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14.8 Individuals’ Rights to Access and Copy PHI


Individuals have the right to access and copy their own protected health information (PHI) maintained/retained by the Health Plan in their designated record set (DRS).


Definition of DRSA group of records maintained by the Health Plan that are:Medical records and billing records about individuals maintained by or for the Health Plan;The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for the Health Plan; orUsed by or for the Health Plan to make decisions about individuals.The term “record” as used above means any item, collection, or grouping of information that includes PHI and is maintained, collected, used, or disseminated by or for the Health Plan.
Individual’s Right to Access and Copy PHIAn individual generally has a right to access and copy his/her PHI maintained in the DRS .
Written RequestRequest for inspection and copying of PHI must be submitted to the HIPAA Privacy Officer in writing.
Time Frame for Retrieval of Requested PHIInsofar as practical, the individual should allow at least thirty (30) days for the Health Plan to obtain requested information. Should an extension be necessary, the individual will be notified of such request. In no case may the extension exceed thirty (30) days.
Denial of AccessShould the individual be denied access to requested records, a written notice must be provided to the individual indicating such denial and the reason(s) for the denial.
Service FeesThe following charge(s) may be assessed for copying services:Per Page Fee: $0.10Postage Fee: $0.50 per ounceLabor Fee: $15.00 per request
ExceptionsIndividuals may be denied access to (1) psychotherapy notes, and (2) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
Denial of Access Without Right of ReviewDenial of access without a right of review may occur:Where information was compiled in anticipation of litigation;Where care was provided under the direction of a correctional institution and provision of access would jeopardize health, safety, or rehabilitation; andWhere information was collected in the course of research that includes treatment of the individual and the individual agreed to a suspension of the right of access during the research period.
Denial in Accordance with Other Applicable LawAccess may also be denied in accordance with other applicable law.
Denial of Access With Right of ReviewDenial of access with a right of review may occur:Where access is determined by a licensed professional to be likely to endanger life or safety of the individual or another person; andWhere access is required by the individual’s representative and a licensed professional determines that such access is reasonably likely to cause substantial harm.
Individual’s Right to Review by Another Licensed ProfessionalIf the basis for denial of access gives the individual a right to review, the individual has the right to have the denial reviewed by a licensed professional who did not participate in the original denial decision. Such review will be completed within thirty (30) days of such request. The Health Plan will provide the individual with a notice of the reviewer’s decision and will comply with the determination to either provide the requested information or deny access to such requested information.
Time Frame for Facility to Act Upon Individual’s Request for AccessThe Health Plan will act upon an individual’s request for access to his/her DRS no later than thirty (30) days after receipt of such request, unless the time period is extended as described below:
 If the information to be accessed is not maintained or accessible on premises, the Health Plan will act upon such request within sixty (60) days of receipt of such request.If the Health Plan is unable to act on the request within the applicable thirty (30) or sixty (60) day period, the Health Plan may extend the time for response by thirty (30) days, provided that the individual is given a written notice of the reason(s) for the delay and the date by which a responsive action will be taken.
Denial of Access Notice The Health Plan will provide a timely, written denial of access to the individual when such denials occur. Denial notices will be written in easy-to-read language and will include, as a minimum, the following information:The basis for the denial of access;Any right of review (as applicable);How to file a complaint with the Health Plan;The name and telephone number of the person to whom the complaint may be filed; andThe address of the U.S. Secretary of Health and Human Services.
Access to Requested InformationTo the extent practical, the individual will be given access to any information requested after excluding the information for which the Health Plan has grounds for denying access.
Access to Information Maintained Off PremisesShould the information for which access has been requested be maintained off premises or the Health Plan does not maintain/retain such information, but knows where the information is located, the Health Plan will either (a) notify the individual where to direct his/her request for access, or (b) otherwise make arrangements for the individual to access such information.
Record RetentionA copy of all HIPAA covered information and any revisions shall be maintained for a period of at least six (6) years. Such retention may be in printed or electronic format, or both.
Privacy OfficerThe Privacy Officer is responsible for the development and implementation of the HIPAA policies and procedures. The Privacy Officer is also the contact person for any questions or complaints regarding HIPAA. Questions or concerns about HIPAA rights should be directed to the Privacy Officer during regular business office hours Monday through Friday, except holidays at (651) 696-6280.
ViolationsViolations of this policy will be subject to discipline.