REFERENCE TITLE: health information; disclosures; prohibition
State of Arizona
First Regular Session
Amending sections 36-568.01, 36-664 and 36-3805, Arizona Revised Statutes; amending title 36, chapter 38, article 1, Arizona Revised Statutes, by adding section 36-3807; relating to health information organizations.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section  1. Section 36-568.01, Arizona Revised Statutes, is amended to read:
START_STATUTE36-568.01. Confidentiality of records
A. All information obtained and records prepared in the course of providing any services under this chapter to clients shall be confidential and privileged matter. Such information and records may be disclosed only as authorized by state or federal law, including the health insurance portability and accountability act privacy standards (45 Code of Federal Regulations part 160 and part 164, subpart E), or pursuant to the following:
1. When the responsible person designates in writing persons to whom records or information may be disclosed.
2. To the extent necessary to make claims on behalf of a client for aid, insurance or medical assistance to which he the client may be entitled.
3. Pursuant to a court order.
4. In communications between professional persons in the providing of services or appropriate referrals.
5. When such a disclosure is necessary to protect against a clear and substantial risk of imminent serious injury.
6. To the superior court when a petition to establish guardianship for the person is filed pursuant to the provisions of title 14, chapter 5.
7. To other state agencies or bodies for official purposes. and In such cases, information or records shall be released without the designation of the name of the client, unless such the name is required for the official purposes of state agencies or bodies requesting such information. Such case information received by a state agency or body shall be maintained as confidential unless a consent to release has been given as provided in this section.
8. To a law enforcement agency or a county medical examiner in the performance of official duties, unless the records requested relate to a person who is the subject of a criminal investigation, in which case the records may only be released pursuant to a court order or grand jury subpoena.   A person shall maintain information provided to a law enforcement agency or a county medical examiner under this paragraph as confidential unless a consent to release has been given pursuant to this section or pursuant to a court order or grand jury subpoena.
B. The person to whom such information has been released pursuant to subsection A shall be of this section is prohibited from using or releasing such information except in the proper performance of his or her the person's duties or as otherwise authorized by state or federal law, including the health insurance portability and accountability act privacy standards (45 Code of Federal Regulations Part 160 and part 164, subpart  E). END_STATUTE
Sec.  2. Section 36-664, Arizona Revised Statutes, is amended to read:
START_STATUTE36-664. Confidentiality; exceptions
A. A person who obtains communicable disease related information in the course of providing a health service or obtains that information from a health care provider pursuant to an authorization shall not disclose or be compelled to disclose that information except as authorized by state or federal law, including the health insurance portability and accountability act privacy standards (45 Code of Federal Regulations part 160 and part 164, subpart E), or pursuant to the following:
1. The protected person or, if the protected person lacks capacity to consent, the protected person's health care decision maker.
2. A health care provider or first responder who has had an occupational significant exposure risk to the protected person's blood or bodily fluid if the health care provider or first responder provides a written request that documents the occurrence and information regarding the nature of the occupational significant exposure risk and the report is reviewed and confirmed by a health care provider who is both licensed pursuant to title 32, chapter 13, 15 or 17 and competent to determine a significant exposure risk. A health care provider who releases communicable disease information pursuant to this paragraph shall provide education and counseling to the person who has had the occupational significant exposure risk.
3. The department or a local health department for purposes of notifying a Good Samaritan pursuant to subsection E of this section.
4. An agent or employee of a health facility or health care provider to provide health services to the protected person or the protected person's child or for billing or reimbursement for health services.
5. A health facility or health care provider, in relation to the procurement, processing, distributing or use of a human body or a human body part, including organs, tissues, eyes, bones, arteries, blood, semen, milk or other body fluids, for use in medical education, research or therapy or for transplantation to another person.
6. A health facility or health care provider, or an organization, committee or individual designated by the health facility or health care provider, that is engaged in the review of professional practices, including the review of the quality, utilization or necessity of medical care, or an accreditation or oversight review organization responsible for the review of professional practices at a health facility or by a health care provider.
7. A private entity that accredits the health facility or health care provider and with whom the health facility or health care provider has an agreement requiring the agency to protect the confidentiality of patient information.
8. A federal, state, county or local health officer if disclosure is mandated by federal or state law.
9. A federal, state or local government agency authorized by law to receive the information. The agency is authorized to redisclose the information only pursuant to this article or as otherwise permitted by law.
10. An authorized employee or agent of a federal, state or local government agency that supervises or monitors the health care provider or health facility or administers the program under which the health service is provided.   An authorized employee or agent includes only an employee or agent who, in the ordinary course of business of the government agency, has access to records relating to the care or treatment of the protected person.
11. A person, health care provider or health facility to which disclosure is ordered by a court or administrative body pursuant to section 36-665.
12. The industrial commission of Arizona or parties to an industrial commission of Arizona claim pursuant to section 23-908, subsection D and section 23-1043.02.
13. Insurance entities pursuant to section 20-448.01 and third-party payors or the payors' contractors.
14. Any person or entity as authorized by the patient or the patient's health care decision maker.
15. A person or entity as required by federal law.
16. The legal representative of the entity holding the information in order to secure legal advice.
17. A person or entity for research only if the research is conducted pursuant to applicable federal or state laws and regulations governing research.
18. A person or entity that provides services to the patient's health care provider, as defined in section 12-2291, and with whom the health care provider has a business associate agreement that requires the person or entity to protect the confidentiality of patient information as required by the health insurance portability and accountability act privacy standards (45 Code of Federal Regulations part 164, subpart E).
19. A county medical examiner or an alternate medical examiner directing an investigation into the circumstances surrounding a death pursuant to section 11-593.
B. At the request of the department of child safety or the department of economic security and in conjunction with the placement of children in foster care or for adoption or court-ordered placement, a health care provider shall disclose communicable disease information, including HIV-related information, to the department of child safety or the department of economic security.
C. A state, county or local health department or officer may disclose communicable disease related information if the disclosure is any of the following:
1. Specifically authorized or required by federal or state law.
2. Made pursuant to an authorization signed by the protected person or the protected person's health care decision maker.
3. Made to a contact of the protected person.   The disclosure shall be made without identifying the protected person.
4. For the purposes of research as authorized by state and federal law.
5. To a nonprofit health information organization as defined in section 36-3801 that is designated by the department as this state's official health information exchange organization.
D. The director may authorize the release of information that identifies the protected person to the national center for health statistics of the United States public health service for the purposes of conducting a search of the national death index.
E. The department or a local health department shall disclose communicable disease related information to a Good Samaritan who submits a request to the department or the local health department.   The request shall document the occurrence of the accident, fire or other life-threatening emergency and shall include information regarding the nature of the significant exposure risk.   The department shall adopt rules that prescribe standards of significant exposure risk based on the best available medical evidence. The department shall adopt rules that establish procedures for processing requests from Good Samaritans pursuant to this subsection. The rules shall provide that the disclosure to the Good Samaritan shall not reveal the protected person's name and shall be accompanied by a written statement that warns the Good Samaritan that the confidentiality of the information is protected by state law.
F. An authorization to release communicable disease related information shall be signed by the protected person or, if the protected person lacks capacity to consent, the protected person's health care decision maker.   An authorization shall be dated and shall specify to whom disclosure is authorized, the purpose for disclosure and the time period during which the release is effective. A general authorization for the release of medical or other information, including communicable disease related information, is not an authorization for the release of HIV-related information unless the authorization specifically indicates its purpose as an authorization for the release of confidential HIV-related information and complies with the requirements of this section.
G. A person to whom communicable disease related information is disclosed pursuant to this section shall not disclose the information to another person except as authorized by this section. This subsection does not apply to the protected person or a protected person's health care decision maker.
H. This section does not prohibit the listing of communicable disease related information, including acquired immune deficiency syndrome, HIV-related illness or HIV infection, in a certificate of death, autopsy report or other related document that is prepared pursuant to law to document the cause of death or that is prepared to release a body to a funeral director.   This section does not modify a law or rule relating to access to death certificates, autopsy reports or other related documents.
I. If a person in possession of HIV-related information reasonably believes that an identifiable third party is at risk of HIV infection, that person may report that risk to the department. The report shall be in writing and include the name and address of the identifiable third party and the name and address of the person making the report. The department shall contact the person at risk pursuant to rules adopted by the department. The department employee making the initial contact shall have expertise in counseling persons who have been exposed to or tested positive for HIV or acquired immune deficiency syndrome.
J. Except as otherwise provided pursuant to this article or subject to an order or search warrant issued pursuant to section 36-665, a person who receives HIV-related information in the course of providing a health service or pursuant to a release of HIV-related information shall not disclose that information to another person or legal entity or be compelled by subpoena, order, search warrant or other judicial process to disclose that information to another person or legal entity.
K. This section and sections 36-663, 36-666, 36-667 and 36-668 do not apply to persons or entities subject to regulation under title 20.END_STATUTE
Sec.  3. Section 36-3805, Arizona Revised Statutes, is amended to read:
START_STATUTE36-3805. Disclosure of individually identifiable health information; consent
A. Except as otherwise provided in state or federal law, disclosure of an individual's individually identifiable health information through a health information organization is allowed only if:
1. The individual has not opted out of having the individual's individually identifiable health information accessible through the health information organization.
2. The purpose of the disclosure is explained in the health information organization's current notice of health information practices.
3. The disclosure complies with the health insurance portability and accountability act privacy standard (45 Code of Federal Regulations part 164, subpart E).
B. A health information organization may not sell or otherwise make commercial use of an individual's individually identifiable health information without the written consent of the individual.
C. A health information organization may not transfer disclose individually identifiable health information or de-identified health information that is accessible through the health information exchange to any person or entity for the purpose of research or using the information for use as part of a set of data for an application for grant or other research funding, unless the health care provider obtains consent from the individual for the transfer. A health care provider must document that it has provided a notice of transfer to the individual and that the individual has received and read and understands the notice.   Documentation must be in the form of a signature by the individual indicating the individual has received and read and understands the notice and that the individual gives consent to the transfer of information. For the purposes of this subsection, "consent" means that a health care provider participating in a health information organization has provided a notice to the individual that is in at least twelve-point type and that describes the purposes of the transfer the disclosure complies with applicable state or federal laws or rules or regulations adopted pursuant to those laws that regulate the use of individually identifiable health information or de-identified health