BILL REQ. #: H-3979.1
| State of Washington | 63rd Legislature | 2014 Regular Session |
READ FIRST TIME 02/05/14.
AN ACT Relating to disclosure of health care information; amending RCW 70.02.010, 70.02.020, 70.02.050, 70.02.200, 70.02.210, 70.02.230, 70.02.270, 70.02.280, 70.02.310, 70.02.340, 71.05.445, 70.02.030, and 70.02.045; providing an effective date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 70.02.010 and 2013 c 200 s 1 are each amended to read
as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Admission" has the same meaning as in RCW 71.05.020.
(2) "Audit" means an assessment, evaluation, determination, or
investigation of a health care provider by a person not employed by or
affiliated with the provider to determine compliance with:
(a) Statutory, regulatory, fiscal, medical, or scientific
standards;
(b) A private or public program of payments to a health care
provider; or
(c) Requirements for licensing, accreditation, or certification.
(3) "Commitment" has the same meaning as in RCW 71.05.020.
(4) "Custody" has the same meaning as in RCW 71.05.020.
(5) "Deidentified" means health information that does not identify
an individual and with respect to which there is no reasonable basis to
believe that the information can be used to identify an individual.
(6) "Department" means the department of social and health
services.
(7) "Designated mental health professional" has the same meaning as
in RCW 71.05.020 or 71.34.020, as applicable.
(8) "Detention" or "detain" has the same meaning as in RCW
71.05.020.
(9) "Directory information" means information disclosing the
presence, and for the purpose of identification, the name, location
within a health care facility, and the general health condition of a
particular patient who is a patient in a health care facility or who is
currently receiving emergency health care in a health care facility.
(10) "Discharge" has the same meaning as in RCW 71.05.020.
(11) "Evaluation and treatment facility" has the same meaning as in
RCW 71.05.020 or 71.34.020, as applicable.
(12) "Federal, state, or local law enforcement authorities" means
an officer of any agency or authority in the United States, a state, a
tribe, a territory, or a political subdivision of a state, a tribe, or
a territory who is empowered by law to: (a) Investigate or conduct an
official inquiry into a potential criminal violation of law; or (b)
prosecute or otherwise conduct a criminal proceeding arising from an
alleged violation of law.
(13) "General health condition" means the patient's health status
described in terms of "critical," "poor," "fair," "good," "excellent,"
or terms denoting similar conditions.
(14) "Health care" means any care, service, or procedure provided
by a health care provider:
(a) To diagnose, treat, or maintain a patient's physical or mental
condition; or
(b) That affects the structure or any function of the human body.
(15) "Health care facility" means a hospital, clinic, nursing home,
laboratory, office, or similar place where a health care provider
provides health care to patients.
(16) "Health care information" means any information, whether oral
or recorded in any form or medium, that identifies or can readily be
associated with the identity of a patient and directly relates to the
patient's health care, including a patient's deoxyribonucleic acid and
identified sequence of chemical base pairs. The term includes any
required accounting of disclosures of health care information.
(17) "Health care operations" means any of the following activities
of a health care provider, health care facility, or third-party payor
to the extent that the activities are related to functions that make an
entity a health care provider, a health care facility, or a third-party
payor:
(a) Conducting: Quality assessment and improvement activities,
including outcomes evaluation and development of clinical guidelines,
if the obtaining of generalizable knowledge is not the primary purpose
of any studies resulting from such activities; population-based
activities relating to improving health or reducing health care costs,
protocol development, case management and care coordination, contacting
of health care providers and patients with information about treatment
alternatives; and related functions that do not include treatment;
(b) Reviewing the competence or qualifications of health care
professionals, evaluating practitioner and provider performance and
third-party payor performance, conducting training programs in which
students, trainees, or practitioners in areas of health care learn
under supervision to practice or improve their skills as health care
providers, training of nonhealth care professionals, accreditation,
certification, licensing, or credentialing activities;
(c) Underwriting, premium rating, and other activities relating to
the creation, renewal, or replacement of a contract of health insurance
or health benefits, and ceding, securing, or placing a contract for
reinsurance of risk relating to claims for health care, including stop-loss insurance and excess of loss insurance, if any applicable legal
requirements are met;
(d) Conducting or arranging for medical review, legal services, and
auditing functions, including fraud and abuse detection and compliance
programs;
(e) Business planning and development, such as conducting cost-management and planning-related analyses related to managing and
operating the health care facility or third-party payor, including
formulary development and administration, development, or improvement
of methods of payment or coverage policies; and
(f) Business management and general administrative activities of
the health care facility, health care provider, or third-party payor
including, but not limited to:
(i) Management activities relating to implementation of and
compliance with the requirements of this chapter;
(ii) Customer service, including the provision of data analyses for
policy holders, plan sponsors, or other customers, provided that health
care information is not disclosed to such policy holder, plan sponsor,
or customer;
(iii) Resolution of internal grievances;
(iv) The sale, transfer, merger, or consolidation of all or part of
a health care provider, health care facility, or third-party payor with
another health care provider, health care facility, or third-party
payor or an entity that following such activity will become a health
care provider, health care facility, or third-party payor, and due
diligence related to such activity; and
(v) Consistent with applicable legal requirements, creating
deidentified health care information or a limited dataset for the
benefit of the health care provider, health care facility, or third-party payor.
(18) "Health care provider" means a person who is licensed,
certified, registered, or otherwise authorized by the law of this state
to provide health care in the ordinary course of business or practice
of a profession.
(19) "Human immunodeficiency virus" or "HIV" has the same meaning
as in RCW 70.24.017.
(20) "Imminent" has the same meaning as in RCW 71.05.020.
(21) "Information and records related to mental health services"
means a type of health care information that relates to all information
and records((, including mental health treatment records,)) compiled,
obtained, or maintained in the course of providing services by a mental
health service agency((, as defined in this section)) or mental health
professional to persons who are receiving or have received services for
mental illness. The term includes mental health information contained
in a medical bill, registration records, as defined in RCW 71.05.020,
and all other records regarding the person maintained by the
department, by regional support networks and their staff, and by
treatment facilities. ((This may)) The term further includes documents
of legal proceedings under chapter 71.05, 71.34, or 10.77 RCW, or
somatic health care information. For health care information
maintained by a hospital as defined in RCW 70.41.020 or a health care
facility or health care provider that participates with a hospital in
an organized health care arrangement defined under federal law,
"information and records related to mental health services" is limited
to information and records of services provided by a mental health
professional or information and records of services created by a
hospital-operated community mental health program as defined in RCW
71.24.025(6). The term does not include psychotherapy notes.
(22) "Information and records related to sexually transmitted
diseases" means a type of health care information that relates to the
identity of any person upon whom an HIV antibody test or other sexually
transmitted infection test is performed, the results of such tests, and
any information relating to diagnosis of or treatment for any confirmed
sexually transmitted infections.
(23) "Institutional review board" means any board, committee, or
other group formally designated by an institution, or authorized under
federal or state law, to review, approve the initiation of, or conduct
periodic review of research programs to assure the protection of the
rights and welfare of human research subjects.
(24) "Legal counsel" has the same meaning as in RCW 71.05.020.
(25) "Local public health officer" has the same meaning as in RCW
70.24.017.
(26) "Maintain," as related to health care information, means to
hold, possess, preserve, retain, store, or control that information.
(27) "Mental health professional" ((has the same meaning as in RCW
71.05.020)) means a psychiatrist, psychologist, psychiatric advanced
registered nurse practitioner, psychiatric nurse, or social worker, and
such other mental health professionals as may be defined by rules
adopted by the secretary of social and health services under chapter
71.05 RCW, whether that person works in a private or public setting.
(28) "Mental health service agency" means a public or private
agency that provides services to persons with mental disorders as
defined under RCW 71.05.020 or 71.34.020 and receives funding from
public sources. This includes evaluation and treatment facilities as
defined in RCW 71.34.020, community mental health service delivery
systems, or community mental health programs, as defined in RCW
71.24.025, and facilities conducting competency evaluations and
restoration under chapter 10.77 RCW.
(29) (("Mental health treatment records" include registration
records, as defined in RCW 71.05.020, and all other records concerning
persons who are receiving or who at any time have received services for
mental illness, which are maintained by the department, by regional
support networks and their staff, and by treatment facilities. "Mental
health treatment records" include mental health information contained
in a medical bill including, but not limited to, mental health drugs,
a mental health diagnosis, provider name, and dates of service stemming
from a medical service. "Mental health treatment records" do not
include notes or records maintained for personal use by a person
providing treatment services for the department, regional support
networks, or a treatment facility if the notes or records are not
available to others.)) "Minor" has the same meaning as in RCW 71.34.020.
(30)
(((31))) (30) "Parent" has the same meaning as in RCW 71.34.020.
(((32))) (31) "Patient" means an individual who receives or has
received health care. The term includes a deceased individual who has
received health care.
(((33))) (32) "Payment" means:
(a) The activities undertaken by:
(i) A third-party payor to obtain premiums or to determine or
fulfill its responsibility for coverage and provision of benefits by
the third-party payor; or
(ii) A health care provider, health care facility, or third-party
payor, to obtain or provide reimbursement for the provision of health
care; and
(b) The activities in (a) of this subsection that relate to the
patient to whom health care is provided and that include, but are not
limited to:
(i) Determinations of eligibility or coverage, including
coordination of benefits or the determination of cost-sharing amounts,
and adjudication or subrogation of health benefit claims;
(ii) Risk adjusting amounts due based on enrollee health status and
demographic characteristics;
(iii) Billing, claims management, collection activities, obtaining
payment under a contract for reinsurance, including stop-loss insurance
and excess of loss insurance, and related health care data processing;
(iv) Review of health care services with respect to medical
necessity, coverage under a health plan, appropriateness of care, or
justification of charges;
(v) Utilization review activities, including precertification and
preauthorization of services, and concurrent and retrospective review
of services; and
(vi) Disclosure to consumer reporting agencies of any of the
following health care information relating to collection of premiums or
reimbursement:
(A) Name and address;
(B) Date of birth;
(C) Social security number;
(D) Payment history;
(E) Account number; and
(F) Name and address of the health care provider, health care
facility, and/or third-party payor.
(((34))) (33) "Person" means an individual, corporation, business
trust, estate, trust, partnership, association, joint venture,
government, governmental subdivision or agency, or any other legal or
commercial entity.
(((35))) (34) "Professional person" has the same meaning as in RCW
71.05.020.
(((36))) (35) "Psychiatric advanced registered nurse practitioner"
has the same meaning as in RCW 71.05.020.
(((37))) (36) "Psychotherapy notes" means notes recorded, in any
medium, by a mental health professional documenting or analyzing the
contents of conversation during a private counseling session or group,
joint, or family counseling session, and that are separated from the
rest of the individual's medical record. The term excludes mediation
prescription and monitoring, counseling session start and stop times,
the modalities and frequencies of treatment furnished, results of
clinical tests, and any summary of the following items: Diagnosis,
functional status, the treatment plan, symptoms, prognosis, and
progress to date.
(37) "Reasonable fee" means the charges for duplicating or
searching the record, but shall not exceed sixty-five cents per page
for the first thirty pages and fifty cents per page for all other
pages. In addition, a clerical fee for searching and handling may be
charged not to exceed fifteen dollars. These amounts shall be adjusted
biennially in accordance with changes in the consumer price index, all
consumers, for Seattle-Tacoma metropolitan statistical area as
determined by the secretary of health. However, where editing of
records by a health care provider is required by statute and is done by
the provider personally, the fee may be the usual and customary charge
for a basic office visit.
(38) "Release" has the same meaning as in RCW 71.05.020.
(39) "Resource management services" has the same meaning as in RCW
71.05.020.
(40) "Serious violent offense" has the same meaning as in RCW
71.05.020.
(41) "Sexually transmitted infection" or "sexually transmitted
disease" has the same meaning as "sexually transmitted disease" in RCW
70.24.017.
(42) "Test for a sexually transmitted disease" has the same meaning
as in RCW 70.24.017.
(43) "Third-party payor" means an insurer regulated under Title 48
RCW authorized to transact business in this state or other
jurisdiction, including a health care service contractor, and health
maintenance organization; or an employee welfare benefit plan,
excluding fitness or wellness plans; or a state or federal health
benefit program.
(44) "Treatment" means the provision, coordination, or management
of health care and related services by one or more health care
providers or health care facilities, including the coordination or
management of health care by a health care provider or health care
facility with a third party; consultation between health care providers
or health care facilities relating to a patient; or the referral of a
patient for health care from one health care provider or health care
facility to another.
Sec. 2 RCW 70.02.020 and 2013 c 200 s 2 are each amended to read
as follows:
(1) Except as authorized elsewhere in this chapter, a health care
provider, an individual who assists a health care provider in the
delivery of health care, or an agent and employee of a health care
provider may not disclose health care information about a patient to
any other person without the patient's written authorization. A
disclosure made under a patient's written authorization must conform to
the authorization.
(2) ((A patient has a right to receive an accounting of all
disclosures of mental health treatment records except disclosures made
under RCW 71.05.425.)) A patient has a right to receive an accounting of disclosures
of health care information((
(3), except for mental health treatment
records which are addressed in subsection (2) of this section,)) made
by a health care provider or a health care facility in the six years
before the date on which the accounting is requested, except for
disclosures:
(a) To carry out treatment, payment, and health care operations;
(b) To the patient of health care information about him or her;
(c) Incident to a use or disclosure that is otherwise permitted or
required;
(d) Pursuant to an authorization where the patient authorized the
disclosure of health care information about himself or herself;
(e) Of directory information;
(f) To persons involved in the patient's care;
(g) For national security or intelligence purposes if an accounting
of disclosures is not permitted by law;
(h) To correctional institutions or law enforcement officials if an
accounting of disclosures is not permitted by law; and
(i) Of a limited data set that excludes direct identifiers of the
patient or of relatives, employers, or household members of the
patient.
Sec. 3 RCW 70.02.050 and 2013 c 200 s 3 are each amended to read
as follows:
(1) A health care provider or health care facility may disclose
health care information, except for information and records related to
sexually transmitted diseases which are addressed in RCW 70.02.220,
about a patient without the patient's authorization to the extent a
recipient needs to know the information, if the disclosure is:
(a) To a person who the provider or facility reasonably believes is
providing health care to the patient;
(b) To any other person who requires health care information for
health care education, or to provide planning, quality assurance, peer
review, or administrative, legal, financial, actuarial services to, or
other health care operations for or on behalf of the health care
provider or health care facility; or for assisting the health care
provider or health care facility in the delivery of health care and the
health care provider or health care facility reasonably believes that
the person:
(i) Will not use or disclose the health care information for any
other purpose; and
(ii) Will take appropriate steps to protect the health care
information;
(c) To any person if the health care provider or health care
facility reasonably believes that disclosure will avoid or minimize an
imminent danger to the health or safety of the patient or any other
individual, however there is no obligation under this chapter on the
part of the provider or facility to so disclose. The fact of admission
to a provider for mental health services and all information and
records compiled, obtained, or maintained in the course of providing
mental health services to either voluntary or involuntary recipients of
services at public or private agencies is not subject to disclosure
unless disclosure is permitted in RCW 70.02.230; or
(d) ((To an official of a penal or other custodial institution in
which the patient is detained; or)) For payment, including information necessary for a recipient
to make a claim, or for a claim to be made on behalf of a recipient for
aid, insurance, or medical assistance to which he or she may be
entitled.
(e)
(2) A health care provider shall disclose health care information,
except for information and records related to sexually transmitted
diseases, unless otherwise authorized in RCW 70.02.220, about a patient
without the patient's authorization if the disclosure is:
(a) To federal, state, or local public health authorities, to the
extent the health care provider is required by law to report health
care information; when needed to determine compliance with state or
federal licensure, certification or registration rules or laws, or to
investigate unprofessional conduct or ability to practice with
reasonable skill and safety under chapter 18.130 RCW. Any health care
information obtained under this subsection is exempt from public
inspection and copying pursuant to chapter 42.56 RCW; or
(b) When needed to protect the public health.
Sec. 4 RCW 70.02.200 and 2013 c 200 s 4 are each amended to read
as follows:
(1) In addition to the disclosures authorized by RCW 70.02.050 and
70.02.210, a health care provider or health care facility may disclose
health care information, except for information and records related to
sexually transmitted diseases and information related to mental health
services which are addressed by RCW 70.02.220 through 70.02.260, about
a patient without the patient's authorization, to:
(a) Any other health care provider or health care facility
reasonably believed to have previously provided health care to the
patient, to the extent necessary to provide health care to the patient,
unless the patient has instructed the health care provider or health
care facility in writing not to make the disclosure;
(b) Immediate family members of the patient, including a patient's
state registered domestic partner, or any other individual with whom
the patient is known to have a close personal relationship, if made in
accordance with good medical or other professional practice, unless the
patient has instructed the health care provider or health care facility
in writing not to make the disclosure;
(c) A health care provider or health care facility who is the
successor in interest to the health care provider or health care
facility maintaining the health care information;
(d) A person who obtains information for purposes of an audit, if
that person agrees in writing to:
(i) Remove or destroy, at the earliest opportunity consistent with
the purpose of the audit, information that would enable the patient to
be identified; and
(ii) Not to disclose the information further, except to accomplish
the audit or report unlawful or improper conduct involving fraud in
payment for health care by a health care provider or patient, or other
unlawful conduct by the health care provider;
(e) Provide directory information, unless the patient has
instructed the health care provider or health care facility not to make
the disclosure;
(f) Fire, police, sheriff, or other public authority, that brought,
or caused to be brought, the patient to the health care facility or
health care provider if the disclosure is limited to the patient's
name, residence, sex, age, occupation, condition, diagnosis, estimated
or actual discharge date, or extent and location of injuries as
determined by a physician, and whether the patient was conscious when
admitted;
(g) Federal, state, or local law enforcement authorities and the
health care provider, health care facility, or third-party payor
believes in good faith that the health care information disclosed
constitutes evidence of criminal conduct that occurred on the premises
of the health care provider, health care facility, or third-party
payor; ((and))
(h) Another health care provider, health care facility, or third-party payor for the health care operations of the health care provider,
health care facility, or third-party payor that receives the
information, if each entity has or had a relationship with the patient
who is the subject of the health care information being requested, the
health care information pertains to such relationship, and the
disclosure is for the purposes described in RCW 70.02.010(17) (a) and
(b); and
(i) An official of a penal or other custodial institution in which
the patient is detained.
(2) In addition to the disclosures required by RCW 70.02.050 and
70.02.210, a health care provider shall disclose health care
information, except for information related to sexually transmitted
diseases and information related to mental health services which are
addressed by RCW 70.02.220 through 70.02.260, about a patient without
the patient's authorization if the disclosure is:
(a) To federal, state, or local law enforcement authorities to the
extent the health care provider is required by law;
(b) To federal, state, or local law enforcement authorities, upon
receipt of a written or oral request made to a nursing supervisor,
administrator, or designated privacy official, in a case in which the
patient is being treated or has been treated for a bullet wound,
gunshot wound, powder burn, or other injury arising from or caused by
the discharge of a firearm, or an injury caused by a knife, an ice
pick, or any other sharp or pointed instrument which federal, state, or
local law enforcement authorities reasonably believe to have been
intentionally inflicted upon a person, or a blunt force injury that
federal, state, or local law enforcement authorities reasonably believe
resulted from a criminal act, the following information, if known:
(i) The name of the patient;
(ii) The patient's residence;
(iii) The patient's sex;
(iv) The patient's age;
(v) The patient's condition;
(vi) The patient's diagnosis, or extent and location of injuries as
determined by a health care provider;
(vii) Whether the patient was conscious when admitted;
(viii) The name of the health care provider making the
determination in (b)(v), (vi), and (vii) of this subsection;
(ix) Whether the patient has been transferred to another facility;
and
(x) The patient's discharge time and date;
(c) Pursuant to compulsory process in accordance with RCW
70.02.060.
Sec. 5 RCW 70.02.210 and 2013 c 200 s 5 are each amended to read
as follows:
(1)(a) A health care provider or health care facility may disclose
health care information about a patient without the patient's
authorization to the extent a recipient needs to know the information,
if the disclosure is for use in a research project that an
institutional review board has determined:
(((a))) (i) Is of sufficient importance to outweigh the intrusion
into the privacy of the patient that would result from the disclosure;
(((b))) (ii) Is impracticable without the use or disclosure of the
health care information in individually identifiable form;
(((c))) (iii) Contains reasonable safeguards to protect the
information from redisclosure;
(((d))) (iv) Contains reasonable safeguards to protect against
identifying, directly or indirectly, any patient in any report of the
research project; and
(((e))) (v) Contains procedures to remove or destroy at the
earliest opportunity, consistent with the purposes of the project,
information that would enable the patient to be identified, unless an
institutional review board authorizes retention of identifying
information for purposes of another research project.
(b) Disclosure under (a) of this subsection may include health care
information and records of treatment programs related to chemical
dependency addressed in chapter 70.96A RCW and as authorized by federal
law.
(2) In addition to the disclosures required by RCW 70.02.050 and
70.02.200, a health care provider or health care facility shall
disclose health care information about a patient without the patient's
authorization if:
(a) The disclosure is to county coroners and medical examiners for
the investigations of deaths;
(b) The disclosure is to a procurement organization or person to
whom a body part passes for the purpose of examination necessary to
assure the medical suitability of the body part; or
(c) The disclosure is to a person subject to the jurisdiction of
the federal food and drug administration in regards to a food and drug
administration-regulated product or activity for which that person has
responsibility for quality, safety, or effectiveness of activities.
Sec. 6 RCW 70.02.230 and 2013 c 200 s 7 are each amended to read
as follows:
(1) Except as provided in this section, RCW 70.02.050, 71.05.445,
70.96A.150, 74.09.295, 70.02.210, 70.02.240, 70.02.250, and 70.02.260,
or pursuant to a valid authorization under RCW 70.02.030, the fact of
admission to a provider for mental health services and all information
and records compiled, obtained, or maintained in the course of
providing mental health services to either voluntary or involuntary
recipients of services at public or private agencies must be
confidential.
(2) Information and records related to mental health services,
other than those obtained through treatment under chapter 71.34 RCW,
may be disclosed only:
(a) In communications between qualified professional persons to
meet the requirements of chapter 71.05 RCW, in the provision of
services or appropriate referrals, or in the course of guardianship
proceedings if provided to a professional person:
(i) Employed by the facility;
(ii) Who has medical responsibility for the patient's care;
(iii) Who is a designated mental health professional;
(iv) Who is providing services under chapter 71.24 RCW;
(v) Who is employed by a state or local correctional facility where
the person is confined or supervised; or
(vi) Who is providing evaluation, treatment, or follow-up services
under chapter 10.77 RCW;
(b) When the communications regard the special needs of a patient
and the necessary circumstances giving rise to such needs and the
disclosure is made by a facility providing services to the operator of
a facility in which the patient resides or will reside;
(c)(i) When the person receiving services, or his or her guardian,
designates persons to whom information or records may be released, or
if the person is a minor, when his or her parents make such a
designation;
(ii) A public or private agency shall release to a person's next of
kin, attorney, personal representative, guardian, or conservator, if
any:
(A) The information that the person is presently a patient in the
facility or that the person is seriously physically ill;
(B) A statement evaluating the mental and physical condition of the
patient, and a statement of the probable duration of the patient's
confinement, if such information is requested by the next of kin,
attorney, personal representative, guardian, or conservator; and
(iii) Other information requested by the next of kin or attorney as
may be necessary to decide whether or not proceedings should be
instituted to appoint a guardian or conservator;
(d)(i) To the courts as necessary to the administration of chapter
71.05 RCW or to a court ordering an evaluation or treatment under
chapter 10.77 RCW solely for the purpose of preventing the entry of any
evaluation or treatment order that is inconsistent with any order
entered under chapter 71.05 RCW.
(ii) To a court or its designee in which a motion under chapter
10.77 RCW has been made for involuntary medication of a defendant for
the purpose of competency restoration.
(iii) Disclosure under this subsection is mandatory for the purpose
of the federal health insurance portability and accountability act;
(e)(i) When a mental health professional is requested by a
representative of a law enforcement or corrections agency, including a
police officer, sheriff, community corrections officer, a municipal
attorney, or prosecuting attorney to undertake an investigation or
provide treatment under RCW 71.05.150, 10.31.110, or 71.05.153, the
mental health professional shall, if requested to do so, advise the
representative in writing of the results of the investigation including
a statement of reasons for the decision to detain or release the person
investigated. The written report must be submitted within seventy-two
hours of the completion of the investigation or the request from the
law enforcement or corrections representative, whichever occurs later.
(ii) Disclosure under this subsection is mandatory for the purposes
of the federal health insurance portability and accountability act;
(f) To the attorney of the detained person;
(g) To the prosecuting attorney as necessary to carry out the
responsibilities of the office under RCW 71.05.330(2), 71.05.340(1)(b),
and 71.05.335. The prosecutor must be provided access to records
regarding the committed person's treatment and prognosis, medication,
behavior problems, and other records relevant to the issue of whether
treatment less restrictive than inpatient treatment is in the best
interest of the committed person or others. Information must be
disclosed only after giving notice to the committed person and the
person's counsel;
(h)(i) To appropriate law enforcement agencies and to a person,
when the identity of the person is known to the public or private
agency, whose health and safety has been threatened, or who is known to
have been repeatedly harassed, by the patient. The person may
designate a representative to receive the disclosure. The disclosure
must be made by the professional person in charge of the public or
private agency or his or her designee and must include the dates of
commitment, admission, discharge, or release, authorized or
unauthorized absence from the agency's facility, and only any other
information that is pertinent to the threat or harassment. The agency
or its employees are not civilly liable for the decision to disclose or
not, so long as the decision was reached in good faith and without
gross negligence.
(ii) Disclosure under this subsection is mandatory for the purposes
of the federal health insurance portability and accountability act;
(i)(i) To appropriate corrections and law enforcement agencies all
necessary and relevant information in the event of a crisis or emergent
situation that poses a significant and imminent risk to the public.
The mental health service agency or its employees are not civilly
liable for the decision to disclose or not so long as the decision was
reached in good faith and without gross negligence.
(ii) Disclosure under this subsection is mandatory for the purposes
of the health insurance portability and accountability act;
(j) To the persons designated in RCW 71.05.425 for the purposes
described in those sections;
(k) Upon the death of a person. The person's next of kin, personal
representative, guardian, or conservator, if any, must be notified.
Next of kin who are of legal age and competent must be notified under
this section in the following order: Spouse, parents, children,
brothers and sisters, and other relatives according to the degree of
relation. Access to all records and information compiled, obtained, or
maintained in the course of providing services to a deceased patient
are governed by RCW 70.02.140;
(l) To mark headstones or otherwise memorialize patients interred
at state hospital cemeteries. The department of social and health
services shall make available the name, date of birth, and date of
death of patients buried in state hospital cemeteries fifty years after
the death of a patient;
(m) To law enforcement officers and to prosecuting attorneys as are
necessary to enforce RCW 9.41.040(2)(a)(ii). The extent of information
that may be released is limited as follows:
(i) Only the fact, place, and date of involuntary commitment, an
official copy of any order or orders of commitment, and an official
copy of any written or oral notice of ineligibility to possess a
firearm that was provided to the person pursuant to RCW 9.41.047(1),
must be disclosed upon request;
(ii) The law enforcement and prosecuting attorneys may only release
the information obtained to the person's attorney as required by court
rule and to a jury or judge, if a jury is waived, that presides over
any trial at which the person is charged with violating RCW
9.41.040(2)(a)(ii);
(iii) Disclosure under this subsection is mandatory for the
purposes of the federal health insurance portability and accountability
act;
(n) When a patient would otherwise be subject to the provisions of
this section and disclosure is necessary for the protection of the
patient or others due to his or her unauthorized disappearance from the
facility, and his or her whereabouts is unknown, notice of the
disappearance, along with relevant information, may be made to
relatives, the department of corrections when the person is under the
supervision of the department, and governmental law enforcement
agencies designated by the physician or psychiatric advanced registered
nurse practitioner in charge of the patient or the professional person
in charge of the facility, or his or her professional designee;
(o) Pursuant to lawful order of a court;
(p) To qualified staff members of the department, to the director
of regional support networks, to resource management services
responsible for serving a patient, or to service providers designated
by resource management services as necessary to determine the progress
and adequacy of treatment and to determine whether the person should be
transferred to a less restrictive or more appropriate treatment
modality or facility;
(q) Within the ((treatment facility)) mental health service agency
where the patient is receiving treatment, confidential information may
be disclosed to persons employed, serving in bona fide training
programs, or participating in supervised volunteer programs, at the
facility when it is necessary to perform their duties;
(r) Within the department as necessary to coordinate treatment for
mental illness, developmental disabilities, alcoholism, or drug abuse
of persons who are under the supervision of the department;
(s) To a licensed physician or psychiatric advanced registered
nurse practitioner who has determined that the life or health of the
person is in danger and that treatment without the information and
records related to mental health services ((contained in the mental
health treatment records)) could be injurious to the patient's health.
Disclosure must be limited to the portions of the records necessary to
meet the medical emergency;
(t) Consistent with the requirements of the federal health
information portability and accountability act, to a licensed mental
health professional or a health care professional licensed under
chapter 18.71, 18.71A, 18.57, 18.57A, 18.79, or 18.36A RCW who is
providing care to a person, or to whom a person has been referred for
evaluation or treatment, to assure coordinated care and treatment of
that person. Psychotherapy notes((, as defined in 45 C.F.R. Sec.
164.501,)) may not be released without authorization of the person who
is the subject of the request for release of information;
(u) To administrative and office support staff designated to obtain
medical records for those licensed professionals listed in (t) of this
subsection;
(v) To a facility that is to receive a person who is involuntarily
committed under chapter 71.05 RCW, or upon transfer of the person from
one evaluation and treatment facility to another. The release of
records under this subsection is limited to the ((mental health
treatment records)) information and records related to mental health
services required by law, a record or summary of all somatic
treatments, and a discharge summary. The discharge summary may include
a statement of the patient's problem, the treatment goals, the type of
treatment which has been provided, and recommendation for future
treatment, but may not include the patient's complete treatment record;
(w) To the person's counsel or guardian ad litem, without
modification, at any time in order to prepare for involuntary
commitment or recommitment proceedings, reexaminations, appeals, or
other actions relating to detention, admission, commitment, or
patient's rights under chapter 71.05 RCW;
(x) To staff members of the protection and advocacy agency or to
staff members of a private, nonprofit corporation for the purpose of
protecting and advocating the rights of persons with mental disorders
or developmental disabilities. Resource management services may limit
the release of information to the name, birthdate, and county of
residence of the patient, information regarding whether the patient was
voluntarily admitted, or involuntarily committed, the date and place of
admission, placement, or commitment, the name and address of a guardian
of the patient, and the date and place of the guardian's appointment.
Any staff member who wishes to obtain additional information must
notify the patient's resource management services in writing of the
request and of the resource management services' right to object. The
staff member shall send the notice by mail to the guardian's address.
If the guardian does not object in writing within fifteen days after
the notice is mailed, the staff member may obtain the additional
information. If the guardian objects in writing within fifteen days
after the notice is mailed, the staff member may not obtain the
additional information;
(y) To all current treating providers of the patient with
prescriptive authority who have written a prescription for the patient
within the last twelve months. For purposes of coordinating health
care, the department may release without written authorization of the
patient, information acquired for billing and collection purposes as
described in RCW 70.02.050(1)(((e))) (d). The department shall notify
the patient that billing and collection information has been released
to named providers, and provide the substance of the information
released and the dates of such release. The department may not release
counseling, inpatient psychiatric hospitalization, or drug and alcohol
treatment information without a signed written release from the client;
(z)(i) To the secretary of social and health services for either
program evaluation or research, or both so long as the secretary adopts
rules for the conduct of the evaluation or research, or both. Such
rules must include, but need not be limited to, the requirement that
all evaluators and researchers sign an oath of confidentiality
substantially as follows:
"As a condition of conducting evaluation or research concerning
persons who have received services from (fill in the facility, agency,
or person) I, . . . . . ., agree not to divulge, publish, or otherwise
make known to unauthorized persons or the public any information
obtained in the course of such evaluation or research regarding persons
who have received services such that the person who received such
services is identifiable.
I recognize that unauthorized release of confidential information
may subject me to civil liability under the provisions of state law.
/s/ . . . . . ."
(ii) Nothing in this chapter may be construed to prohibit the
compilation and publication of statistical data for use by government
or researchers under standards, including standards to assure
maintenance of confidentiality, set forth by the secretary.
(3) Whenever federal law or federal regulations restrict the
release of information contained in the ((treatment records))
information and records related to mental health services of any
patient who receives treatment for chemical dependency, the department
may restrict the release of the information as necessary to comply with
federal law and regulations.
(4) Civil liability and immunity for the release of information
about a particular person who is committed to the department of social
and health services under RCW 71.05.280(3) and 71.05.320(3)(c) after
dismissal of a sex offense as defined in RCW 9.94A.030, is governed by
RCW 4.24.550.
(5) The fact of admission to a provider of mental health services,
as well as all records, files, evidence, findings, or orders made,
prepared, collected, or maintained pursuant to chapter 71.05 RCW are
not admissible as evidence in any legal proceeding outside that chapter
without the written authorization of the person who was the subject of
the proceeding except as provided in RCW 70.02.260, in a subsequent
criminal prosecution of a person committed pursuant to RCW 71.05.280(3)
or 71.05.320(3)(c) on charges that were dismissed pursuant to chapter
10.77 RCW due to incompetency to stand trial, in a civil commitment
proceeding pursuant to chapter 71.09 RCW, or, in the case of a minor,
a guardianship or dependency proceeding. The records and files
maintained in any court proceeding pursuant to chapter 71.05 RCW must
be confidential and available subsequent to such proceedings only to
the person who was the subject of the proceeding or his or her
attorney. In addition, the court may order the subsequent release or
use of such records or files only upon good cause shown if the court
finds that appropriate safeguards for strict confidentiality are and
will be maintained.
(6)(a) Except as provided in RCW 4.24.550, any person may bring an
action against an individual who has willfully released confidential
information or records concerning him or her in violation of the
provisions of this section, for the greater of the following amounts:
(i) One thousand dollars; or
(ii) Three times the amount of actual damages sustained, if any.
(b) It is not a prerequisite to recovery under this subsection that
the plaintiff suffered or was threatened with special, as contrasted
with general, damages.
(c) Any person may bring an action to enjoin the release of
confidential information or records concerning him or her or his or her
ward, in violation of the provisions of this section, and may in the
same action seek damages as provided in this subsection.
(d) The court may award to the plaintiff, should he or she prevail
in any action authorized by this subsection, reasonable attorney fees
in addition to those otherwise provided by law.
(e) If an action is brought under this subsection, no action may be
brought under RCW 70.02.170.
Sec. 7 RCW 70.02.270 and 2013 c 200 s 11 are each amended to read
as follows:
(1) No person who receives health care information for health care
education, or to provide planning, quality assurance, peer review, or
administrative, legal, financial, or actuarial services, or other
health care operations for or on behalf of a health care provider or
health care facility, may use or disclose any health care information
received from the health care provider or health care facility in any
manner that ((is inconsistent with the duties of the health care
provider or health care facility under this chapter)) would violate the
requirements of this chapter if performed by the health care provider
or health care facility.
(2) A health care provider or health care facility that has a
contractual relationship with a person to provide services described
under subsection (1) of this section ((must)) may terminate the
contractual relationship with the person if the health care provider or
health care facility learns that the person has engaged in a pattern of
activity that violates the person's duties under subsection (1) of this
section, unless the person took reasonable steps to correct the breach
of confidentiality or has discontinued the violating activity.
Sec. 8 RCW 70.02.280 and 2013 c 200 s 12 are each amended to read
as follows:
A health care provider, health care facility, and their assistants,
employees, agents, and contractors may not:
(1) Use or disclose health care information for marketing or fund-raising purposes, unless permitted by federal law; or
(2) ((Sell health care information to a third party, except in a
form that is deidentified and aggregated; or)) Sell health care information to a third party, except ((
(3)for
the following purposes)):
(a) For purposes of treatment or payment;
(b) For purposes of sale, transfer, merger, or consolidation of a
business;
(c) For purposes of remuneration to a third party for services;
(d) As disclosures are required by law;
(e) For purposes of providing access to or accounting of
disclosures to an individual;
(f) For public health purposes;
(g) For research;
(h) With an individual's authorization;
(i) Where a reasonable cost-based fee is paid to prepare and
transmit health information, where authority to disclose the
information is provided in this chapter; or
(j) In a format that is deidentified and aggregated.
Sec. 9 RCW 70.02.310 and 2013 c 200 s 15 are each amended to read
as follows:
(1) Resource management services shall establish procedures to
provide reasonable and timely access to information and records related
to mental health services for an individual ((mental health treatment
records)). However, access may not be denied at any time to records of
all medications and somatic treatments received by the person.
(2) Following discharge, a person who has received mental health
services has a right to a complete record of all medications and
somatic treatments prescribed during evaluation, admission, or
commitment and to a copy of the discharge summary prepared at the time
of his or her discharge. A reasonable and uniform charge for
reproduction may be assessed.
(3) ((Mental health treatment records)) Information and records
related to mental health services may be modified prior to inspection
to protect the confidentiality of other patients or the names of any
other persons referred to in the record who gave information on the
condition that his or her identity remain confidential. Entire
documents may not be withheld to protect such confidentiality.
(4) At the time of discharge resource management services shall
inform all persons who have received mental health services of their
rights as provided in this chapter and RCW 71.05.620.
Sec. 10 RCW 70.02.340 and 2013 c 200 s 18 are each amended to
read as follows:
The department of social and health services shall adopt rules
related to the disclosure of ((mental health treatment records))
information and records related to mental health services in this
chapter.
Sec. 11 RCW 71.05.445 and 2013 c 200 s 31 are each amended to
read as follows:
(1)(a) When a mental health service provider conducts its initial
assessment for a person receiving court-ordered treatment, the service
provider shall inquire and shall be told by the offender whether he or
she is subject to supervision by the department of corrections.
(b) When a person receiving court-ordered treatment or treatment
ordered by the department of corrections discloses to his or her mental
health service provider that he or she is subject to supervision by the
department of corrections, the mental health service provider shall
notify the department of corrections that he or she is treating the
offender and shall notify the offender that his or her community
corrections officer will be notified of the treatment, provided that if
the offender has received relief from disclosure pursuant to RCW
9.94A.562, 70.96A.155, or 71.05.132 and the offender has provided the
mental health service provider with a copy of the order granting relief
from disclosure pursuant to RCW 9.94A.562, 70.96A.155, or 71.05.132,
the mental health service provider is not required to notify the
department of corrections that the mental health service provider is
treating the offender. The notification may be written or oral and
shall not require the consent of the offender. If an oral notification
is made, it must be confirmed by a written notification. For purposes
of this section, a written notification includes notification by e-mail
or facsimile, so long as the notifying mental health service provider
is clearly identified.
(2) The information to be released to the department of corrections
shall include all relevant records and reports, as defined by rule,
necessary for the department of corrections to carry out its duties.
(3) The department and the department of corrections, in
consultation with regional support networks, mental health service
providers as defined in RCW 71.05.020, mental health consumers, and
advocates for persons with mental illness, shall adopt rules to
implement the provisions of this section related to the type and scope
of information to be released. These rules shall:
(a) Enhance and facilitate the ability of the department of
corrections to carry out its responsibility of planning and ensuring
community protection with respect to persons subject to sentencing
under chapter 9.94A or 9.95 RCW, including accessing and releasing or
disclosing information of persons who received mental health services
as a minor; and
(b) Establish requirements for the notification of persons under
the supervision of the department of corrections regarding the
provisions of this section.
(4) The information received by the department of corrections under
this section shall remain confidential and subject to the limitations
on disclosure outlined in chapter 71.05 RCW, except as provided in RCW
72.09.585.
(5) No mental health service provider or individual employed by a
mental health service provider shall be held responsible for
information released to or used by the department of corrections under
the provisions of this section or rules adopted under this section.
(6) Whenever federal law or federal regulations restrict the
release of information ((contained in the treatment records of)) and
records related to mental health services for any patient who receives
treatment for alcoholism or drug dependency, the release of the
information may be restricted as necessary to comply with federal law
and regulations.
(7) This section does not modify the terms and conditions of
disclosure of information related to sexually transmitted diseases
under chapter 70.24 RCW.
(8) The department shall, subject to available resources,
electronically, or by the most cost-effective means available, provide
the department of corrections with the names, last dates of services,
and addresses of specific regional support networks and mental health
service providers that delivered mental health services to a person
subject to chapter 9.94A or 9.95 RCW pursuant to an agreement between
the departments.
Sec. 12 RCW 70.02.030 and 2005 c 468 s 3 are each amended to read
as follows:
(1) A patient may authorize a health care provider or health care
facility to disclose the patient's health care information. A health
care provider or health care facility shall honor an authorization and,
if requested, provide a copy of the recorded health care information
unless the health care provider or health care facility denies the
patient access to health care information under RCW 70.02.090.
(2) A health care provider or health care facility may charge a
reasonable fee for providing the health care information and is not
required to honor an authorization until the fee is paid.
(3) To be valid, a disclosure authorization to a health care
provider or health care facility shall:
(a) Be in writing, dated, and signed by the patient;
(b) Identify the nature of the information to be disclosed;
(c) Identify the name and institutional affiliation of the person
or class of persons to whom the information is to be disclosed;
(d) Identify the provider or class of providers who are to make the
disclosure;
(e) Identify the patient; and
(f) Contain an expiration date or an expiration event that relates
to the patient or the purpose of the use or disclosure.
(4) Unless disclosure without authorization is otherwise permitted
under RCW 70.02.050 or the federal health insurance portability and
accountability act of 1996 and its implementing regulations, an
authorization may permit the disclosure of health care information to
a class of persons that includes:
(a) Researchers if the health care provider or health care facility
obtains the informed consent for the use of the patient's health care
information for research purposes; or
(b) Third-party payors if the information is only disclosed for
payment purposes.
(5) Except as provided by this chapter, the signing of an
authorization by a patient is not a waiver of any rights a patient has
under other statutes, the rules of evidence, or common law.
(6) When an authorization permits the disclosure of health care
information to a financial institution or an employer of the patient
for purposes other than payment, the authorization as it pertains to
those disclosures shall expire ((ninety days)) one year after the
signing of the authorization, unless the authorization is renewed by
the patient.
(7) A health care provider or health care facility shall retain the
original or a copy of each authorization or revocation in conjunction
with any health care information from which disclosures are made.
(8) Where the patient is under the supervision of the department of
corrections, an authorization signed pursuant to this section for
health care information related to mental health or drug or alcohol
treatment expires at the end of the term of supervision, unless the
patient is part of a treatment program that requires the continued
exchange of information until the end of the period of treatment.
Sec. 13 RCW 70.02.045 and 2000 c 5 s 2 are each amended to read
as follows:
Third-party payors shall not release health care information
disclosed under this chapter, except ((to the extent that health care
providers are authorized to do so under RCW 70.02.050)) as permitted
under this chapter.
NEW SECTION. Sec. 14 Sections 1 through 4 and 6 through 13 of
this act take effect July 1, 2014.
NEW SECTION. Sec. 15 Section 5 of this act is necessary for the
immediate preservation of the public peace, health, or safety, or
support of the state government and its existing public institutions,
and takes effect immediately.