16 Del. Admin. Code § 14000-14840

Current through Register Vol. 28, No. 7, January 1, 2025

Section 14000-14840 - Confidentiality

Section 1902(a)(7) of the Social Security Act and 42 CFR Subpart F require Medicaid agencies to provide safeguards that restrict the use or disclosure of information about applicants and recipients to purposes directly connected with the administration of the Medicaid Program.

Purposes directly related to administration of the Medicaid Program include establishing eligibility, providing services for recipients, determining the amount of medical assistance, and conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the program.

At a minimum, the types of information about applicants and recipients that must be safeguarded and not released without consent include:

a. Names and addresses;

b. Medical services provided;

c. Social and economic conditions or circumstances;

d. Agency evaluation of personal information;

e. Medical data, including diagnosis and past history of disease or disability;

f. Information received for verifying income eligibility and amount of medical assistance payments; and

g. Information about third party liability.

See Administrative Notice:

A-14-98 Subpoenas for Public Assistance Records

14840.1 Release Of Information To Medicaid Providers

Medicaid providers have a contractual obligation to safeguard information about Medicaid recipients. Providers may have access to certain eligibility information if they can provide:

·	a Medicaid identification number (MCI)

or

·	two of the following identifying factors: individual's full name, date of birth, Social Security number;

AND

the date of service.

Providers who supply the above identifying factors may be given the following information:

a. correct spelling of the recipient's name;

b. MCI number;

c. date of birth;

d. an indication whether the individual is eligible for the date of service given or for a range of dates given. Providers may not be given all periods of eligibility;

e. third party liability information including policy number and type of coverage (for Medicare, only a yes/no indicator for Parts A and B may be provided);

f. prior authorization requirements;

g. restricted coverage.

NOTE: Transportation providers may be given the address and phone number of the recipient because this information is necessary to provide the service.

14840.2 Release Of Information To Interagencies

At the time of application, individuals are informed that all eligibility information is confidential and disclosure without written permission of the individual is limited. Medicaid has the authority to responsibly share information concerning applicants and recipients with:

a. other DHSS employees;

b. other Federal or federally assisted programs that provide assistance to individuals on the basis of need (SSI, HUD);

c. contracted service providers (DCIS and HCBS contractors);

d. consultants (Pre-Admission Screening Annual Resident Review or PASARR, physician consultant);

e. members of multidisciplinary teams providing direct services to the clients (DDDS teams composed of nurse, social worker, and psychologist); and

f. persons officially charged with administrative audit or program evaluation (Independent Professional Review or IPR, Peer Review Organization or PRO).

14840.3 Release Of Information For Legal Requests And An Emergency Situation

Information may be released to comply with a subpoena or other valid court order and in emergency situations when necessary to protect or warn others of imminent threats to their safety. In these circumstances, the case record will be documented with the reason for the disclosure and written notification of the disclosure will be sent to the client's last known address.

14840.4 Release Of Information To Others

Medicaid must obtain specific written permission from the individual before releasing information to other persons or sources.

16 Del. Admin. Code § 14000-14840