§4224. Confidentiality; liability; access to records
1. Confidentiality. Any data or information pertaining to the diagnosis, treatment or health of an enrollee or applicant obtained from that enrollee or applicant or a provider by a health maintenance organization must be held in confidence and may not be disclosed to any person except: to the extent that it may be necessary to carry out the purposes of this chapter; upon the express consent of the enrollee or applicant; pursuant to statute or court order for the production of evidence or the discovery of evidence; or in the event of claim or litigation between that enrollee or applicant and the health maintenance organization when such data or information is pertinent. A health maintenance organization is entitled to claim any statutory privileges against such disclosure that the provider who furnished such information to the health maintenance organization is entitled to claim.
[PL 1991, c. 709, §7 (NEW).]
2. Liability. A person who, in good faith and without malice, as a member, agent or employee of a quality assurance committee, assists in the origination, investigation or preparation of a report or information related to treatment previously rendered, submits that report or information to a health maintenance organization or appropriate state licensing board, or assists the committee in carrying out any of its duties under this chapter is not subject to civil liability for damages as a consequence of those actions, nor is the health maintenance organization that established that committee or the officers, directors, employees or agents of that health maintenance organization liable for the activities of that person. This section may not be construed to relieve any person of liability arising from treatment of a patient.
A. The information considered by a quality assurance committee and the records of its actions and proceedings are confidential and not subject to subpoena or order to produce except in proceedings before the appropriate state licensing or certifying agency or in an appeal, if permitted, from the findings or recommendations of the committee. A member of a quality assurance committee or an officer, director, staff person or other member of a health maintenance organization engaged in assisting the committee or any person assisting or furnishing information to the committee may not be subpoenaed to testify in any judicial or quasi-judicial proceeding if the subpoena is based solely on these activities. [PL 1991, c. 709, §7 (NEW).]
B. Information considered by a quality assurance committee and the records and proceedings of that committee used pursuant to paragraph A by a state licensing or certifying agency or in an appeal must be kept confidential and are subject to the same provisions concerning discovery and use in legal actions as are the original information and records in the possession and control of the health care review committee. [PL 1991, c. 709, §7 (NEW).]
[PL 1991, c. 709, §7 (NEW).]
3. Access to records. To fulfill the obligations of a health maintenance organization under section 4204, subsection 2‑A, paragraph B, a health maintenance organization must have access to treatment records and other information pertaining to the diagnosis, treatment and health status of any enrollee.
[PL 1991, c. 709, §7 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1991, c. 709, §7 (RPR).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS
24-A §4202. Definitions (REPEALED)
24-A §4203. Establishment of health maintenance organizations
24-A §4204. Issuance of certificate of authority
24-A §4204-A. Surplus requirements
24-A §4205. Powers of health maintenance organizations
24-A §4205-A. Continuity of licensure; business combinations
24-A §4207. Evidence of coverage and charges for health care services
24-A §4207-A. Point-of-service products
24-A §4208. Annual and interim reports
24-A §4209. Information to enrollees
24-A §4210-A. Continuity of health insurance coverage (REPEALED)
24-A §4212. Prohibited practices
24-A §4213. Regulation of agents
24-A §4214. Powers of insurers and nonprofit hospital or medical service corporations
24-A §4216. Suspension or revocation of certificate of authority
24-A §4217. Rehabilitation, liquidation or conservation of health maintenance organizations
24-A §4218-A. Compliance with the Affordable Care Act
24-A §4219. Administrative procedures
24-A §4221. Penalties and enforcement
24-A §4222. Statutory construction and relationship to other laws
24-A §4223. Filings and reports as public documents
24-A §4224. Confidentiality; liability; access to records
24-A §4224-A. Loss information (REPEALED)
24-A §4225. Commissioner of Health and Human Services' authority to contract
24-A §4226. Federal legislation
24-A §4227. Choice of alternative coverage
24-A §4228. Utilization review data
24-A §4229. Acquired Immune Deficiency Syndrome
24-A §4230. Trade practices and frauds (REPEALED)
24-A §4231. Insolvency or withdrawal; alternative coverage
24-A §4232. Replacement coverage
24-A §4233. Registration, regulation and supervision of holding company systems
24-A §4233-A. Extension of coverage for dependent children
24-A §4233-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
24-A §4233-C. Mandatory offer of coverage for certain adults with disabilities
24-A §4234-A. Mental health services coverage
24-A §4234-B. Maternity and routine newborn care
24-A §4234-C. Newborn children coverage
24-A §4234-D. Off-label use of prescription drugs for cancer
24-A §4234-E. Off-label use of prescription drugs for HIV or AIDS
24-A §4234-F. Maternity and postpartum care
24-A §4235. Standardized claim forms
24-A §4236. Chiropractors in health maintenance organizations
24-A §4237. Coverage for breast cancer treatment
24-A §4237-A. Screening mammograms
24-A §4238. Medical food coverage for inborn error of metabolism
24-A §4239. Medical child support
24-A §4240. Coverage for diabetes supplies
24-A §4241. Gynecological and obstetrical services
24-A §4242. Coverage for Pap tests (REALLOCATED FROM TITLE 24-A, SECTION 4240)
24-A §4243. Limits on priority liens; subrogation
24-A §4244. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 4243)
24-A §4245. NCQA accreditation survey report
24-A §4246. Coverage for services provided by registered nurse first assistants
24-A §4247. Coverage for contraceptives (REALLOCATED FROM TITLE 24-A, SECTION 4245)
24-A §4249. Mandated offer of domestic partner benefits
24-A §4250. Coverage for hospice care services (REALLOCATED FROM TITLE 24-A, SECTION 4249)
24-A §4252. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
24-A §4253. Enrollment for individuals or families establishing eligibility for MaineCare
24-A §4254. Coverage for colorectal cancer screening
24-A §4255. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 4253)
24-A §4257. Coverage for services provided by independent practice dental hygienist
24-A §4258. Coverage for children's early intervention services