Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
01000 >>> 01220
01210
1221 Confidentiality of Information Concerning Applicants or Recipients - Information concerning applicants or recipients (present and past) is confidential and may not be disclosed to another DCF employee, the client, or any other nonagency personnel except as set forth in this section.
Information concerning clients or providers who have been referred for investigation is confidential and may not be released unless the Fraud Unit or the prosecuting attorney to whom the case has been referred for legal action authorizes such disclosure.
1222 Disclosure of Confidential Information - The agency may disclose confidential information when the purpose of such disclosure is directly related to: (1) the administration of the KDHE-DHCF program; (2) an investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of the KDHE-DHCF program or the SSI program; or (3) the administration of any federal or federally assisted program which provides assistance (in cash or in kind) or services directly to individuals on the basis of need. For exceptions see 1225 and 1226.
Throughout this material related to confidentiality of case records, the term KDHE-DHCF and DCF employees includes contracted employees (e.g., contractor employees responsible for CHIP determinations).
1223 Nature of Information to be Safeguarded - The confidential nature of the following information must be safeguarded:
1223.01 - Names and addresses, including lists of applicants or recipients.
1223.02 - Information contained in applications, reports of investigations, reports of medical examinations, correspondence, and other records concerning the condition or circumstances of any person for whom or about whom information is obtained, and including all such information whether or not it is recorded; and
1223.03 - Records of agency evaluations of such information. General information, not identified with particular individuals, such as total expenditures made, number of recipients, and other statistical information and social data contained in general studies, reports, or surveys of welfare problems, does not fall within the class of material to be safeguarded.
1224 Disclosure of Information to Client - Information entered in the case record is to be made available to the client upon request, for inspection at a time mutually agreeable to the agency and the client, except as set forth below.
1224.01 Information Provided by Other Agency Programs - Information provided by other agency programs is not to be made available to the client unless the respective program regulations authorize such disclosure. This includes programs such as Prevention and Protection Services, Rehabilitation Services, Food Assistance, and Cash Assistance that are managed by DCF and Substance Abuse, Mental Health and Developmental Disabilities that are managed by KDADS.
1224.02 Medical and Psychiatric Reports - Medical and psychiatric reports are not to be made available to the client unless signed, written consent is obtained from the medical practitioner who rendered such report.
1224.03 Names and Addresses of Complainants - The names and addresses of complainants are not to be made available to the client.
1224.04 Investigative Reports - Investigative reports concerning welfare fraud or other types of overpayments are not to be made available to the client during the course of the investigation or during the time period in which the case has been referred for legal action unless the Fraud Unit, Legal Division or the prosecuting attorney to whom the case has been referred for legal action authorizes such disclosure.
NOTE: With the exception of 1224.03, all documents and records to be used by the agency at a fair hearing are to be made available, upon request, to the appellant or his representative for inspection and/or copying at a reasonable time mutually agreeable to the agency and the client or his representative prior to the date of the hearing.
1225 Disclosure of Information to Agency Personnel - Information is not to be disclosed to another KDHE-DHCF, DCF, or KDADS employee unless the employee has a need for the information in the performance of his official duties. The client's signature on the application form authorizes the disclosure of information concerning a Caretaker Medical, Extended Medical, TransMed, Child Care, Medicaid, CHIP, and/or Food Assistance client if the purpose of such disclosure is connected with the administration of any of the aforementioned programs, the Child Welfare or Child Support programs (under titles IV-B, IV-D, and XX), or any other federal or federally assisted program which provides assistance, in cash or in kind, or services directly to individuals on the basis of need. (Example: SSI, LIEAP.)
1226 Disclosure of Information to Nonagency Personnel and the Public - Information is not to be disclosed to nonagency personnel such as courts, school boards, legislators, prosecuting attorneys, policemen, FBI agents, doctors, social service agencies, state employment offices, public housing authorities, landlords, creditors, relatives, etc., except as set forth below.
1226.01 Information Available to the Public - Information Available to the Public - Regulations, Plans of Operation, state manuals, and federal procedures, which affect the public, shall be maintained in the office of the KDHE-DHCF for examination by members of the public on regular workdays during the regular office hours.
1226.02 Directly Related to the Administration of KDHE-DHCF Programs - Information may be disclosed to nonagency personnel when the purpose of such disclosure is directly related to the administration of KDHE-DHCF programs or assisting DCF or KDADS in the administration of their programs. The information concerning a cash, medical, childcare, or food stamp client is not to be disclosed without the signed written consent of the client unless the purpose of such disclosure is directly related to one of those programs. Any information disclosed is to be limited to that which is reasonably necessary to accomplish the purpose of such disclosure. Such purposes include establishing eligibility, determining amount of assistance, and providing services to applicants or recipients.
In the course of providing services to clients, disclosure of information should be made to representatives of other welfare agencies or programs only when they can give assurance that:
(1) - the confidential nature of the information will be preserved;
(2) - the information will be used only for the purposes for which it is made available (such purposes should be reasonably related to the purposes of the KDHE-DHCF program and the functioning of the inquiring agencies); and
(3) - the standards of protection established by the agency to which the information is disclosed are equal to those established by KDHE-DHCF itself, both with regard to the use of information by staff and the provision of protective office procedures.
1226.03 Federal or Federally Assisted Programs - Information concerning clients is to be disclosed to federal or federally assisted programs which provide assistance (in cash or in kind) or services directly to individuals on the basis of financial need if the requesting agency certifies in writing that the information so requested is necessary to the administration of its program. Example: SSI.
1226.04 Officials Conducting an Investigation, Prosecution, or Criminal/ Civil Proceeding - Information is to be disclosed to the official conducting an investigation, prosecution or criminal or civil proceeding in connection with the administration of the KDHE-DHCF program if such information is reasonably necessary to the investigation, prosecution or criminal or civil proceeding. This includes welfare fraud investigations and prosecutions. The client's signature on the application/redetermination form authorizes the disclosure of information from the case record necessary to conduct an investigation, prosecution, criminal or civil proceeding related to eligibility for medical assistance.
Information concerning clients is to be disclosed to the official conducting an investigation, prosecution or criminal or civil proceeding in conjunction with the administration of the SSI program if such information is reasonably necessary to the investigation, prosecution, or criminal or civil proceeding.
Information disclosed pursuant to the above paragraphs shall be provided the appropriate official in the following manner:
(1) - The official requesting such information shall be allowed to review pertinent case record material in the agency office during normal working hours.
(2) - Such official, upon request, shall be furnished with copies, or authenticated copies, or originals of pertinent case record materials as necessary at no cost. Prior to the release of an original document, a copy of the document shall be placed in the case record with a notation as to the disposition of the original.
If a question arises as to the pertinency of any requested material, consult the Office of the Medicaid Inspector General.
1226.05 Intention to Commit Crimes - Information concerning the intention of a client to commit a crime and the information necessary to prevent the crime shall be disclosed to the appropriate authorities.
1226.07 Information Not Otherwise Authorized to be Disclosed - Information not otherwise authorized to be disclosed by this provision may only be disclosed if the client has the authority to disclose such information and the agency has a signed, written consent on file authorizing the agency to disclose the information to the specific person requesting such information, excepting that such information may be disclosed without signed, written consent in an emergency situation such as death or other serious crises to an appropriate person if the agency deems such unauthorized disclosure to be in the best interest of the client. If such information is disclosed without signed, written consent, the client shall be notified of such disclosure as soon thereafter as possible.
1227 Subpoenas and Testifying in Court Concerning Information Not Otherwise Authorized to be Disclosed - Since all information relative to a client is by law confidential and since clients are advised that any information they reveal is held confidential, any information received by the Case Manager or other person connected with the agency, is by statute, in the nature of a privileged communication just as is the information received by an attorney or physician from his client, or received by a minister in the performance of his function as a spiritual advisor.
The Legal Division must be notified immediately of a subpoena to produce records or of a court order to testify; such notice should be in writing whenever time permits. A staff member who is subpoenaed or whose records are subpoenaed, unless otherwise instructed by the Legal Division, should make appearance at the time and place stated in the subpoena, and should bring the records subpoenaed with him, if any.
After being sworn in he should make the following statement to the court in response to the first material question:
"I am attending the court's hearing as a result of a subpoena. The law and KDHE-DHCF policy require that I call the court's attention to the laws and regulations limiting use and disclosure of information concerning public assistance. K.S.A. 39-709b limits the use or disclosure of information concerning applicants and recipients of assistance to purposes directly connected with the administration of the assistance program, unless there is written consent given by the consumer. These federal laws and regulations also similarly limit use and disclosure":
1227.01 - Section 1902(a)(7) of the Social Security Act, codified at 42 U.S.C. Sec. 1936a(a)(7), and 42 C.F.R. Sec. 431.300, et seq. (the Medicaid Program);
The witness will submit the above statement in its entirety to the court and a copy to the attorney and will testify further according to the ruling and instructions of the court. Testifying and releasing confidential information when ordered to do so directly by a judge in an in-court setting is not considered unauthorized disclosure of information. See 1229.
1228 Questions Concerning Disclosure of Information - When there is some question as to the disclosure of information to another KDHE-DHCF, DCF, or KDADS employee, the client or other non-agency personnel, the question is to be referred to the legal division for clearance.
1229 Unauthorized Disclosure of Confidential Information - A KDHE-DHCF employee who discloses confidential information concerning an applicant or recipient (present and past) in violation of the provisions set forth in 1220 and subsections shall be subject to appropriate disciplinary action (official reprimand, suspension, demotion, dismissal, etc.).
Further, any individual who discloses confidential information concerning an applicant or recipient (present, past) in violation of the provisions set forth in 1220 and subsections shall be subject to criminal prosecution, and if convicted, may be fined up to $1,000 and/or sentenced to the county jail for a period not to exceed six months.