Haw. Code R. § 17-1702-5 - Disclosure of information to administer the public assistance or other federal programs

(a) The use or disclosure of any of the information specified in section 17-1702-4(a) shall be limited to the persons or purposes stipulated in this section and, unless otherwise stated, this excludes inspection of the entire case record.

(b) Disclosure for purposes directly connected with the administration of the medical assistance program shall be allowed:

(1) To an employee of the DHS and the U.S. government in the performance of the employee's official duties, who shall have access to the entire case record;

(2) To the extent necessary to provide services and to determine eligibility or the amount of medical assistance for applicants or beneficiaries;

(3) To the following, who shall be subject to the standards of confidentiality that are comparable to those of the Medicaid agency:

(A) Fiscal intermediary;

(B) Other individuals contracted by the Medicaid agency to provide a service;

(C) Medicaid providers who require eligibility, cost share or TPL information for billing or recovery purposes;

(D) Participating health plans that require eligibility, co-payment, or TPL information for billing or recovery purposes;

(E) Private social service agencies, including purchase of service (POS) providers, from which a beneficiary receives services; and

(F) Agencies administering programs under the Social Security Act under such titles as XVI-SSI (42 U.S.C. §§1381 - 1383), IV-A AFDC ( 42 U.S.C. §§630 - 644), or XX-Social Services (42 U.S.C. §1397).

(c) Disclosure for purposes directly connected with any investigation, prosecution, or criminal or civil proceedings conducted in connection with the administration of medical assistance program shall be permitted:

(1) To police departments, prosecutors' offices, the attorney general's office, the ombudsman's office, or any other state or federal agency; and

(2) For such purposes as:

(A) The detection, investigation, or prosecution of violations of applicable state and federal laws of regulations in connection with these programs, including any and all aspects of theft, fraud, deception, or overpayment;

(B) DHS' claims against estates of deceased recipients, or initiation of paternity and nonsupport actions by DHS under Title IV-D of the Social Security Act (42 U.S.C. §§651 - 662);

(C) Responding to requests for information in connection with lawsuits challenging the administration of the medical assistance program; and

(D) Providing information to the ombudsman's office investigating complaints about the administration of the medical assistance program.

(d) Disclosure may be allowed for purposes of the administration of other federal or federally assisted programs which provide assistance, in cash or in kind, or services directly to individuals on the basis of need. Disclosure shall be permitted for purposes of administering programs such as:

(1) Social security - supplemental security income; and

(2) Hawaii housing authority for the section 8 programs and the low income housing projects.

(e) Disclosure may be allowed for purposes of an audit or similar activity, such as a financial review or review of expenditure reports, conducted in connection with the administration of the public assistance programs by any governmental entity which is authorized by law to conduct the audit or activity.

Notes

Haw. Code R. § 17-1702-5

[Eff 08/01/94; am 01/29/96; am 09/14/98; am 09/30/13] (Auth: HRS §§ 92F-18, 346-10, 346-14, 325-101; 42 C.F.R. §431.301) (Imp: HRS §§ 346-10, 571-84, 325-101; 42 C.F.R. §431.306)