§ 122C-55. Exceptions; care and treatment. - North Carolina Statutes

§ 122C‑55.  Exceptions;care and treatment.

(a)        Any area or Statefacility or the psychiatric service of the University of North CarolinaHospitals at Chapel Hill may share confidential information regarding anyclient of that facility with any other area or State facility or thepsychiatric service of the University of North Carolina Hospitals at ChapelHill when necessary to coordinate appropriate and effective care, treatment orhabilitation of the client. For the purposes of this subsection, coordinate meansthe provision, coordination, or management of mental health, developmentaldisabilities, and substance abuse services and related services by one or morefacilities and includes the referral of a client from one facility to another.

(a1)      Any facility mayshare confidential information regarding any client of that facility with theSecretary, and the Secretary may share confidential information regarding anyclient with a facility when necessary to conduct quality assessment andimprovement activities or to coordinate appropriate and effective care,treatment or habilitation of the client. For purposes of this subsection andsubsection (a6) of this section, the purposes or activities for whichconfidential information may be disclosed include, but are not limited to, casemanagement and care coordination, disease management, outcomes evaluation, thedevelopment of clinical guidelines and protocols, the development of caremanagement plans and systems, population‑based activities relating toimproving or reducing health care costs, and the provision, coordination, ormanagement of mental health, developmental disabilities, and substance abuseservices and related services. As used in this section, "facility"includes an LME and "Secretary" includes the Department's CommunityCare of North Carolina Program or other primary care case management programsthat contract with the Department to provide a primary care case managementprogram for recipients of publicly funded health and related services.

(a2)      Any area or Statefacility or the psychiatric service of the University of North CarolinaHospitals at Chapel Hill may share confidential information regarding anyclient of that facility with any other area facility or State facility or thepsychiatric service of the University of North Carolina Hospitals at ChapelHill when necessary to conduct payment activities relating to an individualserved by the facility. Payment activities are activities undertaken by afacility to obtain or provide reimbursement for the provision of services andmay include, but are not limited to, determinations of eligibility or coverage,coordination of benefits, determinations of cost‑sharing amounts, claimsmanagement, claims processing, claims adjudication, claims appeals, billing andcollection activities, medical necessity reviews, utilization management andreview, precertification and preauthorization of services, concurrent andretrospective review of services, and appeals related to utilization managementand review.

(a3)      Whenever there isreason to believe that a client is eligible for benefits through a Departmentprogram, any State or area facility or the psychiatric service of theUniversity of North Carolina Hospitals at Chapel Hill may share confidentialinformation regarding any client of that facility with the Secretary, and theSecretary may share confidential information regarding any client with an areafacility or State facility or the psychiatric services of the University ofNorth Carolina Hospitals at Chapel Hill. Disclosure is limited to thatinformation necessary to establish initial eligibility for benefits, determinecontinued eligibility over time, and obtain reimbursement for the costs ofservices provided to the client.

(a4)      An area authority orcounty program may share confidential information regarding any client with anyarea facility, and any area facility may share confidential informationregarding any client of that facility with the area authority or countyprogram, when the area authority or county program determines the disclosure isnecessary to develop, manage, monitor, or evaluate the area authority's orcounty program's network of qualified providers as provided in G.S. 122C‑115.2(b)(1)b., G.S. 122C‑141(a), the State Plan, and rules of the Secretary. For thepurposes of this subsection, the purposes or activities for which confidentialinformation may be disclosed include, but are not limited to, qualityassessment and improvement activities, provider accreditation and staffcredentialing, developing contracts and negotiating rates, investigating andresponding to client grievances and complaints, evaluating practitioner andprovider performance, auditing functions, on‑site monitoring, conductingconsumer satisfaction studies, and collecting and analyzing performance data.

(a5)      Any area facilitymay share confidential information with any other area facility regarding anapplicant when necessary to determine whether the applicant is eligible forarea facility services. For the purpose of this subsection, the term"applicant" means an individual who contacts an area facility forservices.

(a6)      When necessary toconduct quality assessment and improvement activities or to coordinateappropriate and effective care, treatment, or habilitation of the client, aDHHS primary care case manager may disclose confidential information acquiredpursuant to subsection (a1) of this section to a health care provider or otherentity that has entered into a written agreement with the Department'sCommunity Care of North Carolina Program, or other primary care case managementprogram, to participate in the care management support network and systemsdeveloped and maintained by the primary care case manager for the purpose ofcoordinating and improving the quality of care for recipients of publiclyfunded health and related services. Health care providers and other entitiesreceiving confidential information from the Department's Community Care ofNorth Carolina Program or other primary care case management program pursuantto this subsection may use and disclose the information as authorized by G.S.122C‑53 through G.S. 122C‑56 or as permitted or required by otherapplicable State or federal law.

(b)        A facility,physician, or other individual responsible for evaluation, management,supervision, or treatment of respondents examined or committed for outpatienttreatment under the provisions of Article 5 of this Chapter may request,receive, and disclose confidential information to the extent necessary toenable them to fulfill their responsibilities.

(c)        A facility mayfurnish confidential information in its possession to the Department ofCorrection when requested by that department regarding any client of thatfacility when the inmate has been determined by the Department of Correction tobe in need of treatment for mental illness, developmental disabilities, orsubstance abuse. The Department of Correction may furnish to a facilityconfidential information in its possession about treatment for mental illness,developmental disabilities, or substance abuse that the Department ofCorrection has provided to any present or former inmate if the inmate ispresently seeking treatment from the requesting facility or if the inmate hasbeen involuntarily committed to the requesting facility for inpatient oroutpatient treatment. Under the circumstances described in this subsection, theconsent of the client or inmate shall not be required in order for thisinformation to be furnished and the information shall be furnished despite objectionby the client or inmate. Confidential information disclosed pursuant to thissubsection is restricted from further disclosure.

(d)        A responsibleprofessional may disclose confidential information when in his opinion there isan imminent danger to the health or safety of the client or another individualor there is a likelihood of the commission of a felony or violent misdemeanor.

(e)        A responsibleprofessional may exchange confidential information with a physician or otherhealth care provider who is providing emergency medical services to a client.Disclosure of the information is limited to that necessary to meet theemergency as determined by the responsible professional.

(e1)      A State facility mayfurnish client identifying information to the Department for the purpose ofmaintaining an index of clients served in State facilities which may be used byState facilities only if that information is necessary for the appropriate andeffective evaluation, care and treatment of the client.

(e2)      A responsibleprofessional may disclose an advance instruction for mental health treatment orconfidential information from an advance instruction to a physician,psychologist, or other qualified professional when the responsible professionaldetermines that disclosure is necessary to give effect to or provide treatmentin accordance with the advance instruction.

(f)         A facility maydisclose confidential information to a provider of support services wheneverthe facility has entered into a written agreement with a person to providesupport services and the agreement includes a provision in which the providerof support services acknowledges that in receiving, storing, processing, orotherwise dealing with any confidential information, he will safeguard and notfurther disclose the information.

(g)        Whenever there isreason to believe that the client is eligible for financial benefits through agovernmental agency, a facility may disclose confidential information to State,local, or federal government agencies. Except as provided in G.S.122C‑55(a3),disclosure is limited to that confidential information necessary to establishfinancial benefits for a client. After establishment of these benefits, theconsent of the client or his legally responsible person is required for furtherrelease of confidential information under this subsection.

(h)        Within a facility,employees, students, consultants or volunteers involved in the care, treatment,or habilitation of a client may exchange confidential information as needed forthe purpose of carrying out their responsibility in serving the client.

(i)         Upon specificrequest, a responsible professional may release confidential information to aphysician or psychologist who referred the client to the facility.

(j)         Upon request ofthe next of kin or other family member who has a legitimate role in thetherapeutic services offered, or other person designated by the client or hislegally responsible person, the responsible professional shall provide the nextof kin or other family member or the designee with notification of the client'sdiagnosis, the prognosis, the medications prescribed, the dosage of themedications prescribed, the side effects of the medications prescribed, if any,and the progress of the client, provided that the client or his legallyresponsible person has consented in writing, or the client has consented orallyin the presence of a witness selected by the client, prior to the release ofthis information. Both the client's or the legally responsible person's consentand the release of this information shall be documented in the client's medicalrecord. This consent shall be valid for a specified length of time only and issubject to revocation by the consenting individual.

(k)        Notwithstanding theprovisions of G.S. 122C‑53(b) or G.S. 122C‑206, upon request of thenext of kin or other family member who has a legitimate role in the therapeuticservices offered, or other person designated by the client or his legallyresponsible person, the responsible professional shall provide the next of kin,or family member, or the designee, notification of the client's admission tothe facility, transfer to another facility, decision to leave the facilityagainst medical advice, discharge from the facility, and referrals andappointment information for treatment after discharge, after notification tothe client that this information has been requested.

(l)         In response to awritten request of the next of kin or other family member who has a legitimaterole in the therapeutic services offered, or other person designated by theclient, for additional information not provided for in subsections (j) and (k)of this section, and when such written request identifies the intended use forthis information, the responsible professional shall, in a timely manner:

(1)        Provide theinformation requested based upon the responsible professional's determinationthat providing this information will be to the client's therapeutic benefit,and provided that the client or his legally responsible person has consented inwriting to the release of the information requested; or

(2)        Refuse to providethe information requested based upon the responsible professional'sdetermination that providing this information will be detrimental to thetherapeutic relationship between client and professional; or

(3)        Refuse to providethe information requested based upon the responsible professional'sdetermination that the next of kin or family member or designee does not have alegitimate need for the information requested.

(m)       The Commission forMental Health, Developmental Disabilities, and Substance Abuse Services shalladopt rules specifically to define the legitimate role referred to insubsections (j), (k), and (l) of this section.  (1955, c. 887, s. 12; 1963, c. 1166, s. 10; 1973, c.47, s. 2; c. 476, s. 133; c. 673, s. 5; c. 1408, s. 2; 1979, c. 147; 1983, c.383, s. 10; c. 491; c. 638, s. 22; c. 864, s. 4; 1985, c. 589, s. 2; c. 695, s.15; 1987, c. 638, ss. 2, 3; 1989, c. 141, s. 10; c. 438; c. 625, s. 8; 1989(Reg. Sess., 1990), c. 1024, s. 27; 1991, c. 359, s. 1; c. 544, s. 1; 1998‑198,s. 4; 2003‑313, s. 3; 2009‑65, s. 1(a), (b); 2009‑487, s. 5;2009‑570, s. 43.)