Policy for sharing Protected Health Information of Enrollees between the MCO and the Health Home Prior to the Member Signing a Health Home Consent
In accordance with the Medicaid Managed Care contract, Section 20.3, medical records, which include protected health information, of an enrollee shall be confidential and shall only be disclosed to and by other persons within the MCO's organization, including Participating Providers such as contracted Health Homes, only as necessary to provide medical care, which includes the provision of care coordination.
The Department of Health has determined that in accordance with the Medicaid Managed Care Contract and all Federal and State laws and regulations regarding confidentiality that absent a specific consent from the enrollee, a MCO may share with a contracted Health Home (to which the enrollee has not yet signed a Health Home consent) the last five claims or encounter data (defined as: The last 5 claims are based on service date, and must fall within the criteria for Loyalty which is inpatient, primary care, ER, and case management.), as well as two years of loyalty analysis showing the Enrollee's provider history for the purpose of outreach and engagement of the Enrollee within a Health Home network.
