| Disclosures that are not part of treatment, payment, and/or health care operations and that are not authorized by the client must be tracked in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Los Angeles County Department of Mental Health (DMH) clients have the right to receive an accounting of disclosures of PHI made by DMH during a time period specified up to six (6) years prior to the date of the request, but not before April 14, 2003, including disclosures to or by business associates or Memorandum of Understanding (MOU) Departments.
Clients have the right to know who has received their health information for reasons other than treatment, payment, or health care operations, or disclosures specifically authorized by the client. - Examples of this are public health activities (reporting vital statistics, communicable diseases, cancer/tumor registries); reports about victims of abuse, neglect, or domestic violence; releases as a result of a subpoena; disclosures about decedents to coroners, medical examiners, or funeral directors; and other disclosures required by law.
Accounting Requirements – General
The accounting must include all disclosures, except for disclosures: -
To carry out treatment, payment, and health care operations; -
To clients of PHI about themselves; -
Incident to a use or disclosure otherwise permitted or required by the Privacy Regulations; -
Pursuant to the client’s authorization; -
For a facility directory or to persons involved in the client’s care or other notification purposes (e.g., disaster relief assistance) permitted by law; -
For national security or intelligence purposes; -
To correctional institutions or law enforcement officials to provide them with information about a person in their custody; -
As part of a limited data set; or -
That occurred prior to the compliance date. Examples of Disclosures Subject to the Accounting Requirement
These include, but are not limited to, disclosures for or pursuant to: -
Research, unless authorized by the client; -
Subpoenas, court orders, or discovery requests; -
Abuse and/or neglect reporting; -
Communicable disease reporting; or -
Other reports to the Department of Health such as tumor registry, etc. Accounting Requirements – Research Involving More than 50 Participants
If, during the period covered by the accounting, DMH made disclosures of PHI for a particular research purpose for 50 or more individuals, the accounting may, with respect to such disclosures for which the PHI about the client may have been included, provide: -
The name of the protocol or other research activity; -
A description, in plain language, of the research protocol or other research activity, including the purpose of the research and the criteria for selecting particular records; -
A brief description of the type of PHI that was disclosed; -
The date or period of time during which such disclosures occurred, or may have occurred, including the date of the last such disclosure during the accounting period; -
The name, address, and telephone number of the entity that sponsored the research and of the researcher to whom the information was disclosed; and -
A statement that the PHI of the client may or may not have been disclosed for a particular protocol or other research activity. If DMH provides an accounting for research disclosures as described above, and if it is reasonably likely that the PHI of the client requesting the accounting was disclosed for such research, DMH shall, at the request of the client, assist in contacting the entity that sponsored the research and the researcher.
The research accounting provision above permits DMH to meet the requirement for research disclosures if it provides clients with a list of all protocols for which their PHI may have been disclosed for research purposes pursuant to a waiver of authorization by the Institutional Review Board (IRB). To use this method of accounting the disclosure must involve at least 50 records.
Suspension of Accounting
A client’s right to receive an accounting of disclosure may be suspended at the request of a health oversight agency or law enforcement official if certain conditions are satisfied. -
If DMH receives a request to suspend the client’s right to receive an accounting from a health oversight agency or law enforcement official, County Counsel shall be contacted to determine if the appropriate conditions have been satisfied. -
If the request from a health oversight agency or law enforcement is verbal, DMH shall document the statement, including the identity of the agency or official making the request, and temporarily suspend the individual’s right to an accounting. -
Such suspension shall be no longer than 30 days from the date of the verbal statement unless a written statement is submitted during the 30 days with a time frame exceeding the 30 days. -
A written statement from a health oversight agency or law enforcement to request suspension of accounting must state that such accounting would be reasonably likely to impede their activities. The written statement must also specify the time for which a suspension of rights is required. |
