Section R9-22-512. Release of Safeguarded Information

A.      The Administration, contractors, providers, and noncontract- ing providers shall limit the release of safeguarded information to persons or agencies for the following purposes in accor- dance with 45 CFR 160 and 45 CFR 164, October 1, 2004, and 42 CFR 431.300 through 431.307, October 1, 2004, incorpo- rated by reference, on file with the Administration and avail- able from the U.S. Government Printing Office, 732 N. Capitol St., N.W., Washington, D.C. 20401. This incorporation by reference contains no future editions or amendments:

1.        Official purposes directly related to the administration of the AHCCCS program including:

a.         Establishing eligibility and post-eligibility treatment of income, as applicable;

b.        Determining the amount of medical assistance;

c.         Providing services for members;

d.        Performing evaluations and analysis of AHCCCS operations;

e.         Filing liens on property as applicable;

f.         Filing claims on estates, as applicable; and

g.        Filing, negotiating, and settling medical liens and claims.

2.        Law enforcement. The Administration may release safe- guarded information without the applicant’s or member’s

written or verbal consent, for the purpose of conducting or assisting an investigation, prosecution, or criminal or civil proceeding related to the administration of the AHC- CCS program.

3.        The Administration may release safeguarded member information to a review committee in accordance with the provisions of A.R.S. § 36-2917, without the consent of the applicant or member.

B.       Except as provided in subsection (A), the Administration, con- tractors, providers, and noncontracting providers shall disclose safeguarded information only to:

1.        An applicant;

2.        A member;

3.        An unemancipated minor, with written permission of a parent, custodial relative, or designated representative, if:

a.         An Administration employee, authorized representa- tive, or responsible caseworker is present during the examination of the safeguarded information; or

b.        After written notification to the provider, and at a reasonable time and place.

4.        Persons authorized by the applicant or member; or

5.        A court order or subpoena compliant with 45 CFR 164.512(e), October 1, 2004, incorporated by reference, on file with the Administration and available from the

U.S. Government Printing Office, 732 N. Capitol St., N.W., Washington, D.C. 20401. This incorporation by reference contains no future editions or amendments.

C.      The Administration, contractors, providers, and noncontract- ing providers shall safeguard identifiable information, pro- tected health information as specified in 45 CFR 160, and information obtained in the course of application for or rede- termination of eligibility concerning an applicant or member, that includes, but is not limited to the following:

1.        Name and address;

2.        Social Security number;

3.        Social and economic conditions or circumstances;

4.        Agency evaluation of personal information;

5.        Medical data and information concerning medical ser- vices received, including diagnosis and history of disease or disability;

6.        State Data Exchange (SDX) tapes, and other types of information received from outside sources for the pur- pose of verifying income eligibility and amount of medi- cal assistance payments; and

7.        Any information received in connection with the identifi- cation of legally liable third-party resources.

D.      The restriction upon disclosure of information in this Section does not apply to:

1.        De-identified information as described by 45 CFR 164.514, October 1, 2004, incorporated by reference in subsection (A); or

2.        A disclosure, in response to a request for information, that complies with 45 CFR 160 and 45 CFR 164, October 1, 2004, and 42 CFR 431.300 through 431.307, October 1, 2004, incorporated by reference in subsection (A).

E.       A provider shall furnish records requested by the Administra- tion or a contractor to the Administration or the contractor at no charge.

Historical Note

Adopted as an emergency effective May 20, 1982, pursu- ant to A.R.S. § 41-1003, valid for only 90 days (Supp. 82- 3). Former Section R9-22-512 adopted as an emergency adopted, amended and renumbered as Section R9-22-511, former Section R9-22-513 adopted as an emergency now adopted and renumbered as Section R9-22-512 as a per- manent rule effective August 30, 1982 (Supp. 82-4). For-

mer Section R9-22-512 repealed, new Section R9-22-512 adopted effective October 1, 1985 (Supp. 85-5).

Amended effective December 13, 1993 (Supp. 93-4).

Amended effective December 8, 1997 (Supp. 97-4). Amended by final rulemaking at 11 A.A.R. 4277, effec- tive December 5, 2005 (Supp. 05-4). Amended by final

rulemaking at 14 A.A.R. 4330, effective January 3, 2009

(Supp. 08-4).