Session Laws

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Section 135 of chapter 112 of the General Laws, as amended by chapter 524 of the acts of 1985, is hereby further amended by adding the following paragraph:-

The provision of information acquired by a social worker in any licensed category from persons consulting him in his professional capacity, to any insurance company, nonprofit hospital service corporation, medical service corporation, or health maintenance organization, or to a board established pursuant to section twelve of chapter one hundred and seventy-six B, pertaining to the administration or provision of benefits, including utilization review or peer review, provided for expenses arising from the out-patient diagnosis or treatment, or both, of mental or nervous conditions, shall not constitute a waiver or breach of any right to which a person consulting said social worker is otherwise entitled under this section.

SECTION 2. Chapter 175 of the General Laws is hereby amended by inserting after section 108D the following section:-

Section 108E. No company may, without the express and informed written consent of its insured or a covered family member of the insured, disclose any information it may have acquired from or about any such insured or covered family member pertaining to the administration of benefits provided for expenses arising from the out-patient diagnosis or treatment, or both, of mental or nervous conditions; provided, however, that:

(a) no such written consent from such subscriber or covered family member shall be made a condition of the receipt of such benefits or any other benefits for which the insured is covered under any blanket or general policy of insurance described in subdivision (A), (C), or (D) of section one hundred and ten;

(b) nothing contained in this section shall prohibit the disclosure of any information held by such company which is not privileged pursuant to section one hundred and thirty-five of chapter one hundred and twelve or section twenty B of chapter two hundred and thirty-three;

(c) a company shall not be prohibited from disclosing aggregate patient data if such data contains no information personally identifying any insured or family member of the insured;

(d) a company shall not be prohibited from disclosing patient utilization data to a law enforcement authority, a state board of registration, or a court of competent jurisdiction if the company, a law enforcement authority, or a state board of registration has reason to believe (i) a patient is committing or has committed fraud, or (ii) a provider is committing or has committed fraud or professional misconduct related to the provision of such diagnosis or treatment;

(e) nothing contained herein shall prohibit a company from using or disclosing patient information for coordination of benefits, subrogation, peer review or utilization review. For the purposes of this clause the term "coordination of benefits" shall mean the determination of primary and secondary responsibility for the payment of a claim between or among two or more insurers providing the same or similar coverage to an insured. Nothing contained herein shall prohibit a company from disclosing patient or provider identifiers to a self-insured plan administered by said company; provided, however, that such identifiers shall be used only for purposes of billing and audit; or

(f) nothing contained herein shall prohibit a company from disclosing patient information to an account which is self-insured in whole or in part, and administered by such company for research to be conducted by the account; provided, however, that no patient shall be the subject of such research without having first been notified by the account in writing of the scope and purpose of the research. Such written notice shall clearly state that the patient will not be a participant in any such research and will not be penalized in any way if the patient elects in writing to be excluded. Any research conducted by an account under this clause shall maintain the confidentiality of all identifiable patient information.

SECTION 3. Chapter 176A of the General Laws is hereby amended by inserting after section 14A the following section:-

Section 14B. No nonprofit hospital service corporation may, without the express and informed written consent of its subscriber or a covered family member of its subscriber, disclose any information it may have acquired from or about any such subscriber or covered family member pertaining to the administration of benefits provided for expenses arising from the out-patient diagnosis or treatment, or both, of mental or nervous conditions; provided, however, that:

(a) no such written consent from such subscriber or covered family member shall be made a condition of the receipt of such benefits or any other benefits for which the insured subscribes;

(b) nothing contained herein shall prohibit the disclosure of any information held by such nonprofit hospital service corporation which is not privileged pursuant to section one hundred and thirty-five of chapter one hundred and twelve or section twenty B of chapter two hundred and thirty-three;

(c) a nonprofit hospital service corporation shall not be prohibited from disclosing aggregate patient data if such data contains no information personally identifying any insured or family member of the insured;

(d) a nonprofit hospital service corporation shall not be prohibited from disclosing patient utilization data to a law enforcement authority, a state board of registration, or a court of competent jurisdiction if the nonprofit hospital service corporation, a law enforcement authority, or a state board of registration has reason to believe (i) a patient is committing or has committed fraud, or (ii) a provider is committing or has committed fraud or professional misconduct related to the provision of such diagnosis or treatment;

(e) nothing contained herein shall prohibit a nonprofit hospital service corporation, from using or disclosing patient information for coordination of benefits, subrogation, peer review or utilization review. For the purposes of this clause the term "coordination of benefits" shall mean the determination of primary and secondary responsibility for the payment of a claim between or among two or more insurers providing the same or similar coverage to an insured. Nothing contained herein shall prohibit a nonprofit hospital service corporation from disclosing patient or provider identifiers to a self-insured plan administered by said nonprofit hospital service corporation; provided, however, that such identifiers shall be used only for purposes of billing and audit; or

(f) nothing contained herein shall prohibit a nonprofit hospital service corporation from disclosing patient information to an account which is self-insured in whole or in part, and administered by such corporation for research to be conducted by the account; provided, however, that no patient shall be the subject of such research without having first been notified by the account in writing of the scope and purpose of the research. Such written notice shall clearly state that the patient will not be a participant in any such research and will not be penalized in any way if the patient elects in writing to be excluded. Any research conducted by an account under this clause shall maintain the confidentiality of all identifiable patient information.

SECTION 4. Section 12 of chapter 176B of the General Laws is hereby amended by adding the following paragraph:-

Any dispute or controversy arising between a medical service corporation and any participating psychiatrist, psychologist or social worker licensed under the laws of the commonwealth, or any subscriber, which is submitted by any aggrieved person to a board established pursuant to the provisions of this section shall be heard by such board in such a manner as to protect the privacy of all patient information which is the subject of such dispute or controversy or which comes to the attention of the board in its review. In furtherance of the protection of such privacy a board may and is hereby authorized to exclude the public during its hearing and deliberation of such cases.

SECTION 5. Said chapter 176B is hereby further amended by adding the following section:-

Section 20. No medical service corporation may, without the express and informed written consent of its subscriber or a covered family member of its subscriber, disclose any information it may have acquired from or about any such subscriber or covered family member pertaining to the administration of benefits provided for expenses arising from the out-patient diagnosis or treatment, or both, of mental or nervous conditions; provided, however, that:

(a) no such written consent from such subscriber or covered family member shall be made a condition of the receipt of such benefits or any other benefits for which the insured subscribes;

(b) nothing contained herein shall prohibit the disclosure of any information held by such medical service corporation which is not privileged pursuant to section one hundred and thirty-five of chapter one hundred and twelve or section twenty B of chapter two hundred and thirty-three;

(c) a medical service corporation shall not be prohibited from disclosing aggregate patient data if such data contains no information personally identifying any insured or family member of the insured;

(d) a medical service corporation shall not be prohibited from disclosing patient utilization data to a law enforcement authority, a state board of registration, or a court of competent jurisdiction if the medical service corporation, a law enforcement authority, or a state board of registration has reason to believe (i) a patient is committing or has committed fraud, or (ii) a provider is committing or has committed fraud or professional misconduct related to the provision of such diagnosis or treatment;

(e) nothing contained herein shall prohibit a medical service corporation from using or disclosing patient information for coordination of benefits, subrogation, peer review or utilization review. For the purposes of this clause the term "coordination of benefits" shall mean the determination of primary and secondary responsibility for the payment of a claim between or among two or more insurers providing the same or similar coverage to an insured. Nothing contained herein shall prohibit a medical service corporation from disclosing patient or provider identifiers to a self-insured plan administered by said medical service corporation; provided, however, that such identifiers shall be used only for purposes of billing and audit; or

(f) that nothing contained herein shall prohibit a medical service corporation from disclosing patient information to an account which is self-insured in whole or in part, and administered by such corporation for research to be conducted by the account; provided, however, that no patient shall be the subject of such research without having first been notified by the account in writing of the scope and purpose of the research. Such written notice shall clearly state that the patient will not be a participant in any such research and will not be penalized in any way if the patient elects in writing to be excluded. Any research conducted by an account under this clause shall maintain the confidentiality of all identifiable patient information.

SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after section 4A the following section:-

Section 4B. No health maintenance organization may, without the express and informed written consent of a member, disclose any information it may have acquired from or about such member pertaining to the administration of benefits provided for expenses arising from the out-patient diagnosis or treatment, or both, of mental or nervous conditions; provided, however, that:

(a) no such written consent shall be made a condition of the receipt of such benefits or any other benefits for which the member is otherwise covered;

(b) nothing contained herein shall prohibit the disclosure of any information held by such health maintenance organization which is not privileged pursuant to section one hundred and thirty-five of chapter one hundred and twelve or section twenty B of chapter two hundred and thirty-three;

(c) a health maintenance organization shall not be prohibited from disclosing aggregate patient data if such data contains no information personally identifying any member;

(d) a health maintenance organization shall not be prohibited from disclosing patient utilization data to a law enforcement authority, a state board of registration, or a court of competent jurisdiction if the health maintenance organization, a law enforcement authority, or a state board of registration has reason to believe (i) a patient is committing or has committed fraud, or (ii) a provider is committing or has committed fraud or professional misconduct related to the provision of such diagnosis or treatment;

(e) nothing contained herein shall prohibit a health maintenance organization from using or disclosing patient information for coordination of benefits, subrogation, peer review or utilization review. For the purposes of this clause the term "coordination of benefits" shall mean the determination of primary and secondary responsibility for the payment of a claim between or among two or more insurers providing the same or similar coverage to an insured. Nothing contained herein shall prohibit a health maintenance organization from disclosing patient or provider identifiers to a self-insured plan administered by said health maintenance organization; provided, however, that such identifiers shall be used only for purposes of billing and audit; or

(f) nothing contained herein shall prohibit a health maintenance organization from disclosing patient information to an account which is self-insured in whole or in part, and administered by such organization for research to be conducted by the account; provided, however, that no patient shall be the subject of such research without having first been notified by the account in writing of the scope and purpose of the research. Such written notice shall clearly state that the patient will not be a participant in any such research and will not be penalized in any way if the patient elects in writing to be excluded. Any research conducted by an account under this clause shall maintain the confidentiality of all identifiable patient information.

SECTION 7. Section 20B of chapter 233 of the General Laws is hereby amended by adding the following paragraph:-

The provision of information acquired by a psychotherapist relative to the diagnosis or treatment of a patient's emotional condition, to any insurance company, nonprofit hospital service corporation, medical service corporation, or health maintenance organization, or to a board established pursuant to section twelve of chapter one hundred and seventy-six B, pertaining to the administration or provision of benefits, including utilization review or peer review, for expenses arising from the out-patient diagnosis or treatment, or both, of mental or nervous conditions, shall not constitute a waiver or breach of any right to which said patient is otherwise entitled under this section.