Data Privacy

Compliance

The MCO and State must be in compliance with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPPA).

The States makes available and/or transfers to the MCO certain protected health information (PHI) in connection with the provision of services provided by the MCO on behalf of the State. PHI is considered to be confidential and must be afforded special treatment and protection.

The MCO is permitted to exchange private and confidential data and protected health information (PHI) with a local agency that administers MHCP. The dissemination of private and confidential data and PHI will be limited to that which is necessary to accomplish the task pursuant to Minnesota Statutes, §13.05, subd. 3, and 45 CFR §164.502(b)

Privacy Rights Statement

The Privacy Rights Statement also referred to as the Tennessen Notice or Privacy Act Notice, is included on all program application forms.

The Tennessen notice contains an explanation of the five elements listed in Section 11.03 (Confidential Data) of this Policy Manual and must be provided to individuals who are asked to provide private or confidential information about themselves.

Confidential Data

Within the public assistance system, data confidential by law are:

· Adoption records.

· Certain licensing records.

· The name of persons reporting child abuse and vulnerable adult abuse.

· In exceptional cases only, data that supply the basis for the diagnosis of the medical or psychiatric condition of an individual, as determined by a licensed physician.

· Investigations of client fraud or other wrongdoing.

All data classified as confidential are closed to the public except for program staff responsible for collecting such information, those whose work assignments require access, and others who are specifically authorized by law or court order to have access. The access restriction also applies to the individual for whom the data is maintained; the data subject may not authorize release of confidential data.

Enrollee Eligibility Verification

State and Federal Government Data Practices Acts permit local agencies to verify enrollee eligibility to medical providers.

The Eligibility Verification System (EVS) is a communication system that links a provider with the MMIS eligibility file via telephone. The phone number is 651/431-4399 or 800/657-3613. The primary focus of EVS is to supply information and verification about the eligibility of a recipient for a particular service or procedure on a specified date. Recipient eligibility information has been selected to provide as much information as possible, within the constraints of the Data Privacy Laws of Minnesota.

Through telephone EVS, DHS has the ability to prerecord a message for broadcast to all providers who call the system. All providers hear broadcast messages. These messages may involve policy, reimbursement or technical issues. The EVS system also allows providers access to information regarding their most recent reimbursement, warrant date and number.

Release of Information

Under the following circumstances, a release of information should be obtained from the enrollee for:

· The MCO to contact county social workers.

· The county or the Department ombudsman to contact providers or other persons outside the public assistance system on the enrollee’s behalf