(a) There is no
privilege under this section in any administrative proceeding where the:
(1) Competency;
(2) Practitioner's license;
(3) Provider status; or
(4) Practice;
of the physician is an issue, including fair hearing
criminal cases involving fraud, or civil cases involving over-payment under the
medicaid program. However, the identifying data of a patient whose records are
admitted into evidence at an administrative hearing shall be kept confidential
among the parties to the hearing unless waived by the patient. The
administrative agency, board, or commission may close its proceedings to the
public to protect a patient's confidentiality.
(b) The DHS director may require providers of
health care goods and services, including physicians and psychotherapists, to
seek written authorization from the med-QUEST administration to provide care,
goods, or services to medicaid patients. A provider's request for authorization
shall include:
(1) The patient's
name;
(2) A diagnosis of the
patient's psychiatric, physical, or psychological condition;
(3) Whether or not the patient can work,
either part-time or full-time;
(4)
The number of times the patient has seen the provider over a given prior
period;
(5) The number of future
visits the doctor anticipates needing in order to properly treat the
patient;
(6) Information on whether
the patient is working and if so, whether on a full-time or part-time basis;
and
(7) Any other information
requested by the med-QUEST division which properly relates to the patient's
present or prior condition or appropriate care to be rendered to the
patient.
(c) For
purposes of this section, confidential communication shall consist only of the
statements made between a physician or psychologist and a patient during a
therapy session. The provider's diagnosis, finding, and treatment plan shall
not be considered confidential communications.
(d) Whenever a provider refuses to disclose
unprivileged information to the med-QUEST division, then payment of claims for
which the information is lacking may, at the discretion of the director, be
denied, or if payment is already made, recovery may be initiated by the
department.
