Right of Access to PHI

Op10.03-10 Right of Access to PHI

Complies with the Administrative Requirements of the Health Insurance Portability and Accountability Act of 1996. 45 CFR Section 164.524

Policy

Participants have the right to request to inspect or obtain a copy of their Protected Health Information ("PHI") in the designated record set.

Procedure

  • The Employee Benefit Plan requires and informs participants that requests for access to PHI must be made in writing to the Human Resources Assistant Director.
  • When a request for access to PHI is received, it will be acted upon according to the following time frames:
    • Within thirty (30) days if the requested information is maintained and accessible on site; or
    • Within sixty (60) days if the requested information is maintained off site.
  • If the request is granted, the Employee Benefit Plan informs the participant and provides the access requested, within the time frames above.
  • The time frames stated above may be extended one time for no more than thirty (30) days. If the extension is necessary, the Employee Benefit Plan will provide the participant, within the time frames above, a written statement that specifies the reason(s) for the delay and the date by which the participant may expect to receive a decision on the request to access the PHI for inspection and/or copying.
  • The Employee Benefit Plan documents the records that comprise the designated record set that is subject to access requests and maintains such records for a period of six (6) years from the date they were created or were last in effect, whichever is later.
  • The Employee Benefit Plan maintains the titles of the persons/offices responsible for receiving and processing access requests for a period of six (6) years.
When the Employee Benefit Plan denies a request for access (in whole or in part (164.524(d)):
  • The participant is given a statement written in plain language that includes:
    • the reasons for the denial decision;
    • if applicable, the participant's right to a review of the decision with an explanation of how to exercise this right; and
    • a description of how the participant may file a complaint with the Employee Benefit Plan and DHHS, including the title and telephone number of a Employee Benefit Plan contact person.
  • To the extent possible, the Employee Benefit Plan will grant access to other PHI for which there are no grounds to deny access.
  • If the denial is reviewable and the participant requests such a review, the Employee Benefit Plan will designate a licensed health care professional, not involved in the original denial decision, to serve as a reviewing official. Upon receipt of a review request, the Employee Benefit Plan will promptly refer the denial to the reviewing official for reevaluation. The Employee Benefit Plan will provide written notice to the participant of the reviewing official's determination.
  • If the Employee Benefit Plan denies access because it does not maintain the PHI requested but knows where the requested PHI is maintained, the Employee Benefit Plan will inform the participant of where to direct the request.
When a request for access is accepted (in whole or in part (164.524(c)):
  • The participant is notified of the decision and may choose to inspect the PHI, copy it, or both, in the form or format requested.
  • In lieu of providing access, the Employee Benefit Plan may provide a summary of the requested PHI for an additional charge if the participant agrees to the summary and to the additional fee.
  • The Employee Benefit Plan and the participant will arrange a mutually convenient time and place for the participant to inspect and/or obtain a copy of the requested PHI.
  • The Employee Benefit Plan will mail a copy of the requested PHI if the participant prefers this method of obtaining a copy.
Fees charged by the Employee Benefit Plan for access to PHI (164.524(c)):
  • The Employee Benefit Plan charges a reasonable, cost-based fee for copying, including labor and supplies (for instance, paper, computer disks).
  • The Employee Benefit Plan charges the cost of postage when the participant requests that the information be mailed.
  • No fee is charged for retrieving or handling the PHI or for processing the participant's access request.
  • The Employee Benefit Plan may charge a nominal fee for preparing an explanation or summary of the requested PHI if the participant is informed of and agrees to receive a summary of the PHI and is willing to pay the fee.

Effective Date: April 14, 2003