Background:

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes nationwide standards for the use, disclosure, storage, and transfer of protected health information. Entities covered by HIPAA must have a patient's authorization to use or disclose health care information, unless there is a specified exception. Some exceptions pertain to disclosures for treatment, payment, and health care operations; public health activities; judicial proceedings; law enforcement purposes; and research purposes. The HIPAA allows a state to establish standards that are more stringent than its provisions.

In Washington, the Uniform Health Care Information Act (UHCIA) governs the disclosure of health care information by health care providers and their agents or employees. The UHCIA provides that a health care provider may not disclose health care information about a patient unless there is a statutory exception or a written authorization by the patient. Some exceptions include disclosures for the provision of health care; quality improvement, legal, actuarial, and administrative services; research purposes; directory information; public health and law enforcement activities as required by law; and judicial proceedings.

Washington has heightened protections for information related to mental health, human immunodeficiency virus (HIV), and sexually transmitted disease (STD). For mental health information, the fact of admission and all information and records compiled in the course of providing services to patients at public or private mental health agencies is confidential. With respect to HIV and STD information, it is prohibited to disclose the identity of a person who has considered or requested a test for an STD; the identity of the subject of an HIV antibody test or test for any other STD; the results of those tests; and information regarding the diagnosis of or treatment for HIV infection and for any other confirmed STD. Both the protections related to mental health, HIV, and STD information have several exceptions to allow the disclosure of the information without the patient's authorization or consent.

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Summary of Substitute Bill:

The term "information and records related to mental health services" (mental health information) is codified under the UHCIA with predominantly the same meaning as related terms in the mental health statutes. The term "information and records related to sexually transmitted diseases" (STD information) is defined, similar to the standard in the STD statute, as health care information related to the identity of a person who has had a HIV or other STD test performed upon them, any results of such tests, and any information regarding the diagnosis or treatment of a STD. Both definitions expressly state that they are a type of "health care information."

Statutory provisions related to the disclosure of mental health information, including children's mental health information, and STD information are consolidated into the UHCIA. The heightened standards of privacy for those types of information are maintained.

The requirement that an attorney seeking health care information from a health care provider or patient be given 14 days' notice so that either may object to the request is changed so that, upon receipt of such a request, a health care provider must send a copy of the request to the last known address of the patient and then the health care provider may produce the health care information if the patient does not raise an objection.

The requirement that health care providers give an accounting to patients of disclosures of their health care information is changed by limiting several of the exceptions. The following exceptions only apply to accounting requests for health care information maintained in nonelectronic format: disclosures related to treatment, payment, and health care operations; disclosures regarding the patient's own information; information disclosed pursuant to the patient's authorization; disclosures incident to emergency department services; disclosures of directory information; and information disclosed to people involved in the patient's care.

Health care providers and their employees and contractors are prohibited from using or disclosing health care information for marketing or fundraising purposes or selling health care information to a third party, unless the information is in a de-identified and aggregated form.

Entities that receive health care information for health care education or to provide services to a health care provider, such as planning, quality assurance, legal, or financial activities, are subject to the same disclosure requirements as the health care provider for which the entity is working. If a health care provider learns that an entity has violated this responsibility, the health care provider must terminate the contract with the entity unless reasonable steps to correct the situation were taken or the violating activity has been discontinued.

General Mental Health Information.

Patient mental health information disclosure standards are maintained as they have been in the mental health chapters, except in some cases in which there is either a change in the standard for disclosure without authorization or a new type of disclosure without authorization is established. These include:

Mental health information may be disclosed to a person who is providing health care to the patient, as provided under the UHCIA.
The permitted disclosure of mental health records for management or financial audits is changed to the UHCIA standard that allows disclosure to a person for health care education; planning; quality assurance; peer review; administrative, legal, financial, or actuarial purposes; or for assisting a health care provider or facility in the delivery of health care.
The permitted disclosure of: (1) adult mental health information for evaluation or research subject to the Department of Social and Health Services (DSHS) adopting related rules and the researcher signing an oath of confidentiality; and (2) mental health records for purposes of research, are changed to the UHCIA standard allowing disclosures for use in a research project approved by an institutional review board.
Mental health information may be disclosed to an official of a penal or other custodial institution in which the patient is detained.
The permitted disclosure of: (1) mental health information for a recipient of the information to make a claim for aid, insurance, or Medicaid; and (2) mental health treatment records to the DSHS, regional support network directors, or qualified staff when needed for billing and collection purposes, are changed to allow disclosures for payment, including making a claim for aid, insurance, or medical assistance.
The permitted disclosure of mental health information to the Department of Health for determining compliance with licensing standards is expanded to the UHCIA standard that requires that the information be provided to federal, state, or local public health authorities as required by law to determine compliance with credentialing laws or to protect public health.
Mental health information must be disclosed to county coroners and medical examiners for death investigations.

In cases in which there is not a specific exception to the privacy standard, the subject of the mental health information may allow disclosure pursuant to the written authorization requirements of the UHCIA, as opposed to the undefined "release" and "written informed consent" requirements of the mental health chapters.

Prohibitions against the willful release of confidential information and records related to mental health services are eliminated.

General STD Information.

Patient STD information disclosure standards are maintained as they have been in the STD chapter, except that information and records related to STDs must be disclosed to a coroner or medical examiner without the patient's authorization. Sexually transmitted disease information may be disclosed for use in a research project approved by an institutional review board.

In cases in which there is not a specific exception to the privacy standard, the subject of the STD information may allow disclosure pursuant to the written authorization requirements of the UHCIA, as opposed to the undefined "release" requirement of the STD chapters.

Substitute Bill Compared to Original Bill:

The substitute bill changes the requirement that health care providers give an accounting to patients of disclosures of their health care information by limiting several of the exceptions. The following exceptions only apply to accounting requests for health care information maintained in nonelectronic format: disclosures related to treatment, payment, and health care operations; disclosures regarding the patient's own information; information disclosed pursuant to the patient's authorization; disclosures incident to emergency department services; disclosures of directory information; and information disclosed to people involved in the patient's care.

Fitness and wellness plans are exempt from the definition of employee welfare benefits for purposes of defining a "third party payor."

Definitions that reference terms defined in other chapters of law related to HIV/AIDS, mental health for adults, and mental health for minors are added to the substitute bill. Corrections to references and technical changes are made. The implementation of the bill is delayed until July 1, 2014.

Staff Summary of Public Testimony:

(In support) This bill tries to put all of the confidentiality laws into one single chapter in the code to make it simpler and easier to understand. Confidentiality laws can be very confusing. This bill makes the compulsory process uniform across the country for court-ordered receipt of treatment records. This bill is an honest attempt to provide improved access to needed mental health care services and programs while providing client privacy of individual health care information. This version protects an individual who is accessing HIV testing, not just the results of the test, which is a huge improvement. The research exemption for HIV/AIDS is a good step toward treating this public health threat. This bill allows disclosures to coroners and medical examiners while preventing them from redisclosing the information.

(In support with concerns) When a provider receives a subpoena for health care information, the provider must respond immediately and provide a copy of the subpoena to the patient. The burden of informing the patient should remain with the party issuing the subpoena to stay in order to keep state law consistent with federal privacy laws and avoid undue burdens on providers.

(Opposed) Confidentiality laws are very confusing and this bill does not add much clarity. It is not certain that some of the current disclosures of information will still be allowed under this bill. Some sections have conflicting statements. There seems to be a broadening of the definition of mental health services. It is difficult to put all of these provisions together without streamlining the laws.