Bill Text: NJ A3078 | 2014-2015 | Regular Session | Introduced
Bill Title: Establishes certain requirements, including allowable fees, for provision of medical records to patients, legally authorized representatives, and authorized third parties.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-05-08 - Introduced, Referred to Assembly Health and Senior Services Committee [A3078 Detail]
Download: New_Jersey-2014-A3078-Introduced.html
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
SYNOPSIS
Establishes certain requirements, including allowable fees, for provision of medical records to patients, legally authorized representatives, and authorized third parties.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning medical records and supplementing Titles 26 and 45 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Except as provided in subsection d. of this section, if a patient of a general, special, or psychiatric hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), the patient's legally authorized representative, or an authorized third party requests, in writing, a copy of the patient's medical record, the hospital shall provide a legible paper or electronic reproduction of the medical record from each individual admission within the dates requested to the patient, the patient's legally authorized representative, or the authorized third party within 30 days of the request, in accordance with the following:
(1) (a) For a request by a patient or the patient's legally authorized representative for an individual admission record, the fee for reproducing the record shall not exceed $1 per page or $100 per individual admission record for the first 100 pages, whichever is less. For individual admission records that contain more than 100 pages, a copying fee of no more than $0.25 per page may be charged for pages in excess of the first 100 pages, up to a maximum of $200 for each admission record; and
(b) For a request by an authorized third party, the fee for reproducing an individual admission record shall be no more than $1 per page.
(2) Delivery of an electronic reproduction of a patient's medical record shall be required only if: (a) the entire request can be reproduced from an electronic health record system; (b) the medical record is specifically requested to be delivered in electronic format; and (c) the medical record can be delivered electronically.
(3) In addition to per-page fees, a hospital shall apply the following charges:
(a) a search fee of no more than $10 per request. Although the patient may have had more than one admission, and thus more than one individual admission record is provided, only one search fee shall be charged for each request. The search fee shall apply even if no individual admission record is found as a result of the search;
(b) a fee for the reproduction of x-rays or any other material within an individual admission record that cannot be routinely copied or duplicated on a commercial photocopy machine, which shall be no more than the actual cost of the duplication of the materials, plus an administrative fee of the lesser of $10 or 10 percent of that cost. The actual cost of duplication shall include: cost of materials; time spent by office personnel for retrieving, duplicating, and refiling the materials; and overhead costs;
(c) a fee for certification of a copy of a medical record of no more than $10 per certification; and
(d) costs for delivering records in any medium, plus sales tax, if applicable.
(4) The fees established in this subsection shall be charged for electronic reproductions as well as paper copies of medical records.
(5) The hospital shall establish a policy assuring access to copies of medical records for patients who do not have the ability to pay for the copies.
(6) The hospital shall establish a fee policy providing an incentive for the use of abstracts or summaries of medical records; however, a patient, a patient's legally authorized representative, or an authorized third party shall have the right to receive a full or certified copy of the medical record.
(7) As used in P.L. , c. (C. ) (pending before the Legislature as this bill), "legally authorized representative" means the following:
(a) the patient's spouse, domestic partner, or civil union partner;
(b) the patient's immediate next of kin;
(c) the patient's legal guardian;
(d) the patient's attorney;
(e) the patient's third party insurer; or
(f) the patient's worker's compensation carrier, where access is permitted by contract or law, but limited only to that portion of the medical record that is relevant to the specific work-related incident at issue in the worker's compensation claim.
(8) As used in P.L. , c. (C. ) (pending before the Legislature as this bill), "authorized third party" shall mean a third party with a valid authorization, subpoena, or court order granting access to a patient's medical records.
b. Access to a copy of a patient's medical record shall be limited only to the extent necessary to protect the patient. The patient's attending physician shall provide a verbal explanation for any denial of access to the patient, legally authorized representative, or authorized third party, and shall document the denial and explanation in the medical record. In the event that direct access to a copy by the patient is medically contraindicated, as documented by a physician in the patient's medical record, the hospital shall make the medical record available to a legally authorized representative of the patient, an authorized third party, or the patient's attending physician.
c. A hospital shall not assess any fees or charges for a copy of a patient's medical records as provided herein other than those provided for in this section.
d. The fees authorized by this section shall not be imposed on:
(1) A patient who does not have the ability to pay and who presents either: (a) a statement certifying to annual income at or below 250 percent of the federal poverty level; or (b) proof of eligibility for, or enrollment in, a State or federal assistance program including, but not limited to: the federal Supplemental Nutrition Assistance Program established pursuant to the "Food and Nutrition Act of 2008," Pub.L.110-246 (7 U.S.C. s.2011 et seq.); the federal Supplemental Security Income program established pursuant to Title XVI of the federal Social Security Act, Pub.L.92-603 (42 U.S.C. s.1381 et seq.); the National School Lunch Program established pursuant to the "Richard B. Russell National School Lunch Act," Pub.L.79-396 (42 U.S.C. s.1751 et seq.); the federal special supplemental food program for women, infants, and children established pursuant to Pub.L.95-627 (42 U.S.C. s.1786); the State Medicaid program established pursuant to the "New Jersey Medical Assistance and Health Services Act," P.L.1968, c.413 (C.30:4D-1 et seq.); the NJ FamilyCare Program established pursuant to the "Family Health Care Coverage Act," P.L.2005, c.156 (C.30:4J-8 et al.); the Work First New Jersey program established pursuant to the "Work First New Jersey Act," P.L.1997, c.38 (C.44:10-55 et seq.); the New Jersey Supplementary Food Stamp Program established pursuant to the "New Jersey Supplementary Food Stamp Program Act," P.L.1998, c.32 (C.44:10-79 et seq.); any successor program; or any other State or federal assistance program now or hereafter established by law;
(2) A not-for-profit corporation indicating in writing that it is representing a patient; or
(3) An attorney representing a patient on a pro bono basis, provided that the attorney submits with the request a certification that the attorney is representing the patient on a pro bono basis. An attorney representing a patient on a contingency fee basis shall be assessed the ordinary fees to obtain a copy of the patient's records.
2. A person licensed to practice a health care profession regulated by the State Board of Medical Examiners shall provide copies of professional treatment records, including records from other health care providers that are part of a patient's record, to a patient, the patient's authorized representative, or an authorized third party in accordance with the following:
a. No later than 30 days from receipt of a request from a patient, a patient's authorized representative, or an authorized third party, the licensee shall provide an electronic copy or photocopy of the professional treatment records, billing records, or both, as requested. The record shall include all pertinent, objective data, including test results and x-ray results, as applicable, and subjective information.
b. Unless otherwise required by law, a licensee may elect to provide a summary of the record in lieu of providing the electronic copy or photocopy required pursuant to subsection a. of this section, so long as that summary adequately reflects the patient's history and treatment. A licensee may charge a reasonable fee for the preparation of a summary that has been provided in lieu of the actual record, which shall not exceed the cost that would be charged for the actual record pursuant to subsection d. of this section; however, a patient, a patient's legally authorized representative, or an authorized third party shall have the right to receive a full or certified copy of the medical record. The fee for certification shall be no more than $10 per certification.
c. If, in the exercise of the licensee's professional judgment, a licensee has reason to believe that the patient's mental or physical condition will be adversely affected upon being made aware of the subjective information contained in the professional treatment record or a summary of the record, the licensee may refuse to provide the record or summary to the patient. The licensee shall include in the record a notice setting forth the reasons for the original refusal. The licensee shall, however, provide a copy of the record or summary upon request to:
(1) the patient's attorney;
(2) another licensed health care professional;
(3) the patient's health insurance carrier through an employee thereof;
(4) a governmental reimbursement program or an agent thereof, with responsibility to review utilization or quality of care; or
(5) an authorized third party.
d. A licensee may require a record request to be in writing and, except as provided in subsection j. of this section, may charge a fee for:
(1) (a) A request by a patient or a patient's legally authorized representative for the reproduction of patient records, which shall be no more than $1 per page or $200 for the entire record, whichever is less; and
(b) A request by an authorized third party for the reproduction of patient records, which shall be no more than $1 per page;
(2) The reproduction of x-rays or any other material within a patient record that cannot be routinely copied or duplicated on a commercial photocopy machine, which shall be no more than the actual cost of the duplication of the materials, plus an administrative fee of the lesser of $10 or 10 percent of that cost. The actual cost of duplication shall include: cost of materials; time spent by office personnel for retrieving, duplicating, and refiling the materials; and overhead costs;
(3) A search for records. The search fee shall be no more than $10 per request. Although the patient may have had more than one admission, and thus more than one individual admission record is provided, only one search fee shall be charged for each request. The search fee shall apply even if no individual admission record is found as a result of the search; and
(4) The costs for delivering records in any medium, plus sales tax, if applicable.
A licensee shall not assess any fees or charges for a copy of a patient's records as provided herein other than those provided for in this section.
e. The fees established in subsection d. of this section shall be charged for electronic copies as well as paper copies of medical records.
f. Delivery of an electronic copy of a patient record to the requestor shall be required only if:
(1) the entire request can be reproduced from an electronic health record system;
(2) the patient record is specifically requested to be delivered in electronic format; and
(3) the patient record can be delivered electronically.
g. A licensee shall not charge a patient for a copy of the patient's record when:
(1) the licensee has affirmatively terminated a patient from practice in accordance with the requirements of N.J.A.C.13:35-6.22; or
(2) the licensee leaves a practice that the licensee was formerly a member of, or associated with, and the patient requests that the patient's medical care continue to be provided by that licensee.
h. If the patient or a subsequent treating health care professional is unable to read the treatment record, either because it is illegible or prepared in a language other than English, the licensee shall provide a transcription or translation, as applicable, at no cost to the patient.
i. The licensee shall not refuse to provide a professional treatment record on the grounds that the patient owes the licensee an unpaid balance if the record is needed by another health care professional for the purpose of rendering care.
j. The fees authorized by this section shall not be imposed on:
(1) A patient who does not have the ability to pay and who presents either: (a) a statement certifying to annual income at or below 250 percent of the federal poverty level; or (b) proof of eligibility for, or enrollment in, a State or federal assistance program including, but not limited to: the federal Supplemental Nutrition Assistance Program established pursuant to the "Food and Nutrition Act of 2008," Pub.L.110-246 (7 U.S.C. s.2011 et seq.); the federal Supplemental Security Income program established pursuant to Title XVI of the federal Social Security Act, Pub.L.92-603 (42 U.S.C. s.1381 et seq.); the National School Lunch Program established pursuant to the "Richard B. Russell National School Lunch Act," Pub.L.79-396 (42 U.S.C. s.1751 et seq.); the federal special supplemental food program for women, infants, and children established pursuant to Pub.L.95-627 (42 U.S.C. s.1786); the State Medicaid program established pursuant to the "New Jersey Medical Assistance and Health Services Act," P.L.1968, c.413 (C.30:4D-1 et seq.); the NJ FamilyCare Program established pursuant to the "Family Health Care Coverage Act," P.L.2005, c.156 (C.30:4J-8 et al.); the Work First New Jersey program established pursuant to the "Work First New Jersey Act," P.L.1997, c.38 (C.44:10-55 et seq.); the New Jersey Supplementary Food Stamp Program established pursuant to the "New Jersey Supplementary Food Stamp Program Act," P.L.1998, c.32 (C.44:10-79 et seq.); any successor program; or any other State or federal assistance program now or hereafter established by law;
(2) A not-for-profit corporation indicating in writing that it is representing a patient; or
(3) An attorney representing a patient on a pro bono basis, provided that the attorney submits with the request a certification that the attorney is representing the patient on a pro bono basis. An attorney representing a patient on a contingency fee basis shall be assessed the ordinary fees to obtain a copy of the patient's records.
3. The Commissioner of Health and the State Board of Medical Examiners, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations as necessary to effectuate the purposes of this act.
4. This act shall take effect on the first day of the seventh month next following the date of enactment, except that the Commissioner of Health and the State Board of Medical Examiners may take such anticipatory administrative action in advance thereof as may be necessary for the implementation of this act.
STATEMENT
This bill clarifies and revises certain provisions currently set forth in regulations concerning fees for the provision of medical records to patients, legally authorized representatives, and authorized third parties. The bill defines "legally authorized representative" to include the patient's: spouse, domestic partner, or civil union partner; immediate next of kin; legal guardian; attorney; third party insurer; or, subject to certain limitations, worker's compensation carrier. The bill defines "authorized third party" as a third party that has a valid authorization, subpoena, or court order granting the party access to the patient's records.
The bill would apply to fees charged by hospitals and by health care professionals licensed by the State Board of Medical Examiners (BME). The current regulations governing hospitals are set forth at N.J.A.C.8:43G-15.3; the current regulations governing BME licensees are set forth at N.J.A.C.13:35-6.5.
The bill sets forth certain maximum fees that may be charged by hospitals and BME licensees, including: per page reproduction fees; maximum reproduction fees for entire records; search fees; special duplication fees; and certification fees. For hospitals, the bill clarifies that the specified fees are for individual admission records. The bill sets the fee for certification of a record at no more than $10; there is currently no certification fee set forth in the regulations for either hospitals or BME licensees. The bill permits up to a $10 search fee for records, even when no record is found, which fee is not currently permitted in the regulations for BME licensees. Additionally, hospitals and BME licensees are restricted to assessing one search fee per request, even if multiple records are requested at one time. The bill provides that a maximum $200 reproduction fee may be charged for a particular record by both hospitals and BME licensees. This maximum fee is independent of search, special duplication, and certification fees, and is an increase over the maximum $100 reproduction fee currently permitted for BME licensees by regulation; however, it is identical to the maximum reproduction fee that hospitals may assess under current regulations. The bill provides that no fees may be assessed that are not expressly permitted under its provisions. All records must be provided within 30 days of a written request. The bill sets forth certain restrictions on when access to a record may be limited or denied, including certain documentation requirements.
The bill provides that both hospitals and BME licensees must provide an electronic copy of the record only if the entire request can be reproduced from an electronic record system, the requester specifically requests an electronic copy, and the record can be delivered electronically. The same fees would apply to both paper and electronic copies of patient records.
Hospitals and BME licensees would be permitted to charge less than the maximum fees set forth in the bill, and certain parties would be permitted to obtain a free copy of a patient's records, including: a patient whose annual income is at or below 250 percent of the federal poverty level or who can demonstrate eligibility for, or enrollment in, any State or federal assistance program; a not-for-profit corporation indicating in writing that it is representing a patient; and an attorney representing the patient on a pro bono basis. A pro bono attorney requesting a free copy of patient records would be required to submit with the request a certification that the representation is pro bono. An attorney representing a patient on a contingency fee basis would be assessed the ordinary fees to obtain copies of the patient's records.
The bill additionally clarifies the fees that may be charged for x-rays and other materials that cannot be easily duplicated, which are not currently provided for in hospital regulations. In particular, the bill specifies that the "actual cost of duplication" that may be charged for such records includes the cost of materials, time spent by office personnel for retrieving, duplicating, and refiling the materials, and overhead costs. An additional administrative fee may be charged, which would be the lesser of $10 or 10 percent of the actual cost of duplication.
The bill also clarifies that, although hospitals and BME licensees would be required to provide incentives for the provision of summaries and abstracts of patient records, a requester has the right to receive a full or certified copy of the record. The bill further provides that BME licensees may not charge more for a summary than would be assessed for the full record.
The bill additionally provides that a BME licensee may not charge any fees for providing records when the licensee has affirmatively terminated a patient from practice or when the licensee leaves a practice and the patient requests that the licensee continue to provide the patient with treatment; this provision appears in current BME regulations. BME licensees would not be permitted to refuse to provide a record on the basis that the patient owes the licensee an unpaid balance if the record is needed by another health care professional for the purpose of rendering care; this provision appears in current BME regulations. Additionally, as required under current BME regulations, when the patient cannot read a record because it is illegible or prepared in a language other than English, BME licensees would be required to transcribe or translate the record, as appropriate, without cost to the patient.
