HB-4706, As Passed House, June 19, 2003                                     

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                              SUBSTITUTE FOR                                    

                                                                                

                           HOUSE BILL NO. 4706                                  

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                 A bill to provide for and to regulate access to and                               

                                                                                

    disclosure of medical records; to prescribe powers and duties of            

                                                                                

    certain state agencies and departments; to establish fees; to               

                                                                                

    prescribe administrative sanctions; and to provide remedies.                

                                                                                

                THE PEOPLE OF THE STATE OF MICHIGAN ENACT:                      

                                                                                

1       Sec. 1.  This act shall be known and may be cited as the                    

                                                                                

2   "medical records access act".                                               

                                                                                

3       Sec. 3.  As used in this act:                                               

                                                                                

4       (a) "Guardian" means an individual who is appointed as a full               

                                                                                

5   guardian of a legally incapacitated person under section 5306 of            

                                                                                

6   the estates and protected individuals code, 1998 PA 386,                    

                                                                                

7   MCL 700.5306.  Guardian includes an individual who is appointed             

                                                                                

8   as the guardian of a minor under section 5202 or 5204 of the                

                                                                                

9   estates and protected individuals code, 1998 PA 386, MCL 700.5202           

                                                                                

10  and 700.5204.                                                               

                                                                                


                                                                                

1       (b) "Health care" means any care, service, or procedure                     

                                                                                

2   provided by a health care provider or health facility to                    

                                                                                

3   diagnose, treat, or maintain a patient's physical condition, or             

                                                                                

4   that affects the structure or a function of the human body.                 

                                                                                

5       (c) "Health care provider" means a person who is licensed or                

                                                                                

6   registered or otherwise authorized under article 15 of the public           

                                                                                

7   health code, 1978 PA 368, MCL 333.16101 to 333.18838, to provide            

                                                                                

8   health care in the ordinary course of business or practice of a             

                                                                                

9   health profession.  Health care provider does not include a                 

                                                                                

10  person who provides health care solely through the sale or                  

                                                                                

11  dispensing of drugs or medical devices or a psychiatrist,                   

                                                                                

12  psychologist, social worker, or professional counselor who                  

                                                                                

13  provides only mental health services.                                       

                                                                                

14      (d) "Health facility" means a health facility or agency                     

                                                                                

15  licensed under article 17 of the public health code, 1978 PA 368,           

                                                                                

16  MCL 333.20101 to 333.22260, or any other organized entity where a           

                                                                                

17  health care provider provides health care to patients.                      

                                                                                

18      (e) "Maintain", as related to medical records, means to hold,               

                                                                                

19  possess, preserve, retain, store, or control medical records.               

                                                                                

20      (f) "Medicaid" means that term as defined in section 2701 of                

                                                                                

21  the public health code, 1978 PA 368, MCL 333.2701.                          

                                                                                

22      (g) "Medical record" means information oral or recorded in                  

                                                                                

23  any form or medium that pertains to a patient's health care,                

                                                                                

24  medical history, diagnosis, prognosis, or medical condition and             

                                                                                

25  that is maintained by a health care provider or health facility             

                                                                                

26  in the process of the patient's health.                                     

                                                                                

27      (h) "Medical records company" means a person who stores,                    


     House Bill No. 4706 (H-2) as amended June 19, 2003

   

1   locates, or copies medical records for a health care provider or            

                                                                                

2   health facility, is compensated for doing so by a health care               

                                                                                

3   provider or health facility, and charges a fee for providing                

                                                                                

4   medical records to a patient or patient's representative.                   

                                                                                

5       (i) "Medically indigent individual" means that term as                      

                                                                                

6   defined under section 106 of the social welfare act, 1939 PA 280,           

                                                                                

7   MCL 400.106.                                                                

                                                                                

8       (j) "Medicare" means that term as defined in section 2701 of                

                                                                                

9   the public health code, 1978 PA 368, MCL 333.2701.                          

                                                                                

10      (k) "Minor" means an individual who is less than 18 years of                

                                                                                

11  age, but does not include an individual who is emancipated under            

                                                                                

12  section 4 of 1968 PA 293, MCL 722.4.                                        

                                                                                

13                                                                               (l) "Patient" means an individual who receives or has                               

                                                                                

14  received health care from a health care provider.                           

                                                                                

15      (m) "Patient advocate" means an individual designated to make               

                                                                                

16  medical treatment decisions under section 5506 of the estates and           

                                                                                

17  protected individuals code, 1998 PA 386, MCL 700.5506.                      

                                                                                

18      (n) "Patient representative" means [a minor patient's parent or a person to whom a patient, a minor patient's parent,]                                      

                                                                                

19  or a patient's guardian has given written authorization to act on           

                                                                                

20  the patient's behalf for a specific, limited purpose or for                 

                                                                                

21  general purpose regarding the patient's health care and medical             

                                                                                

22  records.  This person may include, but is not limited to, a                 

                                                                                

23  [       ] parent, guardian, patient advocate, or personal                   

                                                                                

24  representative.  If the patient is deceased, patient                        

                                                                                

25  representative means the executor or administrator of the                   

                                                                                

26  patient's estate or the person responsible for the patient's                

                                                                                

27  estate if it is not to be probated.  Patient representative does            


                                                                                

1   not include a third party payer.                                            

                                                                                

2       (o) "Person" means an individual, corporation, estate, trust,               

                                                                                

3   partnership, association, joint venture, government, governmental           

                                                                                

4   subdivision or agency, or other legal or commercial entity.                 

                                                                                

5       (p) "Personal representative" means that term as defined in                 

                                                                                

6   section 1106 of the estates and protected individuals code, 1998            

                                                                                

7   PA 386, MCL 700.1106.                                                       

                                                                                

8       (q) "Third party payer" means a public or private health care               

                                                                                

9   payment or benefits program that is created, authorized, or                 

                                                                                

10  licensed under the laws of this state, including, but not limited           

                                                                                

11  to, all of the following:                                                   

                                                                                

12                                                                               (i) A health insurer.                                                               

                                                                                

13      (ii) A nonprofit health care corporation.                                    

                                                                                

14      (iii) A health maintenance organization.                                     

                                                                                

15      (iv) A preferred provider organization.                                      

                                                                                

16      (v) A nonprofit dental care corporation.                                    

                                                                                

17      (vi) Medicaid or medicare.                                                   

                                                                                

18      Sec. 5.  (1) Except as otherwise provided by law or                         

                                                                                

19  regulation, a patient or his or her patient representative has              

                                                                                

20  the right to examine or obtain the patient's medical record.                

                                                                                

21      (2) An individual authorized under subsection (1) who wishes                

                                                                                

22  to examine or obtain a copy of the patient's medical record shall           

                                                                                

23  submit a written request that is signed and dated by that                   

                                                                                

24  individual not more than 60 days before being submitted to the              

                                                                                

25  health care provider or health facility that maintains the                  

                                                                                

26  medical record that is the subject of the request.  Upon receipt            

                                                                                

27  of a request under this subsection, a health care provider or               


                                                                                

1   health facility shall, as promptly as required under the                    

                                                                                

2   circumstances, but not later than 30 days after receipt of the              

                                                                                

3   request or if the medical record is not maintained or accessible            

                                                                                

4   on-site not later than 60 days after receipt of the request, do 1           

                                                                                

5   or more of the following:                                                   

                                                                                

6       (a) Make the medical record available for inspection or                     

                                                                                

7   copying, or both, at the health care provider's or health                   

                                                                                

8   facility's business location during regular business hours or               

                                                                                

9   provide a copy of all or part of the medical record, as requested           

                                                                                

10  by the patient or patient's representative.                                 

                                                                                

11      (b) If the health care provider or health facility has                      

                                                                                

12  contracted with another person or medical records company to                

                                                                                

13  maintain the health care provider's or health facility's medical            

                                                                                

14  records, the health care provider or health facility shall                  

                                                                                

15  transmit a request made under this subsection to the person or              

                                                                                

16  medical records company maintaining the medical records.  The               

                                                                                

17  health care provider or health facility shall retrieve the                  

                                                                                

18  medical record from the person or medical records company                   

                                                                                

19  maintaining the medical records and comply with subdivision (a)             

                                                                                

20  or shall require the person or medical records company that                 

                                                                                

21  maintains that medical record to comply with subdivision (a).               

                                                                                

22      (c) Inform the patient or the patient's representative if the               

                                                                                

23  medical record does not exist or cannot be found.                           

                                                                                

24      (d) If the health care provider or health facility to which                 

                                                                                

25  the request is directed does not maintain the medical record                

                                                                                

26  requested and does not have a contract with another person or               

                                                                                

27  medical records company as described in subdivision (b), so                 


                                                                                

1   inform the patient or the patient's representative and provide              

                                                                                

2   the name and address, if known, of the health care provider or              

                                                                                

3   health facility that maintains the medical records.                         

                                                                                

4       (e) If the health care provider or health facility determines               

                                                                                

5   that disclosure of the requested medical record is likely to have           

                                                                                

6   an adverse effect on the patient, the health care provider or               

                                                                                

7   health facility shall provide a clear statement supporting that             

                                                                                

8   determination and provide the medical record to another health              

                                                                                

9   care provider, health facility, or legal counsel designated by              

                                                                                

10  the patient or patient's representative.                                    

                                                                                

11      (f) If the health care provider or health facility receives a               

                                                                                

12  request for a medical record that was obtained from another                 

                                                                                

13  health care provider or health facility under a confidentiality             

                                                                                

14  agreement, the health care provider or health facility may deny             

                                                                                

15  access to that medical record.  If the health care provider or              

                                                                                

16  health facility denies access under this subdivision, it shall              

                                                                                

17  provide the patient or patient's representative with a written              

                                                                                

18  denial.                                                                     

                                                                                

19      (g) The health care provider or health facility shall take                  

                                                                                

20  reasonable steps to verify the identity of the person making the            

                                                                                

21  request to examine or obtain a copy of the patient's medical                

                                                                                

22  record.                                                                     

                                                                                

23      (3) If the health care provider or health facility is unable                

                                                                                

24  to take action as required under subsection (2) and the health              

                                                                                

25  care provider or health facility provides the patient with a                

                                                                                

26  written statement indicating the reasons for its delay within the           

                                                                                

27  required time period, the health care provider or health facility           


                                                                                

1   may extend the response time for no more than 30 days.  A health            

                                                                                

2   care provider or health facility may only extend the response               

                                                                                

3   time once per request under this subsection.                                

                                                                                

4       Sec. 7.  A health care provider or health facility that                     

                                                                                

5   receives a request for a medical record under section 5 shall not           

                                                                                

6   inquire as to the purpose of the request.                                   

                                                                                

7       Sec. 9.  (1) If a patient or the patient's representative                   

                                                                                

8   makes a request for a copy of all or part of his or her medical             

                                                                                

9   record under section 5, the health care provider or health                  

                                                                                

10  facility to which the request is directed may charge the patient            

                                                                                

11  or the patient's representative a reasonable and cost base fee              

                                                                                

12  that is not more than the amount set forth in this section.  The            

                                                                                

13  total cost for all copies and services related to obtaining a               

                                                                                

14  copy of all or part of a medical record shall not exceed the sum            

                                                                                

15  of the following:                                                           

                                                                                

16      (a) An initial fee of $10.00 per request for a copy of the                  

                                                                                

17  record.                                                                     

                                                                                

18      (b) Paper copies as follows:                                                

                                                                                

19                                                                               (i) One dollar per page for the first 10 pages.                                     

                                                                                

20      (ii) Fifty cents per page for pages 11 through 50.                           

                                                                                

21      (iii) Twenty cents for pages 51 and over.                                    

                                                                                

22      (c) If the medical record is in some form or medium other                   

                                                                                

23  than paper, the actual cost of preparing a duplicate.                       

                                                                                

24      (d) Any postage or shipping costs incurred by the health care               

                                                                                

25  provider, health facility, or medical records company in                    

                                                                                

26  providing the copies.                                                       

                                                                                

27      (e) Any actual costs incurred by the health care provider,                  


                                                                                

1   health facility, or medical records company in retrieving medical           

                                                                                

2   records that are 7 years old or older and not maintained or                 

                                                                                

3   accessible on-site.                                                         

                                                                                

4       (2) A health care provider or health facility may refuse to                 

                                                                                

5   retrieve or copy all or part of a medical record for a patient or           

                                                                                

6   patient's representative until the applicable fee is paid.                  

                                                                                

7       (3) A health care provider or health facility shall not                     

                                                                                

8   charge a fee for retrieving, copying, or mailing all or part of a           

                                                                                

9   medical record other than a fee allowed under subsection (1).               

                                                                                

10  Except as otherwise provided in subsection (4), a health care               

                                                                                

11  provider or health facility shall waive all fees for a medically            

                                                                                

12  indigent individual.  The health care provider or health facility           

                                                                                

13  may require the patient or the patient's representative to                  

                                                                                

14  provide proof that the patient is a recipient of assistance as              

                                                                                

15  described in this subsection.                                               

                                                                                

16      (4) A medically indigent individual that receives copies of                 

                                                                                

17  medical records at no charge under subsection (3) is limited to 1           

                                                                                

18  set of copies per health care provider or health facility.  Any             

                                                                                

19  additional requests for the same records from the same health               

                                                                                

20  care provider or health care facility shall be subject to the fee           

                                                                                

21  provisions under subsection (1).                                            

                                                                                

22      (5) A patient or the patient's representative may supply his                

                                                                                

23  or her own copying equipment on the premises of the health care             

                                                                                

24  provider or health facility and pay only the initial fee allowed            

                                                                                

25  under subsection (1)(a).                                                    

                                                                                

26      Sec. 11.  (1) This act does not apply to copies of medical                  

                                                                                

27  records provided to an insurer or insurance organization issued a           


                                                                                

1   license or certification of authority in this state.                        

                                                                                

2       (2) This act does not require or preclude the distribution of               

                                                                                

3   a medical record at any particular cost or fee to an insurer or             

                                                                                

4   insurance organization issued a license or certification of                 

                                                                                

5   authority in this state.