuse, neglect, or domestic violence:

 

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     (1) To the extent the disclosure is required by law and the disclosure complies with, and

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is limited to, the relevant requirements of such law;

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     (2) If the patient agrees to the disclosure; or

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     (3) To the extent the disclosure is expressly authorized by statute or regulation and:

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     (i) The health care provider, in the exercise of professional judgment, believes the

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disclosure is necessary to prevent serious harm to the patient or other potential victims; or

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     (ii) If the patient is unable to agree because of incapacity, a law enforcement or other

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public official authorized to receive the report represents that the protected health information for

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which disclosure is sought is not intended to be used against the patient and that an immediate

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enforcement activity that depends upon the disclosure would be materially and adversely affected

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by waiting until the patient is able to agree to the disclosure.

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     (B) A health care provider that makes a disclosure permitted by subsection (b)(4)(vii)(A)

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of this section must promptly inform the patient that such a report has been, or will be, made,

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except if:

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     (1) The health care facility, in the exercise of professional judgment, believes informing

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the patient would place the individual at risk of serious harm; or

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     (2) The health care provider would be informing a personal representative, and the health

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care provider reasonably believes the personal representative is responsible for the abuse, neglect,

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or other injury, and that informing such person would not be in the best interests of the individual

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as determined by the covered entity in the exercise of professional judgment.

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     (viii) The disclosures authorized by this subsection shall be limited to the minimum

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amount of information necessary to accomplish the intended purpose of the release of

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information.

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     (5) Between, or among, qualified personnel and health care providers within the health

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care system for purposes of coordination of health care services given to the patient and for

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purposes of education and training within the same health care facility; or

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     (6) To third party health insurers, including to utilization review agents as provided by §

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23-17.12-9(c)(4), third party administrators licensed pursuant to chapter 20.7 of title 27, and other

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entities that provide operational support to adjudicate health insurance claims or administer health

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benefits;

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     (7) To a malpractice insurance carrier or lawyer if the health care provider has reason to

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anticipate a medical liability action; or

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     (8)(i) To the health care provider's own lawyer or medical liability insurance carrier if the

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patient whose information is at issue brings a medical liability action against a health care

 

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provider.

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     (ii) Disclosure by a health care provider of a patient's health care information that is

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relevant to a civil action brought by the patient against any person or persons other than that

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health care provider may occur only under the discovery methods provided by the applicable

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rules of civil procedure (federal or state). This disclosure shall not be through ex parte contacts

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and not through informal ex parte contacts with the provider by persons other than the patient or

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his or her legal representative.

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     Nothing in this section shall limit the right of a patient, or his or her attorney, to consult

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with that patient's own physician and to obtain that patient's own health care information;

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     (9) To public health authorities in order to carry out their functions as described in this

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title and titles 21 and 23 and rules promulgated under those titles. These functions include, but are

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not restricted to, investigations into the causes of disease, the control of public health hazards,

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enforcement of sanitary laws, investigation of reportable diseases, certification and licensure of

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health professionals and facilities, review of health care such as that required by the federal

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government and other governmental agencies;

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     (10) To the state medical examiner in the event of a fatality that comes under his or her

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jurisdiction;

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     (11) In relation to information that is directly related to a current claim for workers'

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compensation benefits or to any proceeding before the workers' compensation commission or

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before any court proceeding relating to workers' compensation;

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     (12) To the attorneys for a health care provider whenever that provider considers that

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release of information to be necessary in order to receive adequate legal representation;

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     (13) By a health care provider to appropriate school authorities of disease, health

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screening, and/or immunization information required by the school; or when a school-age child

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transfers from one school or school district to another school or school district;

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     (14) To a law enforcement authority to protect the legal interest of an insurance

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institution, agent, or insurance-support organization in preventing and prosecuting the

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perpetration of fraud upon them;

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     (15) To a grand jury, or to a court of competent jurisdiction, pursuant to a subpoena or

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subpoena duces tecum when that information is required for the investigation or prosecution of

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criminal wrongdoing by a health care provider relating to his, her or its provisions of health care

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services and that information is unavailable from any other source; provided, that any information

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so obtained, is not admissible in any criminal proceeding against the patient to whom that

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information pertains;

 

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     (16) To the state board of elections pursuant to a subpoena or subpoena duces tecum

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when that information is required to determine the eligibility of a person to vote by mail ballot

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and/or the legitimacy of a certification by a physician attesting to a voter's illness or disability;

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     (17) To certify, pursuant to chapter 20 of title 17, the nature and permanency of a

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person's illness or disability, the date when that person was last examined and that it would be an

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undue hardship for the person to vote at the polls so that the person may obtain a mail ballot;

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     (18) To the central cancer registry;

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     (19) To the Medicaid fraud control unit of the attorney general's office for the

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investigation or prosecution of criminal or civil wrongdoing by a health care provider relating to

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his, her or its provision of health care services to then-Medicaid-eligible recipients or patients,

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residents, or former patients or residents of long-term residential care facilities; provided, that any

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information obtained shall not be admissible in any criminal proceeding against the patient to

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whom that information pertains;

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     (20) To the state department of children, youth and families pertaining to the disclosure

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of health care records of children in the custody of the department;

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     (21) To the foster parent, or parents, pertaining to the disclosure of health care records of

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children in the custody of the foster parent, or parents; provided, that the foster parent or parents

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receive appropriate training and have ongoing availability of supervisory assistance in the use of

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sensitive information that may be the source of distress to these children;

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     (22) A hospital may release the fact of a patient's admission and a general description of a

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patient's condition to persons representing themselves as relatives or friends of the patient or as a

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representative of the news media. The access to confidential health care information to persons in

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accredited educational programs under appropriate provider supervision shall not be deemed

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subject to release or transfer of that information under subsection (a) of this section; or

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     (23) To the workers' compensation fraud prevention unit for purposes of investigation

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under §§ 42-16.1-12 -- 42-16.1-16. The release or transfer of confidential health care information

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under any of the above exceptions is not the basis for any legal liability, civil or criminal, nor

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considered a violation of this chapter; or

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     (24) To a probate court of competent jurisdiction, petitioner, respondent, and/or their

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attorneys, when the information is contained within a decision-making assessment tool that

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conforms to the provisions of § 33-15-47.

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     (c) Third parties receiving, and retaining, a patient's confidential health care information

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must establish at least the following security procedures:

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     (1) Limit authorized access to personally identifiable, confidential health care

 

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information to persons having a "need to know" that information; additional employees or agents

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may have access to that information that does not contain information from which an individual

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can be identified;

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     (2) Identify an individual, or individuals, who have responsibility for maintaining

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security procedures for confidential health care information;

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     (3) Provide a written statement to each employee or agent as to the necessity of

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maintaining the security and confidentiality of confidential health care information, and of the

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penalties provided for in this chapter for the unauthorized release, use, or disclosure of this

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information. The receipt of that statement shall be acknowledged by the employee or agent, who

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signs and returns the statement to his or her employer or principal, who retains the signed

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original. The employee or agent shall be furnished with a copy of the signed statement; and

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     (4) Take no disciplinary or punitive action against any employee or agent solely for

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bringing evidence of violation of this chapter to the attention of any person.

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     (d) Consent forms for the release or transfer of confidential health care information shall

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contain, or in the course of an application or claim for insurance be accompanied by a notice

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containing, the following information in a clear and conspicuous manner:

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     (1) A statement of the need for and proposed uses of that information;

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     (2) A statement that all information is to be released or clearly indicating the extent of the

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information to be released; and

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     (3) A statement that the consent for release or transfer of information may be withdrawn

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at any future time and is subject to revocation, except where an authorization is executed in

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connection with an application for a life or health insurance policy in which case the

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authorization expires two (2) years from the issue date of the insurance policy, and when signed

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in connection with a claim for benefits under any insurance policy, the authorization shall be

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valid during the pendency of that claim. Any revocation shall be transmitted in writing.

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     (e) Except as specifically provided by law, an individual's confidential health care

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information shall not be given, sold, transferred, or in any way relayed to any other person not

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specified in the consent form or notice meeting the requirements of subsection (d) of this section

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without first obtaining the individual's additional written consent on a form stating the need for

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the proposed new use of this information or the need for its transfer to another person.

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     (f) Nothing contained in this chapter shall be construed to limit the permitted disclosure

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of confidential health care information and communications described in subsection (b) of this

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section.

 

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     SECTION 3. This act shall take effect upon passage.

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LC001121

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING

***

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     This act would amend the current law so that, as part of a comprehensive discharge plan,

2

a hospital or an emergency care facility would be allowed to attempt to contact the patient's

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emergency contact and the certified peer recovery specialist, in accordance with federal law.

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     This act would take effect upon passage.

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