HOUSE BILL 651

47th legislature - STATE OF NEW MEXICO - first session, 2005

INTRODUCED BY

Peter Wirth

AN ACT

RELATING TO INSURANCE; CLARIFYING EXCEPTIONS TO CERTAIN DISCLOSURES BY HEALTH MAINTENANCE ORGANIZATIONS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     Section 1. Section 59A-46-27 NMSA 1978 (being Laws 1993, Chapter 266, Section 27) is amended to read:

     "59A-46-27. CONFIDENTIALITY OF MEDICAL INFORMATION AND LIMITATION OF LIABILITY.--

          A. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except:

                (1) to the extent that it may be necessary to carry out the purposes of the Health Maintenance Organization Law;

                (2) upon the express consent of the enrollee or applicant;

                (3) as authorized by federal or state statute or rule, including the privacy standard promulgated pursuant to the federal Health Insurance Portability and Accountability Act of 1996;

                [(3)] (4) pursuant to [statute or] court order for the production of evidence or the discovery thereof; or

                [(4)] (5) in the event of claim or litigation between [such] the person and the health maintenance organization in which [such] the data or information is pertinent.

          B. A health maintenance organization shall be entitled to claim any statutory privileges against disclosure of information described in Subsection A of this section that the provider who furnished the information to the health maintenance organization is entitled to claim.

          C. A person who in good faith and without malice takes any action or makes any decision or recommendation as a member, agent or employee of a health care review committee or who furnishes any records, information or assistance to such a committee shall not be subject to liability for civil damages or any legal action in consequence of such action, nor shall the health maintenance organization that established [such] the committee or the officers, directors, employees or agents of [such] the health maintenance organization be liable for the activities of any such person. The provisions of this subsection do not relieve any person of liability arising from treatment of a patient.

          D. The information considered by a health care review committee and the records of [their] its actions and proceedings shall be 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 committee's findings or recommendations. No member of a health care review committee or officer, director or other member of a health maintenance organization or its staff engaged in assisting [such] the committee, or any person assisting or furnishing information to [such] the committee may be subpoenaed to testify in any judicial or quasi-judicial proceeding if [such] the subpoena is based solely on such activities.

          E. Information considered by a health care review committee and the records of its actions and proceedings that are used pursuant to Subsection D of this section by a state licensing or certifying agency or in an appeal shall be kept confidential and shall be subject to the same provision concerning discovery and use in legal actions as are the original information and records in the possession and control of a health care review committee.

          F. To fulfill its obligations under Section

59A-46-7 NMSA 1978, the health maintenance organization shall have access to treatment records and other information pertaining to the diagnosis, treatment or health status of any enrollee."

     Section 2. TEMPORARY PROVISION--PURPOSE--APPLICABILITY.--

          A. The purpose of this act is to not change the exceptions for disclosing information by health maintenance organizations but to clarify the law and the intent of the law as it existed prior to the effective date of this act.

          B. This act applies to disclosures made both before and after its effective date.

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