If a health care service plan requests medical information from providers in order to determine whether to approve, modify, or deny requests for authorization of services, the plan shall request only the information reasonably necessary to make the determination.
A provider of health care or a health care service plan may disclose medical information in the following circumstances: 1) to other healthcare providers to facilitate diagnosis and treatment 2) to find financially liable party and obtain payment 3) to administrative subcontractors 4) quality control organizations (peer review boards, etc.) 5) accrediting agencies 6) coroners 7) \bona fide research purposes\" 8) employer
In order to obtain and maintain a registration, in-state or out-of-state telephone medical advice services shall comply with the requirements established by the Department of Consumer Affairs. The service providers must maintain records of telephone medical advice services provided to California patients [e.g. oral or written transcripts of all medical advice conversations with the health care service plan's enrollees or subscribers in California] and records of complaints, for at least five years.
Every professional liability insurer, self-insured governmental agency, or licensee (or counsel) must file a complete report of any settlement or arbitration award over $30,000 emanating from a claim for death or personal injury caused by the licensee's alleged negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services, if the license was granted by either the Medical Board of California, the Osteopathic Medical Board of California, or the California Board of Podiatric Medicine.
Investigative consumer reporting agency shall not furnish report to employer, court, insurance, or landlord if it includes medical information unless consumer consents.
The section provides immunity to consultants who communicate with the Director of the Department of Managed Health Care for the purpose of determining whether health care services are being provided in accordance with the Knox-Keene Act of 1975. Nothing in the code section alters existing laws regarding the confidentiality of medical records.
The CMIA defines the following terms: health care service plan; authorization; authorized recipient; contractor; licensed health care professional; marketing; medical information; patient; pharmaceutical company; and provider of health care.
No provider of health care, health care service plan, or contractor shall disclose medical information regarding a patient of the provider of health care or an enrollee or subscriber of a health care service plan without first obtaining an authorization, except as provided in subdivision (b) or (c).
No provider of health care, health care service plan, or contractor may require a patient, as a condition of receiving health care services, to sign an authorization, release, consent, or waiver that would permit the disclosure of medical information that otherwise may not be disclosed.
Support orders issued or modified shall include a provision requiring the child support obligor to keep the agency informed of whether the obligor has health insurance coverage and, if so, the health insurance policy information. The court shall require that health insurance coverage for a supported child shall be maintained by either or both parents if that insurance is available at no cost or at a reasonable cost to the parent.
