Revision 11-4; Effective December 1, 2011

 

Notes:

  • See Section C-4000, Confidential Nature of Medical Information, for restrictions on the release of an applicant's/recipient's protected health information under Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.
  • Reasonable efforts must be made to limit the use, request or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of individual medical information from HHSC records must be limited to the minimum necessary to accomplish the requested disclosure. Example: If an applicant/recipient authorizes release of income verification, including disability income, do not release related case medical information unless specifically authorized by the applicant/recipient.

Certain information about applicants/recipients may be disclosed provided that no indication exists that the information can be used against the applicant/recipient:

  • Identifying information may be released to funeral homes, police departments or other agencies attempting to locate friends or relatives of deceased applicants/recipients.
  • Replies to inquiries and complaints, written or oral, from public officials or interested citizens about a decision by HHSC affecting a specific applicant/recipient may include general information about that applicant/recipient. In this event, the reply may give the status of the case (that is, whether an application has been filed, the action taken by HHSC and the reason for the action). This information may be released on the basis of a reasonable assumption that the interested person is acting as an agent for, and with the knowledge and consent of, the applicant/recipient.
  • HHSC staff may not respond to inquiries from relatives or friends for addresses of applicants/recipients unless the applicant/recipient gives his/her permission. HHSC informs the applicant/recipient about the inquiry and leaves the decision to him/her.
  • Information may be given to Medicaid providers to assist them in filing claims for payment.

Give applicant/recipient addresses or other case information only to a person who has written permission from the applicant/recipient to obtain the information. The applicant/recipient authorizes the release of information by completing and signing:

  • Form H1003, Appointment of an Authorized Representative; or
  • A document containing all of the following information:
    • the applicant's or recipient's full name (including middle initial) and case number, or full name (including middle initial) and either the date of birth or Social Security number;
    • a description of the information to be released (Note: If a general release is authorized, provide the information that can be disclosed to the applicant/recipient. Withhold confidential information from the case record, such as names of persons who disclosed information about the household without the household's knowledge, and the nature of pending criminal prosecution.);
    • statement specifically authorizing HHSC to release the information;
    • the name of the person or agency to whom the information will be released;
    • the purpose of the release;
    • an expiration event that is related to the applicant/recipient or the purpose of the release or an expiration date of the release;
    • statement about whether refusal to sign the release affects eligibility for or delivery of services;
    • a statement describing the applicant's or recipient's right to revoke the authorization to release information;
    • the date the document is signed; and
    • signature of the applicant or applicant/recipient.

Note: If the case information to be released includes individually identifiable health information, the document also must tell the applicant or recipient that information released under the document may no longer be private and may be released further by the person receiving the information.

Occasionally requests for information from the case records of deceased applicants/recipients are received. In these instances, also protect the confidentiality of the former applicants/recipients and their survivors. See Section C-5300, Deceased Individuals, for information about who can act on behalf of a deceased applicant/recipient regarding individually identifiable health information.

HHSC's Office of the General Counsel handles questions about the release of information under the Open Records Act. All questions and problems encountered by individuals concerning release of information should be referred to the Office of the General Counsel.