BILL ANALYSIS
AB 952
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 952 (Krekorian)
As Amended July 23, 2009
Majority vote
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|ASSEMBLY: |76-0 |(June 2, 2009) |SENATE: |38-0 |(August 27, |
| | | | | |2009) |
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Original Committee Reference: HEALTH
SUMMARY : Authorizes a health care provider or a health care
service plan (health plan) to disclose private medical
information to an employee welfare benefit plan formed under the
federal Taft-Hartley Act (Taft-Hartley plan), or an entity
contracting with the Taft-Hartley plan, providing the disclosure
is for billing, claims management, medical data processing, or
other administrative services related to the provision of
medical care to employees enrolled in the Taft-Hartley plan, and
providing specified conditions are met. Specifically, this
bill :
1)Authorizes a health care provider or a health plan, to
disclose medical information relating to an employee enrolled
in a Taft-Hartley plan, including medical information
otherwise protected by state and federal privacy laws, to a
Taft-Hartley plan, or an entity contracted with the
Taft-Hartley plan, for specified purposes, and if all of the
following conditions are met:
a) The disclosure is for the purpose of determining
eligibility, coordinating benefits, or allowing the
Taft-Hartley plan, or the contracting entity, to advocate
on behalf of a patient or enrollee with a health care
provider, a health plan, or a state or federal regulatory
agency;
b) The request for the information is accompanied by a
written authorization for the release of the information
submitted by the patient, the legal representative of the
patient (if the patient is a minor or is incompetent), the
spouse of the patient, the person financially responsible
for the patient under specified circumstances, or the
beneficiary or personal representative of a deceased
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patient;
c) The disclosure is authorized by and made in a manner
consistent with the federal Health Insurance Portability
and Accountability Act of 1996 (HIPAA); and,
d) Any information disclosed is not further used or
disclosed by the recipient in any way that would directly
or indirectly violate the state Confidentiality of Medical
Information Act (CMIA), or the privacy restrictions imposed
by federal HIPAA regulations, including the manipulation of
the information in any way that might reveal individually
identifiable medical information.
2)Exempts disclosures made pursuant to the provisions of this
bill from the existing prohibition that health plans and
health insurers may not release any information to an employer
that would directly or indirectly indicate that an employee is
receiving or has received services from a health care provider
covered by the health plan or insurer unless authorized to do
so by the employee.
The Senate amendments make technical and clarifying changes.
EXISTING LAW :
1)Prohibits health plans and health insurers from releasing any
information to an employer that would directly or indirectly
indicate that an employee is receiving or has received
services from a health care provider covered by the health
plan or insurer unless authorized to do so by the employee.
2)Prohibits, under the CMIA, a provider of health care, health
plan, or health care contractor from disclosing a person's
medical information without first obtaining that person's
authorization, except as specified. Requires, however, a
health care provider, health care service plan, or health care
contractor to disclose protected medical information if
required by a subpoena, search warrant, or other court order,
as specified.
3)Permits under the CMIA, notwithstanding 2) above, a provider,
plan, or contractor to disclose information in other specified
circumstances, including for purposes of diagnosis or
treatment or as necessary to provide billing or other
administrative services to the provider or plan. Prohibits a
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provider, plan, or contractor from disclosing a person's
medical information for marketing purposes, or any other
purpose not necessary to provide health care services to the
patient, without express authorization from that person.
4)Prohibits, under the California Insurance Information and
Privacy Protection Act, insurers, including health insurers,
from disclosing any personal or privileged individual
information collected or received in an insurance transaction,
except as specified.
5)Prohibits, under the federal HIPAA, with exceptions, covered
entities, as defined, from using or disclosing protected
health information, except pursuant to a written authorization
signed by the patient or for treatment, payment, or health
care operations, and generally requires a covered entity to
make reasonable efforts to limit the use or disclosure of
protected health information to the minimum necessary to
accomplish the intended purpose of the disclosure.
6)Defines, under the federal Taft-Hartley Act, an "employee
welfare benefit plan" as any plan, fund, or program which is
established or maintained by an employer or by an employee
organization, or by both, for the purpose of providing for its
participants or their beneficiary's medical insurance or other
specified employee benefits. Authorizes employers to make
payments to a trust fund under specified circumstances, such
as if the trust fund is established for the sole and exclusive
benefit of the employees, and employees are equally
represented in the administration of the fund.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the version passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
Analysis Prepared by : Deborah Kelch / HEALTH / (916) 319-2097
FN:
0002450