TN 1 (11-22)

HI 00201.010 Confidentiality of Official Records and Information

The law (section 1106 of the Act) provides that records and information acquired about individuals in the administration of the Social Security Act are confidential and may be disclosed only under the conditions prescribed in Regulation No. 1 or on the express authorization of the Commissioner of Social Security. The rules and regulations of the other components of the Department of Health and Human Services regarding the confidentiality of records and information also apply to governmental and private agencies participating in the administration of the program; to institutions, facilities, agencies, and clinics, and persons providing services; and to those furnishing services under arrangements with a provider of services.

The Privacy Act of 1974 requires: ( a ) that information requested from or about an individual must be limited to that necessary to accomplish CMS’s purpose as set forth by statute or by executive order of the President; ( b ) that information about an individual should, whenever possible, be obtained from the individual rather than from a third party (a legal guardian is not considered a third party); and ( c ) when SSA requests information from a third party, and in doing so, identifies the individual by name, SSN, etc., SSA makes a disclosure for which an accounting must be maintained and made available to the individual upon request.

Information furnished specifically for purposes of a claim under the Health Insurance program is subject to these rules and regulations. Such information includes the individual’s health insurance claim number, the fact of the individual's entitlement to health insurance benefits, and medical and other information obtained from SSA or an intermediary. However, the information in the provider’s own patient medical records is not subject to these rules and regulations even though the patient receives benefits under the Health Insurance program. These records are subject to the requirements of confidentiality in the provider conditions for participation and may also be subject to State or local laws or provider rules governing disclosure.

A provider may disclose records acquired under the Health Insurance program only when the record of information is to be used in connection with a claim for Health Insurance benefits or the disclosure is necessary for the proper performance of the duties of any officer or employee of (1) the Department of Health and Human Services, or (2) any public or private agency or organization under an agreement with the Secretary of Health and Human Services.

The Health Care Financing Administration has issued guidelines for intermediaries in arranging to supply billing information to State public welfare agencies when payment of the cost of provider services is to be made under both the Health Insurance and State welfare program. State public welfare agencies which have entered into agreements with Medicare intermediaries make the necessary arrangements with the providers involved.