HB-4706, As Passed Senate, March 9, 2004                                    

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                          SENATE 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) "Authorized representative" means either of the                         

                                                                                

5   following:                                                                  

                                                                                

6                                                                                (i) A person empowered by the patient by explicit written                           

                                                                                

7   authorization to act on the patient's behalf to access, disclose,           

                                                                                

8   or consent to the disclosure of the patient's medical record, in            

                                                                                

9   accordance with this act.                                                   

                                                                                

10      (ii) If the patient is deceased, his or her personal                         

                                                                                


                                                                                

1   representative or his or her heirs at law or the beneficiary of             

                                                                                

2   the patient's life insurance policy, to the extent provided by              

                                                                                

3   section 2157 of the revised judicature act of 1961, 1961 PA 236,            

                                                                                

4   MCL 600.2157.                                                               

                                                                                

5       (b) "Detroit consumer price index" means the most                           

                                                                                

6   comprehensive index of consumer prices available for the Detroit            

                                                                                

7   area from the bureau of labor statistics of the United States               

                                                                                

8   department of labor.                                                        

                                                                                

9       (c) "Guardian" means an individual who is appointed under                   

                                                                                

10  section 5306 of the estates and protected individuals code, 1998            

                                                                                

11  PA 386, MCL 700.5306, to the extent that the scope of the                   

                                                                                

12  guardianship includes the authority to act on the individual's              

                                                                                

13  behalf with regard to his or her health care.  Guardian includes            

                                                                                

14  an individual who is appointed as the guardian of a minor under             

                                                                                

15  section 5202 or 5204 of the estates and protected individuals               

                                                                                

16  code, 1998 PA 386, MCL 700.5202 and 700.5204, or under the mental           

                                                                                

17  health code, 1974 PA 258, MCL 330.1001 to 330.2106, to the extent           

                                                                                

18  that the scope of the guardianship includes the authority to act            

                                                                                

19  on the individual's behalf with regard to his or her health                 

                                                                                

20  care.                                                                       

                                                                                

21      (d) "Health care" means any care, service, or procedure                     

                                                                                

22  provided by a health care provider or health facility to                    

                                                                                

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

                                                                                

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

                                                                                

25      (e) "Health care provider" means a person who is licensed or                

                                                                                

26  registered or otherwise authorized under article 15 of the public           

                                                                                

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


                                                                                

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

                                                                                

2   health profession.  Health care provider does not include a                 

                                                                                

3   person who provides health care solely through the sale or                  

                                                                                

4   dispensing of drugs or medical devices or a psychiatrist,                   

                                                                                

5   psychologist, social worker, or professional counselor who                  

                                                                                

6   provides only mental health services.                                       

                                                                                

7       (f) "Health facility" means a health facility or agency                     

                                                                                

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

                                                                                

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

                                                                                

10  health care provider provides health care to patients.                      

                                                                                

11      (g) "Maintain", as related to medical records, means to hold,               

                                                                                

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

                                                                                

13      (h) "Medicaid" means that term as defined in section 2701 of                

                                                                                

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

                                                                                

15      (i) "Medical record" means information oral or recorded in                  

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

19  in the process of the patient's health.                                     

                                                                                

20      (j) "Medical records company" means a person who stores,                    

                                                                                

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

                                                                                

22  health facility under a contract or agreement with that health              

                                                                                

23  care provider or health facility and charges a fee for providing            

                                                                                

24  medical records to a patient or his or her authorized                       

                                                                                

25  representative for that health care provider or health facility.            

                                                                                

26      (k) "Medically indigent individual" means that term as                      

                                                                                

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


    House Bill No. 4706 as amended March 4, 2004                                

1   MCL 400.106.                                                                

                                                                                

2                                                                                (l) "Medicare" means that term as defined in section 2701 of                        

                                                                                

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

                                                                                

4       (m) "Minor" means an individual who is less than 18 years of                

                                                                                

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

                                                                                

6   section 4 of 1968 PA 293, MCL 722.4.                                        

                                                                                

7       (n) "Patient" means an individual who receives or has                       

                                                                                

8   received health care from a health care provider or health                  

                                                                                

9   facility.  Patient includes a guardian, if appointed, and a                 

                                                                                

10  parent, guardian, or person acting in loco parentis, if the                 

                                                                                

11  individual is a minor, unless the minor lawfully obtained health            

                                                                                

12  care without the consent or notification of a parent, guardian,             

                                                                                

13  or other person acting in loco parentis, in which case the minor            

                                                                                

14  has the exclusive right to exercise the rights of a patient under           

                                                                                

15  this act with respect to those medical records relating to that             

                                                                                

16  care.                                                                       

                                                                                

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

                                                                                

18  partnership, association, joint venture, government, governmental           

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

22  PA 386, MCL 700.1106.                                                       

                                                                                

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

                                                                                

24  payment or benefits program <<                                              

                                                                                

25                                        >> including, but not limited         

                                                                                

26  to, all of the following:                                                   

                                                                                

27                                                                               (i) A health insurer.                                                               


                                                                                

1       (ii) A nonprofit health care corporation.                                    

                                                                                

2       (iii) A health maintenance organization.                                     

                                                                                

3       (iv) A preferred provider organization.                                      

                                                                                

4       (v) A nonprofit dental care corporation.                                    

                                                                                

5       (vi) Medicaid or medicare.                                                   

                                                                                

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

                                                                                

7   regulation, a patient or his or her authorized representative has           

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

13  health care provider or health facility that maintains the                  

                                                                                

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

                                                                                

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

                                                                                

16  health facility shall, as promptly as required under the                    

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

20  or more of the following:                                                   

                                                                                

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

                                                                                

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

                                                                                

23  facility's business location during regular business hours or               

                                                                                

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

                                                                                

25  by the patient or his or her authorized representative.                     

                                                                                

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

                                                                                

27  contracted with another person or medical records company to                


                                                                                

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

                                                                                

2   records, the health care provider or health facility shall                  

                                                                                

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

                                                                                

4   medical records company maintaining the medical records.  The               

                                                                                

5   health care provider or health facility shall retrieve the                  

                                                                                

6   medical record from the person or medical records company                   

                                                                                

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

                                                                                

8   or shall require the person or medical records company that                 

                                                                                

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

                                                                                

10      (c) Inform the patient or his or her authorized                             

                                                                                

11  representative if the medical record does not exist or cannot be            

                                                                                

12  found.                                                                      

                                                                                

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

                                                                                

14  the request is directed does not maintain the medical record                

                                                                                

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

                                                                                

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

                                                                                

17  inform the patient or his or her authorized representative and              

                                                                                

18  provide the name and address, if known, of the health care                  

                                                                                

19  provider or health facility that maintains the medical records.             

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

23  health facility shall provide a clear statement supporting that             

                                                                                

24  determination and provide the medical record to another health              

                                                                                

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

                                                                                

26  the patient or his or her authorized representative.                        

                                                                                

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


                                                                                

1   request for a medical record that was obtained from someone other           

                                                                                

2   than a health care provider or health facility under a                      

                                                                                

3   confidentiality agreement, the health care provider or health               

                                                                                

4   facility may deny access to that medical record if access to that           

                                                                                

5   medical record would be reasonably likely to reveal the source of           

                                                                                

6   the information.  If the health care provider or health facility            

                                                                                

7   denies access under this subdivision, it shall provide the                  

                                                                                

8   patient or his or her authorized representative with a written              

                                                                                

9   denial.                                                                     

                                                                                

10      (g) The health care provider, health facility, or medical                   

                                                                                

11  records company shall take reasonable steps to verify the                   

                                                                                

12  identity of the person making the request to examine or obtain a            

                                                                                

13  copy of the patient's medical record.                                       

                                                                                

14      (3) If the health care provider, health facility, or medical                

                                                                                

15  records company is unable to take action as required under                  

                                                                                

16  subsection (2) and the health care provider, health facility, or            

                                                                                

17  medical records company provides the patient with a written                 

                                                                                

18  statement indicating the reasons for its delay within the                   

                                                                                

19  required time period, the health care provider, health facility,            

                                                                                

20  or medical records company may extend the response time for no              

                                                                                

21  more than 30 days.  A health care provider, health facility, or             

                                                                                

22  medical records company may only extend the response time once              

                                                                                

23  per request under this subsection.                                          

                                                                                

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

                                                                                

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

                                                                                

26  inquire as to the purpose of the request.                                   

                                                                                

27      Sec. 9.  (1) Except as otherwise provided in this section,                  


                                                                                

1   if a patient or his or her authorized representative makes a                

                                                                                

2   request for a copy of all or part of his or her medical record              

                                                                                

3   under section 5, the health care provider, health facility, or              

                                                                                

4   medical records company to which the request is directed may                

                                                                                

5   charge the patient or his or her authorized representative a fee            

                                                                                

6   that is not more than the following amounts:                                

                                                                                

7       (a) An initial fee of $20.00 per request for a copy of the                  

                                                                                

8   record.                                                                     

                                                                                

9       (b) Paper copies as follows:                                                

                                                                                

10                                                                               (i) One dollar per page for the first 20 pages.                                     

                                                                                

11      (ii) Fifty cents per page for pages 21 through 50.                           

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

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

                                                                                

16  provider, health facility, or medical records company in                    

                                                                                

17  providing the copies.                                                       

                                                                                

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

                                                                                

19  health facility, or medical records company in retrieving medical           

                                                                                

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

                                                                                

21  accessible on-site.                                                         

                                                                                

22      (2) A health care provider, health facility, or medical                     

                                                                                

23  records company may refuse to retrieve or copy all or part of a             

                                                                                

24  medical record for a patient or his or her authorized                       

                                                                                

25  representative until the applicable fee is paid.                            

                                                                                

26      (3) A health care provider, health facility, or medical                     

                                                                                

27  records company shall not charge a fee for retrieving, copying,             


    House Bill No. 4706 as amended March 4, 2004                                

1   or mailing all or part of a medical record other than a fee                 

                                                                                

2   allowed under subsection (1).  Except as otherwise provided in              

                                                                                

3   subsection (4), a health care provider, health facility, or                 

                                                                                

4   medical records company shall waive all fees for a medically                

                                                                                

5   indigent individual.  The health care provider, health facility,            

                                                                                

6   or medical records company may require the patient or his or her            

                                                                                

7   authorized representative to provide proof that the patient is a            

                                                                                

8   recipient of assistance as described in this subsection.                    

                                                                                

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

                                                                                

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

                                                                                

11  set of copies per health care provider, health facility, or                 

                                                                                

12  medical records company.  Any additional requests for the same              

                                                                                

13  records from the same health care provider, health facility, or             

                                                                                

14  medical records company shall be subject to the fee provisions              

                                                                                

15  under subsection (1).                                                       

                                                                                

16      (5) Notwithstanding subsection (1), a health care provider,                 

                                                                                

17  health facility, or medical records company shall not charge a              

                                                                                

18  patient an initial fee for his or her medical record.                       

                                                                                

19      (6) Beginning 2 years after the effective date of this act,                 

                                                                                

20  the department of community health shall adjust on an annual                

                                                                                

21  basis the fees prescribed by subsection (1) by an amount                    

                                                                                

22  determined by the state treasurer to reflect the cumulative                 

                                                                                

23  annual percentage change in the Detroit consumer price index.               

                                                                                

24      Sec. 11.  This act does not apply to copies of medical                      

                                                                                

25  records provided to a third party payer <<, insurer as defined in section 106 of the insurance code of 1956, 1956 PA 218, MCL 500.106, or self-funded plan>>.