C Release of Confidential Information

Revised 10/04/2022

Policy

The policy in this section focuses on the release of confidential information and covers three main areas:

Releasing confidential information for official purposes;
Authorization to release confidential information; and
Additional protections for certain medical information.

When you receive a request for confidential information, see Handling Requests for Information.

1) Releasing confidential information for official purposes

Certain medical records have specific protection under Federal or State law and may only be released under specific conditions as described in section 3. Other confidential information may be released to any of the following without specific written authorization, but only when the information will be used for official purposes:

Other areas of the AHCCCS Administration;
Arizona Department of Economic Security (DES);
Arizona Department of Health Services (DHS);
The State of Arizona Attorney General’s Office;
Federal agencies, such as the U.S. Department of Health and Human Services and the Social Security Administration, related to the administration of AHCCCS programs;
AHCCCS program contractors and subcontractors, including case managers;
Health care professionals;
Law enforcement officials, when related to the administration of AHCCCS programs; and
Health Management Systems (HMS), the agency’s contractor for third-party recoveries, including special treatment trusts and estate recovery.

Requests for information from the media, public interest groups, advocate groups, and requests from the legal community in the form of subpoenas and bankruptcy documents are handled by the Office of the General Counsel. These documents are time sensitive and are treated differently from customer requests.

2) Authorization to release confidential information

In general, the following people may review and request copies of information in the customer’s case file without written permission:

The customer, when a competent adult or emancipated minor;
The customer’s legal guardian; and
The custodial parent or legal guardian of a minor customer.

Unless the release of information is for official purposes, all others require written authorization to receive information from the customer’s case. When written authorization is needed, one of the people listed above may authorize AHCCCS to release information. The written authorization must be signed, separate from any other document, and must specify all of the following:

The information that AHCCCS is authorized to release from the case file;
To whom the release can be made; and
The period of time the authorization is valid. If no time is stated, the authorization is valid for one year from the date it is signed.

The following guidelines are used to determine who needs written authorization for each type of information:

Information Type	No written authorization needed for…	Written authorization needed for…
Non-Medical Records	An adult customer, when competent An emancipated minor child, when competent The customer’s legal guardian The custodial parent of a minor child customer The customer’s authorized representative A person with appropriate power of attorney (financial for non-medical information) The Well Woman HealthCheck program (WWHP) through the Arizona Department of Health when the customer has signed a BCCTP Patient Contact and Consent form (BC-102).	A minor child (from a custodial parent or guardian) The customer’s spouse The non-custodial parent of a minor child customer A stepparent A customer that has been determined incompetent The customer’s attorney The customer’s conservator Any other third party A foster parent (only needed when the foster parent does not have legal guardianship)
PAS Information	Same as non-medical information, except that the customer’s authorized representative must have written authorization.	Same as non-medical information above
Medical Records	Same as PAS information, except that the information may only be released when a request for a hearing based on medical eligibility or disability has been filed.	Same as PAS Information, except that the information may only be released when a request for a hearing based on medical eligibility or disability has been filed.

Generally, there is no charge to the customer or the customer’s representative for copying material from the case file. However, there may be a charge for costs when copying a large volume of documents.

An AHCCCS employee must be present any time a case file is viewed by an authorized person, to answer any questions and ensure that the case file is not altered.

3) Additional protections for certain medical information

Certain types of medical information may only be released under specific circumstances, as follows:

Type of Information	Policy
Alcohol or drug abuse information	Cannot be released without specific written consent from the person named in the information.
Communicable disease information	Cannot be released without specific written consent from the person named in the information.
Developmental disability (DD) information, including all records created in the course of providing services to DD customers	Cannot be released without written permission from the parent or guardian of a minor with a developmental disability, or the guardian of an adult with developmental disability. NOTE When no guardian has been appointed, a developmentally disabled adult may authorize the release of his or her own information.
Genetic testing information	Cannot be released without specific written consent from the person named in the information.
Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) information	Cannot be released without specific written consent from the person named in the information.
Mental health information	Cannot be released unless a mental health professional has interviewed the person undergoing treatment. The mental health professional must provide a written statement that releasing the information is in the patient’s best interest.

Definitions

Term	Definition
Authorized Representative	A person who may act on the customer’s behalf in the AHCCCS eligibility process. This person must be authorized by the customer, the customer’s legal representative, or a responsible relative of the customer.
Case File	The record of a customer’s applications for AHCCCS Medical Assistance and changes reported, and the resulting eligibility decisions. The case file includes all of the following related to the customer’s AHCCCS eligibility: Proof and information provided for an eligibility decision; Proof from electronic data sources recorded in the eligibility system; Information from other electronic data sources when used to determine eligibility; Supporting documents and information stored in a document imaging system; Notes created by eligibility staff to support decisions made and actions taken. Some electronic sources may generate information for the customer that is not used to determine eligibility. When the information is not used to determine eligibility and is stored in the customer’s record, it is not considered part of the case file. When a request is received for information from an electronic source that is not already in the customer’s HEAplus, OnBase or DocuWare file, submit a PCR.
Competent	Means capable of handling one’s own affairs. A person is considered competent unless a court has declared that the person is incompetent.
Conservator	A person appointed by a court to manage another person’s finances. A conservator is required by law to act in the best financial interest of the person whose finances he or she manages.
Custodial Parent	The parent or parents to whom the court has awarded legal custody of a minor child.
Emancipated Minor	A minor who meets at least one of these conditions: Has married or divorced; Has enlisted in military service; or Has been declared emancipated by court order.
Foster Parent	Any person licensed by the Department of Economic Security (DES) or an Arizona tribe to provide out-of-home care for a foster child
Incompetent	Means legally declared incapable of pursuing one’s own interests and for whom a legal guardian has been appointed.
Legal Guardian	A person who has been appointed by a court to act as a representative for an incompetent person, as well as to manage their property and rights. NOTE This does not include a conservator.
Non-Medical Information	All confidential information in the customer’s case file other than medical records.
Official Purposes	Means directly related to administering an AHCCCS program, including the following actions: Determining eligibility; Determining the amount of medical assistance; Providing services; Conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the AHCCCS program; Evaluating and analyzing AHCCCS operations; and Recovering AHCCCS costs.
Power of Attorney	A written authorization to act on behalf of another person. The authority given can be as broad or as narrow as the person chooses.

Legal Authority

Programs

Legal Authority

All programs

42 CFR 431.300 through 307

45 CFR, Part 160, and Part 164 (subparts A and E)

AAC R9-22-512