Amendment AA1-ASA1-AB552

LRBa1518/1

PJK&KSH:jlg:ch

1997 - 1998 LEGISLATURE

ASSEMBLY AMENDMENT 1, TO ASSEMBLY SUBSTITUTE AMENDMENT 1, TO 1997 ASSEMBLY BILL 552

February 5, 1998 - Offered by Joint committee on Information Policy.

AB552-ASA1-AA1,1,1 At the locations indicated, amend the substitute amendment as follows:

AB552-ASA1-AA1,1,4 1. Page 2, line 2: after "records," insert "authorizing disclosure of personal medical information to an insurer, disclosure by an insurer of personal medical information,".

AB552-ASA1-AA1,1,5 2. Page 3, line 11: after that line insert:

AB552-ASA1-AA1,1,6 " Section 5c. 51.30 (4) (a) of the statutes is amended to read:

AB552-ASA1-AA1,2,2 51.30 (4) (a) Confidentiality of records. Except as otherwise provided in this chapter and ss. 610.70 (3) and (5), 905.03 and 905.04, all treatment records shall remain confidential and are privileged to the subject individual. Such records may be released only to the persons designated in this chapter or ss. 610.70 (3) and (5), 905.03 and 905.04, or to other designated persons with the informed written consent of the subject individual as provided in this section. This restriction applies to elected officials and to members of boards appointed under s. 51.42 (4) (a) or 51.437 (7) (a).

AB552-ASA1-AA1, s. 16m Section 16m. 146.82 (2) (b) of the statutes is amended to read:

AB552-ASA1-AA1,2,7 146.82 (2) (b) Unless Except as provided in s. 610.70 (3) and (5), unless authorized by a court of record, the recipient of any information under par. (a) shall keep the information confidential and may not disclose identifying information about the patient whose patient health care records are released.".

AB552-ASA1-AA1,2,8 3. Page 15, line 15: after that line insert:

AB552-ASA1-AA1,2,9 " Section 56m. 610.70 of the statutes is created to read:

AB552-ASA1-AA1,2,11 610.70 Disclosure of personal medical information. (1) Definitions. In this section:

AB552-ASA1-AA1,2,15 (a) "Health care provider" means any person licensed, registered, permitted or certified by the department of health and family services or the department of regulation and licensing to provide health care services, items or supplies in this state.

AB552-ASA1-AA1,2,19 (b) "Individual" means a natural person who is a resident of this state. For purposes of this paragraph, a person is a state resident if his or her last-known mailing address, according to the records of an insurer or insurance support organization, was in this state.

AB552-ASA1-AA1,3,3 (c) 1. "Insurance support organization" means any person that regularly engages in assembling or collecting personal medical information about natural persons for the primary purpose of providing the personal medical information to insurers for insurance transactions, including the collection of personal medical information from insurers and other insurance support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity.

AB552-ASA1-AA1,3,5 2. Notwithstanding subd. 1., "insurance support organization" does not include insurance agents, government institutions, insurers or health care providers.

AB552-ASA1-AA1,3,7 (d) "Insurance transaction" means any of the following involving insurance that is primarily for personal, family or household needs:

AB552-ASA1-AA1,3,9 1. The determination of an individual's eligibility for an insurance coverage, benefit or payment.

AB552-ASA1-AA1,3,10 2. The servicing of an insurance application, policy, contract or certificate.

AB552-ASA1-AA1,3,19 (e) "Medical care institution" means a facility, as defined in s. 647.01 (4), or any hospital, nursing home, community-based residential facility, county home, county infirmary, county hospital, county mental health center, tuberculosis sanatorium, adult family home, assisted living facility, rural medical center, hospice or other place licensed, certified or approved by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.90, 51.04, 51.08, 51.09, 58.06, 252.073 or 252.076 or a facility under s. 45.365, 51.05, 51.06 or 252.10 or under ch. 233 or licensed or certified by a county department under s. 50.032 or 50.033.

AB552-ASA1-AA1,3,21 (f) 1. "Personal medical information" means information concerning an individual that satisfies all of the following:

AB552-ASA1-AA1,3,23 a. Relates to the individual's physical or mental health, medical history or medical treatment.

AB552-ASA1-AA1,3,25 b. Is obtained from a health care provider, a medical care institution, the individual or the individual's spouse, parent or legal guardian.

AB552-ASA1-AA1,4,4 2. "Personal medical information" does not include information that is obtained from the public records of a governmental authority and that is maintained by an insurer or its representatives for the purpose of insuring title to real property located in this state.

AB552-ASA1-AA1,4,7 (2) Disclosure authorization. (a) Any form that is used in connection with an insurance transaction and that authorizes the disclosure of personal medical information about an individual to an insurer shall comply with all of the following:

AB552-ASA1-AA1,4,9 1. All instructions and other information contained in the form are presented in plain language.

AB552-ASA1-AA1,4,10 2. The form is dated.

AB552-ASA1-AA1,4,12 3. The form specifies the types of persons that are authorized to disclose information about the individual.

AB552-ASA1-AA1,4,14 4. The form specifies the nature of the information that is authorized to be disclosed.

AB552-ASA1-AA1,4,16 5. The form names the insurer, and identifies by generic reference representatives of the insurer, to whom the information is authorized to be disclosed.

AB552-ASA1-AA1,4,17 6. The form specifies the purposes for which the information is being obtained.

AB552-ASA1-AA1,4,19 7. Subject to par. (b), the form specifies the length of time for which the authorization remains valid.

AB552-ASA1-AA1,4,21 8. The form advises that the individual, or an authorized representative of the individual, is entitled to receive a copy of the completed authorization form.

AB552-ASA1-AA1,5,2 (b) 1. For an authorization under this subsection that will be used for the purpose of obtaining information in connection with an insurance policy application, an insurance policy reinstatement or a request for a change in policy benefits, the length of time specified in par. (a) 7. may not exceed 30 months from the date on which the authorization is signed.

AB552-ASA1-AA1,5,6 2. For an authorization under this subsection that will be used for the purpose of obtaining information in connection with a claim for benefits under an insurance policy, the length of time specified in par. (a) 7. may not exceed the policy term or the pendency of a claim for benefits under the policy, whichever is longer.

AB552-ASA1-AA1,5,12 (3) Access to recorded personal medical information. (a) If, after proper identification, an individual or an authorized representative of an individual submits a written request to an insurer for access to recorded personal medical information that concerns the individual and that is in the insurer's possession, within 30 business days after receiving the request the insurer shall do all of the following:

AB552-ASA1-AA1,5,15 1. Inform the individual or authorized representative of the nature and substance of the recorded personal medical information in writing, by telephone or by any other means of communication at the discretion of the insurer.

AB552-ASA1-AA1,5,22 2. At the option of the individual or authorized representative, permit the individual or authorized representative to inspect and copy the recorded personal medical information, in person and during the insurer's normal business hours, or provide by mail to the individual or authorized representative a copy of the recorded personal medical information. If the recorded personal medical information is in coded form, the insurer shall provide to the individual or authorized representative an accurate written translation in plain language.

AB552-ASA1-AA1,6,3 3. Disclose to the individual or authorized representative the identities, if recorded, of any persons to whom the insurer has disclosed the recorded personal medical information within 2 years prior to the request. If the identities are not recorded, the insurer shall disclose to the individual or authorized representative the names of any insurance agents, insurance support organizations or other entities to whom such information is normally disclosed.

AB552-ASA1-AA1,6,7 4. Provide to the individual or authorized representative a summary of the procedures by which the individual or authorized representative may request the correction, amendment or deletion of any recorded personal medical information in the possession of the insurer.

AB552-ASA1-AA1,6,16 (b) Notwithstanding par. (a), an insurer may, in the insurer's discretion, provide a copy of any recorded personal medical information requested by an individual or authorized representative under par. (a) to a health care provider who is designated by the individual or authorized representative and who is licensed, registered, permitted or certified to provide health care services with respect to the condition to which the information relates. If the insurer chooses to provide the information to the designated health care provider under this paragraph, the insurer shall notify the individual or authorized representative, at the time of disclosure, that the information has been provided to the health care provider.

AB552-ASA1-AA1,6,20 (c) An insurer is required to comply with par. (a) or (b) only if the individual or authorized representative provides a reasonable description of the information that is the subject of the request and if the information is reasonably easy to locate and retrieve by the insurer.

AB552-ASA1-AA1,7,2 (d) If an insurer receives personal medical information from a health care provider or a medical care institution with instructions restricting disclosure of the information under s. 51.30 (4) (d) 1. to the individual to whom the information relates, the insurer may not disclose the personal medical information to the individual under this subsection, but shall disclose to the individual the identity of the health care provider or a medical care institution that provided the information.

AB552-ASA1-AA1,7,5 (e) Any copy of recorded personal medical information provided under par. (a) or (b) shall include the identity of the source of the information if the source is a health care provider or a medical care institution.

AB552-ASA1-AA1,7,8 (f) An insurer may charge the individual a reasonable fee to cover the costs incurred in providing a copy of recorded personal medical information under par. (a) or (b).

AB552-ASA1-AA1,7,11 (g) The requirements for an insurer under this subsection may be satisfied by another insurer, an insurance agent, an insurance support organization or any other entity authorized by the insurer to act on its behalf.

AB552-ASA1-AA1,7,15 (h) The requirements under this subsection do not apply to information concerning an individual that relates to, and that is collected in connection with or in reasonable anticipation of, a claim or civil or criminal proceeding involving the individual.

AB552-ASA1-AA1,7,19 (4) Correction, amendment or deletion of recorded personal medical information. (a) Within 30 business days after receiving a written request from an individual to correct, amend or delete any recorded personal medical information that is in the insurer's possession, an insurer shall do either of the following: