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MA 300 & 3500
Medicaid Confidentiality
| Question | Answer |
|---|---|
| What governing body mandates that it is unlawful for any person to obtain or disclose information about individuals applying for or receiving public assistance? | NC General Statutes |
| Under what circumstance is it acceptable to release information from the client's eligibility record? | Purposes directly connected with the administration of programs of public assistance. |
| What programs are included under this policy? | Work First, Special Assistance, FNS, Medicaid, and Foster Care & Adoption Payment Services |
| What are the purposes directly related to the administration of these programs? | Establishing eligibility, determining the amount of assistance, providing services to clients (including transportation), and conducting an investigation |
| What information is Not considered to be confidential? | Information that does not identify a specific client. For example: statistical information, general information about covered services, or written policies. |
| Who is a Client? | "Client" means any applicant for, or recipient of Medicaid, or someone who makes inquiries, is interviewed, or has been otherwise served. |
| What is Client Information or Client Record? | "Client information" or "Client record" means any information, including information stored in computer data banks or computer files, relating to the Medicaid eligibility in the Medicaid eligibility case record. |
| What is a Court Order? | "Court order" for purposes of confidentiality, means any written order signed by a judge that explicitly directs the release of client information from the Medicaid eligibility case files. |
| What is the difference between a Representative and Authorized Representative? | A representative acts on behalf of the applicant/recipient (AR). An Authorized Representative is an individual legally authorized or designated in writing by the AR to act on their behalf. |
| Who owns Client Records? | All client files are the property of the county social services agency, and employees of the agency must safeguard the confidentiality of the information in the files. |
| Does the client have the right to view their records? | Yes. They may view and / or obtain a copy of the record free of charge. |
| Who must be present when the client reviews their records? | The agency director or their designee. |
| What information cannot be viewed by clients? | Information received from third party that is marked "Confidential". Documents and / or records from ESC, SSA, SOLQ, or OLV. |
| What should you do if a client contests the accuracy of the record? | If the county concurs, insert the corrected information and do not delete the old. If the county does not concur, allow the AR to enter a statement into the record. |
| Clients cannot be required to sign a blank Consent of Release. What information should be included on a complete release form? | Name of the person, provider or agency to whom the information is being released, of information to be released, signature of AR and date, a statement that the consent is subject to revocation at any time, and length of time the consent is valid. |
| With whom is it acceptable to share client information? | DSS employes of this or another county or state, auditors connected with monitoring DSS files, courts when there is a subpoena, and other states for matching purposes. |
| With whom is it permissible to release information to outside sources without a consent? | Medicaid enrolled providers, Referral for Medicaid to providers of inpatient care, Health Check and Community Care Coordinators, SSA / SSI, agencies with agreements, |
| What information can be released to Medicaid Enrolled Providers? | Medicaid ID number and Prior Approval information |
| Under what circumstances can information be released to a school? | If they are enrolled as a Medicaid provider. |
| What form serves as a referral for Medicaid? | DHB 5020 Notice of Case Status |
| Under what circumstances does the DHB 5020 Not require a signature? | Automatic Newborns and d to verify dates of authorization for an individual who is already authorized for Medicaid. |
| Is it acceptable to release information to WIC agencies? | No. Caseworkers must explain the WIC program and make a referral for women who are pregnant, breastfeeding or within 6 months of postpartum, or who have children under the age of 5. |
| When is it acceptable to release information to law enforcement? | When under a subpoena signed by a judge. |
| Where is the Release of Information Without Consent Chart located? | MA 300 VIII |
Created by:
SurryDSS
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