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Confidential information must be protected and can only be released as allowed by Federal and State laws, regulations, and administrative policy. The following policies apply to AHCCCS customers as well as people who are not applying for benefits, but their information is gathered by AHCCCS for any reason.
There are two main legal authorities for AHCCCS Medical Assistance confidentiality policy:
Title XIX of the Social Security Act restricts the release of confidential information about Medicaid customers for purposes of administering the Medicaid program.
The Health Insurance Portability and Accountability Act (HIPAA) sets privacy and security standards that apply to health care facilities, providers and insurers, including AHCCCS.
NOTE Both Title XIX and HIPAA may apply to a situation. When this happens, the stricter of the two is applied.
Protected health information (PHI) should never be included in HEAPlus case notes. For more information, see Safeguarding Confidential Information for details on protecting, requesting and releasing confidential customer information.
The following information is considered confidential:
Names, addresses, ZIP Codes, phone numbers, dates of birth, and Social Security numbers;
Social and economic circumstances;
Agency evaluations of personal information;
Protected health information (PHI), including diagnosis and history of disease or disability and Pre-Admission Screening (PAS);
Information received from electronic data matches, including reports from Federal and State systems;
Information received from other sources, such as the Arizona Department of Economic Security, Social Security Administration, or private-sector employers;
Information received when identifying legally liable third-party sources;
Information related to alcohol or drug abuse, communicable disease, Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), mental health, developmental disability, or genetic testing; and
Non-confidential information does not need to be safeguarded. When information cannot be used to identify a specific person, it is not confidential.
If there is any doubt whether information should be treated as confidential, submit a policy clarification request.
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Term |
Definition |
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Communicable Disease |
A contagious, epidemic or infectious disease that must be reported to the local board of health or health department. |
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Developmental Disability |
A severe, chronic condition caused by cognitive disability, cerebral palsy, epilepsy, or autism that is manifested before the age of eighteen. |
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Pre-Admission Screening (PAS) |
A screening tool used to assess a customer’s medical need for long-term care services and is at immediate risk of institutionalization in a nursing facility. |
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Protected Health Information (PHI) |
Health and demographic information about a person created or received by a health plan, health care provider, employer, or health care clearinghouse. Any information that relates to a person's health, health care services received, or payment for health care. This includes PAS information. |
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Programs |
Legal Authority |
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All Programs |
42 U.S.C. 1396a(a)(7) 42 CFR 431.300 through 307 45 CFR, Part 160 and Part 164 AAC R9-22-512 |