Revision 15-4; Effective October 1, 2015

 

 

B—1210 Disclosure of Information

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must disclose information to applicants or individuals who want to review their case records for information used in the eligibility determination. Advisors must 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 or status of pending criminal prosecution.

TANF and Medical Programs

Advisors must disclose information about applicants or individuals to federal, state, or local agencies, if the information is directly connected with:

  • administration of a program approved under any of the following titles of the Social Security Act:
    • Title IV-A (Temporary Assistance for Needy Families [TANF]/Choices)
    • Title IV-B (Child Protective Services [CPS])
    • Title IV-D (Child Support)
    • Title IV-E (Foster Care and Adoption Assistance)
    • Title XVI (Supplemental Security Income [SSI])
    • Title XIX (Medicaid)
    • Title XX (Social Services/Child Care)

Disclosure of information is permitted for any case audits, reviews of expenditure reports, financial reviews, investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of these programs.

  • administration of any other federal or federally assisted program that provides assistance directly to individuals on the basis of need.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

Advisors must disclose information about applicants or individuals to Medicaid providers or their contractors that is needed for the providers to submit claims for reimbursement of Medicaid services provided to individuals. See the list of releasable data items in B-1230, Releasable Information for Medicaid Providers and Their Contractors.

SNAP

Advisors must disclose information about applicants or individuals to persons or agencies directly connected to the administration or enforcement of:

  • the Supplemental Nutrition Assistance Program (SNAP);
  • food distribution programs for households on Indian reservations; or
  • other federal assistance programs or federally aided programs that base assistance on an individual's income and resources.

    Such programs include, but are not limited to: Women, Infants, and Children (WIC); TANF; Medicaid; Child Protective Services; and SSI.

Advisors must disclose information about applicants or individuals to employees of the U.S. Comptroller General's Office for audit purposes.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

 

B—1211 Reporting Abuse and Neglect

Revision 15-4; Effective October 1, 2015  

All Programs

Policies on confidentiality do not prohibit reporting abuse or neglect that threatens the health or welfare of a child or an elderly adult or adult with disabilities. Advisors must report instances of suspected:

  • physical or mental injury,
  • sexual abuse,
  • exploitation, and
  • neglect.

Exception: Advisors are not required to report family violence.

Advisors must inform adults or their personal representative (PR) when reporting abuse or neglect of an adult, unless the advisor believes that informing the individual or PR would place the individual at risk of serious harm.

 

B—1212 Personal Representatives

Revision 15-4; Effective October 1, 2015  

All Programs

Only the individual's PR can exercise the individual's rights with respect to individually identifiable health information. Therefore, only an individual's PR may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual. Individually identifiable health information is information that identifies or could be used to identify an individual and that relates to the:

  • past, present, or future physical or mental health or condition of the individual;
  • provision of health care to the individual; or
  • past, present, or future payment for the provision of health care to the individual.

Note: An authorized representative (AR) is not automatically a PR.

 

B—1212.1 Adults and Emancipated Minors

Revision 15-4; Effective October 1, 2015  

All Programs

If the individual is an adult or emancipated minor, including married minors, the individual's personal representative is a person who has the authority to make health care decisions about the individual and includes a:

  • person the individual has appointed under a medical power of attorney, a durable power of attorney with the authority to make health care decisions, or a power of attorney with the authority to make health care decisions;
  • court-appointed guardian for the individual; or
  • person designated by law to make health care decisions when the individual is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication. Advisors follow regional procedures to contact the regional attorney for approval.

 

B—1212.2 Unemancipated Minors

Revision 15-4; Effective October 1, 2015  

All Programs

A parent is the personal representative for a minor child except when:

  • the minor child can consent to medical treatment by him or herself. Under these circumstances, do not disclose to a parent information about the medical treatment to which the minor child can consent. A minor child may consent to medical treatment by him or herself when the:
    • minor is on active duty with the US military;
    • minor is age 16 or older, lives separately from the parents and manages his own financial affairs;
    • consent involves diagnosis and treatment of disease that must be reported to the local health officer or the Texas Department of State Health Services;
    • minor is unmarried and pregnant and the treatment (other than abortion) relates to the pregnancy;
    • minor is age 16 or older and the consent involves examination and treatment for drug or chemical addiction, dependency or use at a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • consent involves examination and treatment for drug or chemical addiction, dependency or use by a physician or counselor at a location other than a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • minor is unmarried, is the parent of a child, has actual custody of the child and consents to treatment for the child; or
    • consent involves suicide prevention or sexual, physical or emotional abuse.
  • a court is making health care decisions for the minor child or has given the authority to make health care decisions for the minor child to an adult other than a parent or to the minor child. Under these circumstances, the advisor must not disclose to a parent information about the health care decisions not made by the parent.

 

B—1212.3 Deceased Individuals

Revision 15-4; Effective October 1, 2015  

All Programs

The PR for a deceased individual is an executor, administrator, or other person with authority to act on behalf of the individual or the individual's estate. These individuals include:

  • an executor, including an independent executor;
  • an administrator, including a temporary administrator;
  • a surviving spouse;
  • a child;
  • a parent; and
  • an heir.

Advisors may consult the regional attorney with questions about whether a particular person is the PR of an applicant or individual.

 

B—1213 Establishing Identity for Contact Outside the Interview Process

Revision 15-4; Effective October 1, 2015  

All Programs

All information the Texas Health and Human Services Commission (HHSC) has about an individual or any person on the individual's case must be kept confidential. Confidential information includes, but is not limited to, individually identifiable health information.

Before discussing or releasing information about an individual or any person on the individual's case, steps must be taken to reasonably ensure that the person receiving the confidential information is either the individual or a person the individual authorized to receive confidential information (such as an attorney or personal representative).

Related Policy
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.1 Telephone Contact

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must establish a person's identity when contacting the individual, AR or PR by telephone. Refer to A-2020, Authenticating a Caller, for identity authentication policy.

Advisors must establish the identity of attorneys or legal representatives by asking the individual to provide Form H1826, Case Information Release, completed and signed by the individual. Advisors refer to B-1220, Specific Information That May Be Released, for authorization requirements.

Establish the identity of legislators or their staff by following regional procedures.

Related Policy
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.2 In-Person Contact

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must establish the identity of a person who presents himself as an individual or individual's representative at a local eligibility determination office by:

  • driver's license,
  • date of birth,
  • Social Security number (SSN), or
  • other identifying information.

Advisors must establish the identity of other staff, federal agency staff, researchers, or contractors by:

  • employee badge, or
  • government-issued identification card with a photograph.

Advisors must identify the need for other staff, federal staff, research staff, or contractors to access confidential information through:

  • official correspondence or phone call from state or regional offices, or
  • contact with a regional attorney.

Advisors must contact appropriate regional or state office staff when federal agency staff, contractors, researchers, or other staff, etc., come to the office without prior notification or adequate identification and request permission to access HHSC records.

 

B—1220 Specific Information That May Be Released

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must give individual addresses or other case information only to a person who has written permission from the individual to obtain the information. The individual authorizes the release of information by completing and signing:

  • Form H1826, Case Information Release; or
  • a document containing all of the following information:
    • the applicant/individual'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, the advisor must provide the information that can be disclosed to the individual described in B-1210, Disclosure of Information, under All Programs.

    • statement specifically authorizing HHSC to release the information;
    • the name of the person or agency to whom the information will be released;
    • purpose of the release;
    • an expiration event that is related to the individual, 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 individual's right to revoke the authorization to release information;
    • the date the document is signed; and
    • the signature of the applicant or individual.

      If the case information being released includes individually identifiable health information, the document must also inform the applicant or individual that the information released under the document may no longer be private and may be further released by the person receiving the information.

Note: Advisors must not include Form H1826 or other information release authorization documents in application packets.

Advisors must give information to government agencies conducting case audits, reviewing expenditure reports, or conducting financial reviews.

Advisors must give an applicant or individual's most recent address and place of employment to Parent Locator services in state or local offices.

Advisors must refer all requests from federal, state, or local law enforcement officials for case information to the local investigation division office.

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 agency records must be limited to the minimum necessary to accomplish the requested disclosure. For example, if an individual authorizes release of income verification, including disability income, related case medical information must not be released unless specifically authorized by the individual.

TANF and Medical Programs

Advisors must release identifying information (such as the name and address of the individual's friends and relatives) to funeral homes, police, or agencies attempting to locate friends or relatives of deceased individuals.

Advisors reply to inquiries and complaints concerning the status of an individual's case from public officials or interested citizens who are acting as an agent for and have the consent of the individual. The case status includes whether an application was filed, action taken by HHSC and the reason for the agency's action.

Advisors provide only the specific information stated in a summons on an Internal Revenue Service (IRS) Form 2039 to the IRS representative.

Advisors provide only the following information to the Armed Forces:

  • whether an individual is receiving TANF, and
  • the amount of the TANF grant.

Advisors provide only the information in B-1230, Releasable Information for Medicaid Providers and Their Contractors, to Medicaid providers and their contractors. Note: Advisors must verify the contract with the Medicaid provider by obtaining:

  • the contract with the provider, or
  • a written document from the provider confirming the contract.

SNAP

Advisors release the names and addresses of participating individuals to persons or agencies directly connected with nutrition education.

 

B—1230 Releasable Information for Medicaid Providers and Their Contractors

Revision 15-4; Effective October 1, 2015  

All Programs

 

Applicant Data
  • Name
  • SSN*
  • Social Security Claim Number (SSCN or PCN)*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Category Code
  • Application Number
  • Application Disposition Date
  • Application Status
  • Client Number
Client Data
  • Name
  • Client Number
  • SSN*
  • SSCN*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Certification Date
  • Claims Administrator Update Date (Ins Sub Date)
  • Last Medical Update Date
  • Code for Type Change in Medical Coverage
  • Medicaid:
    • Open Date
    • Close Date
    • Type Coverage
    • Category
    • Type Program
    • Qualified Medicare Beneficiary (QMB) Indicator, if applicable
    • Medically Needy Indicator, if applicable
    • Client Medical Record
    • Case Numbers (active)
  • Third-Party Resource (TPR) Policy Occurs (most recent three):
    • Ins. Policy Number
    • Ins. Policy Sequence
    • Ins. Information Status
    • Type Coverage
    • Company Number
    • Group Number
    • Ins. Begin Date
    • Ins. End Date
    • Ins. Policy Holder
    • Ins. Employer
  • Medicare (Yes or No)
  • THSteps Data:
    • THSteps Decision Date
    • Dental Treatment Date
    • Medical Screen Date
  • Lock-in Data (most recent six):
    • Provider Type
    • Provider Name
    • Start Date
    • Through Date
Public Assistance (PA) Case Data
  • Case Number
  • Eligibility Determination Group (EDG) Number
  • Case Name
  • Case Status
  • Three Month Prior Date
  • End Date (For Medically Needy)
  • Denial Reasons **
  • Type Program
  • Active Clients List:
    • Client Number
    • Name
    • Date of Birth
    • Sex
  • Three Months Prior with Spend Down (not the spend down amount)

 

* Advisors must confirm that the number given by the requestor is correct. Advisors do not release Social Security numbers.

** Only the following denial reasons can be released:

Reason
Refusal to furnish information
Failure to furnish information
Appointment not kept (application/review)
Unable to locate
Voluntary withdrawal

 

B—1240 Preventing Disclosure of Information

Revision 15-4; Effective October 1, 2015  

All Programs

If the advisor receives a request for information which cannot be released, the advisor must inform the person requesting the information about the confidentiality of case records based on federal and state laws.

If the advisor receives a subpoena to appear in court with an individual's record, the advisor must notify the supervisor about the hearing. The advisor must take the case record and appear in court. When asked to disclose information from the case record, the advisor must ask the judge to be excused from disclosing information because of the laws concerning confidentiality. The advisor must abide by the judge's ruling.

See Part I, Section 3000, Health Insurance Portability and Accountability (HIPPA), in the Texas Department of Aging and Disability Services Operational Handbook for more information on disclosure of information laws.

 

B—1241 Destruction of Confidential Material

Revision 07-3; Effective July 1, 2007  

Confidential material that includes identifying information such as name, address or Social Security number must be disposed of according to local office procedures.

 

B—1250 Reporting Unauthorized Inspection or Disclosure of Social Security Administration (SSA)-Provided Information

Revision 14-4; Effective October 1, 2014  

All Programs

Staff who become aware of an incident of unauthorized access to or disclosure of restricted information (i.e., IRS Federal Tax Information and verified SSA information) or confidential information must immediately contact the HHSC IRS coordinator by sending a secure email to HHSC IRS_FTI_Safeguards@hhsc.state.tx.us.

The HHSC IRS coordinator will report the incident by contacting the information security officer (ISO).

If a person is responsible for a security breach or a person’s employment is terminated, the user's access to all information must be removed. Supervisors must follow agency procedures for removing access for employees, contractors, vendors or trainees.

Related Policy
Reporting a Security Incident Regarding Internal Revenue Service (IRS) Federal Tax Information (FTI), C-1060

 

B—1260 Verification Requirements

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must verify the identity of the person who contacts the advisor with a request to disclose individually identifiable health information, using sources found in A-621, Verification Sources. In addition, Form H1826, Case Information Release, presented by a legal representative or with an employee badge, may be used to identify the person.

 

B—1270 Documentation Requirements

Revision 15-4; Effective October 1, 2015  

All Programs

If disclosing individually identifiable health information, the advisor must document how the identity of the person was verified when contact occurs outside of the interview.

Advisors must document:

  • the name of the personal representative (see B-1212, Personal Representatives);
  • the reason why a parent is not considered a PR for an unemancipated minor (see B-1212.2, Unemancipated Minors);
  • that the inquiring agency will agree to keep information confidential; and
  • that the information is limited to the purpose of the disclosure.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide