Source: http://ksag.washburnlaw.edu/opinions/2002/2002-004.htm
Timestamp: 2019-04-19 02:46:54+00:00

Document:
Under subsection (e) of 45 C.F.R. § 164.512, a professional licensing board must provide prior notice to the client or patient, or attempt to secure a qualified protective order, before a health care provider may disclose health information records pursuant to a licensing board-issued investigative subpoena. Under subsection (d) of 45 C.F.R. § 164.512, these preliminary steps are not required prior to the issuance of a subpoena for investigative purposes by the Behavioral Sciences Regulatory Board or the Board of Healing Arts. As long as a licensing board-issued subpoena complies with statutory requirements regarding grounds for disciplinary action, relevancy and particularity, either Board would be able to access health information records concerning an individual that are maintained by a health care provider. Cited herein: K.S.A. 65-2839a; 74-7508, as amended by L. 2001, Ch. 154, § 1(b)(1); 45 C.F.R. §§ 160.103; 164.104; 164.501; 164.502; 164.512.
As General Counsel for the Kansas Board of Healing Arts you request that we re-visit the conclusion reached in Part 3 of Attorney General Opinion No. 2001-36. You suggest that the conclusion reached therein was more restrictive in relation to the ability of state licensing agencies to obtain health information records than intended by federal privacy regulations. For the reasons stated herein, we agree and thus expand that conclusion.
"Pursuant to the authority granted by the Health Insurance Portability and Accountability Act of 1996, the Health Care Financing Administration, a division of the Department of Health and Human Services, issued final regulations related to the security and privacy of health care information.48 Although the regulations became effective April 16, 2001, the Department of Health and Human Services has given health care providers two years to achieve compliance.
"The obligations of these broad regulations apply to covered entities: 'health plans, health care clearinghouses, and health care providers'49 who 'transmit health information in electronic form in connection with certain transactions.'50 Health care includes 'preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, and counseling, service, assessment or procedure with respect to the physical or mental condition or functional status of an individual or that affects the structure or function of the body.'51 A psychologist is clearly considered a covered health care provider.
"The general privacy rule established by these regulations provides that a covered entity may not use or disclose protected health information, except as permitted or required by the regulations.52 Six general categories of permitted uses and disclosures are specified: (1) to the individual, (2) with a consent that complies with specified requirements, (3) without consent under certain conditions, except with respect to psychotherapy notes, (4) with an authorization that complies with specified requirements, (5) pursuant to an agreement as specified by the regulations and (6) as permitted by and in compliance with the section titled 'Uses and disclosures for which consent, an authorization, or opportunity to agree or object is not required.'53 It is this last disclosure category with which we are concerned.
"Assuming, therefore, that the Board complies with requirements of 45 C.F.R. 164.512(e) regarding notice or attempt to secure a qualified protective order and a Board-issued subpoena complies with statutory requirements regarding grounds for disciplinary action, relevancy and particularity, the Board would be able to access health information records, including psychotherapy notes, concerning an individual that are maintained by a health care provider, such as a psychologist.
"48 45 C.F.R. § 160 et seq. and 45 C.F.R. § 164 et seq.
"49 'Health care provider' includes any person or organization who furnishes, bills, or is paid for health care in the normal course of business. 45 C.F.R. § 160.103.
"50 45 C.F.R. § 164.104.
"51 45 C.F.R. § 160.103.
"52 45 C.F.R. § 164.502.
"54 45 C.F.R. § 164.512(e). The other circumstances for which uses and/or disclosure is authorized under this subsection are as required by law, for public health activities, about victims of abuse, neglect or domestic violence, for health oversight activities, for law enforcement purposes, about decedents, for cadaveric organ, eye or tissue donation purposes, for research purposes, to avert a serious threat to health or safety, for specialized government functions, and for workers' compensation. 45 C.F.R. § 160.512(a) through (l).
"55 45 C.F.R. § 164.512 [reference omitted].
"56 45 C.F.R. § 164.508(a).
Additionally, according to the Department of Health and Human Services, "overseeing the health care system" includes "oversight of health care providers."(5) In our opinion the Behavioral Sciences Regulatory Board and the Board of Healing Arts would be considered health oversight agencies.
As discussed in our earlier opinion, under subsection (e) of 45 C.F.R. § 164.512, a professional licensing board must provide prior notice to the client or patient, or attempt to secure a qualified protective order, before a health care provider may disclose health information records pursuant to a board-issued investigative subpoena. Under subsection (d) of 45 C.F.R. § 164.512 these preliminary steps are not required prior to the issuance of a subpoena for investigative purposes by the Behavioral Sciences Regulatory Board or the Board of Healing Arts. As long as a licensing board-issued subpoena complies with statutory requirements regarding grounds for disciplinary action, relevancy and particularity, either Board, without taking the preliminary steps, would be able to access health information records, including psychotherapy notes,(6) concerning an individual that are maintained by a health care provider.
1. 45 C.F.R. Parts 160 through 164.
2. We note that the Board of Healing Arts investigative subpoena authority found at K.S.A. 65-2839a is nearly identical to that of the Behavioral Sciences Regulatory Board's authority found at K.S.A. 74-7508, as amended by L. 2001, Ch. 154, § 1(b)(1).
3. 45 C.F.R. § 164.501.
4. 65 Federal Register 82492 (Dec. 28, 2000), Section-by-Section Description of Rule Provisions, "Health Oversight Agency."
6. "[A] covered entity must obtain an authorization for any use or disclosure of psychotherapy notes, except: . . . (ii) A use or disclosure that is . . . permitted by § 164.512(d) with respect to the oversight of the originator of the psychotherapy notes; . . ." 45 C.F.R. 164.508(a)(2).

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