Montana Code 33-36-305. Confidentiality of health care and quality assurance records — disclosure
33-36-305. Confidentiality of health care and quality assurance records — disclosure. (1) Except as provided in subsection (2), the following information held by a health carrier offering a closed plan or a combination plan is confidential and may not be disclosed by the carrier to a person:
Terms Used In Montana Code 33-36-305
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Closed plan: means a managed care plan that requires covered persons to use only participating providers under the terms of the managed care plan. See Montana Code 33-36-103
- Combination plan: means an open plan with a closed component. See Montana Code 33-36-103
- Covered person: means a policyholder, subscriber, or enrollee or other individual participating in a health benefit plan. See Montana Code 33-36-103
- Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
- Health carrier: means an entity subject to the insurance laws and rules of this state that contracts, offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a disability insurer, health maintenance organization, or health service corporation or another entity providing a health benefit plan. See Montana Code 33-36-103
- Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
- provider: means a health care professional or a facility. See Montana Code 33-36-103
- Quality assessment: means the measurement and evaluation of the quality and outcomes of medical care provided to individuals, groups, or populations. See Montana Code 33-36-103
- Quality assurance: means quality assessment and quality improvement. See Montana Code 33-36-103
- Quality improvement: means an effort to improve the processes and outcomes related to the provision of health care services within a health plan. See Montana Code 33-36-103
- Subpoena: A command to a witness to appear and give testimony.
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
(a)information pertaining to the diagnosis, treatment, or health of a covered person, regardless of whether the information is in the form of paper, is preserved on microfilm, or is stored in computer-retrievable form;
(b)information considered by a quality assurance program and the records of its actions, including testimony of a member of a quality committee, of an officer, director, or other member of a health carrier or its staff engaged in assisting the quality committee or engaged in the health carrier’s quality assessment, quality improvement, or quality assurance activities, or of any person assisting or furnishing information to the quality committee.
(2)The information specified in subsection (1) may be disclosed:
(a)as allowed by Title 33, chapter 19;
(b)as required in proceedings before the commissioner, a professional or occupational licensing board provided in Title 37, or the department of public health and human services pursuant to Title 50, chapter 5, part 2;
(c)in an appeal, if an appeal is permitted, from a quality committee’s findings or recommendations; or
(d)as otherwise required by law or court order, including a judicial or administrative subpoena.
(3)Information specified in subsection (1) identifying:
(a)the provider may also be disclosed upon a written, dated, and signed approval of the provider if the information does not identify the covered person;
(b)the covered person may also be disclosed upon a written, dated, and signed approval of the covered person or of the parent or guardian of a covered person if the covered person is a minor and if the information does not identify the provider;
(c)neither the provider nor the covered person may also be disclosed upon request for use for statistical purposes only.