Billing Manual for Community Care Network Providers

III.C.4 Ability to Give Informed Authorization for Release of Member IdentifiableInformationCommunity Care obtains special authorization from members or representatives torelease member identifiable information, as described in the procedure for Disclosure ofInformation (See Section III.C.6). Community Care has made the followingdeterminations regarding the giving of valid authorization for the release of memberidentifiable health information:A member who has reached the age of majority as identified by Community Care’seligibility data is capable of giving informed authorization for release of informationon his or her own behalf unless Community Care has received notification that themember has been adjudicated incompetent.The natural or adoptive parent of a minor member, as identified by CommunityCare’s eligibility data, is capable of giving informed authorization for release ofinformation on behalf of the minor member unless Community Care has beeninformed that the parent has been adjudicated incompetent, the parent is not thelegal guardian of the minor member, or the minor member has been legallyemancipated.An emancipated minor member is capable of giving informed authorization on his orher own behalf. If not already on file with Community Care, Community Care willrequest proof of the minor member’s status from the minor member before honoringthe authorization for release of member information.Community Care expends all reasonable effort to develop and maintain an accurate andefficient system for identifying who is eligible to give valid authorization for release ofmember identifying information. Having established such a system, Community Carereasonably relies on the absence of information indicating that a member or parent of aminor member has been adjudicated incompetent or that a parent is not a minormember’s legal representative, for accepting an authorization for release of informationas valid. Verifying that a member or parent of a minor member is competent wouldplace an undue burden on Community Care and in most instances would require abreach of confidentiality.When Community Care is informed that a member is unable to give specialauthorization for the release of information, Community Care will accept authorizationfrom and/or release records to, a representative legally authorized to approve(authorize) the release of, or to receive, a member’s personal health information.Community Care requires written proof of the individual’s status as a legally authorizedrepresentative of the member and that the status as a legally authorized representativecovers the area for which the authorization for information is being sought.Individuals capable of giving valid authorization for the release of member identifiablehealth information are also entitled to have access to that information, except thatparents or guardians of children age 14 years or over may not have access to thechild’s health information without the authorization of the child.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 72