HHS Clarifies Medical Info Release

March 17, 2006 (PLANSPONSOR.com) - Federal officials have clarified the circumstances under which health plans can legitimately give out medical information to people who call on the patient's behalf.

The new release from the US Department of Health and Human Services (HHS) focuses on releasing protected health information (PHI) under the medical information privacy dictates of the Health Insurance Portability And Accountability Act (HIPAA).  

The HHS document said that plans may share with the beneficiary’s “family member, relative or close personal friend” PHI “directly relevant to that person’s involvement with the individual’s care or payment for care.” Other people also
may receive PHI “provided the covered entity has reasonable assurance that the person has been identified by the individual as being involved in his or her care or payment.”

For example, according to HHS, a health plan may disclose relevant PHI to a human resources representative of the beneficiary’s employer who calls the plan with the beneficiary on the line; or turns the phone over to the beneficiary, “who could then confirm for the plan that the representative calling is assisting the beneficiary.”

In other examples cited by HHS, a plan may disclose relevant PHI to the adult child of a hospitalized, elderly beneficiary to resolve a claims issue, or to a congressional office that forwards the beneficiary’s letter or e-mail requesting its assistance. HHS also addressed the implementation of Medicare’s Part D prescription drug benefit by allowing Part D plans to disclose relevant PHI to staff of the Centers for Medicare and Medicaid Services who are helping Part D beneficiaries, if the staffer can “reasonably satisfy the plan that the individual has requested” his or her assistance.

The new HHS information is  here . More information about HIPAA is  here .