(1)Existing law generally governs a patients access to his or her health records. Existing law requires a health care provider to provide any patient, former patient, or the representative of a patient or former patient a copy, at no charge, of the relevant portion of the patients health records upon presenting to the health care provider a written request and proof that the health records are needed to support an appeal regarding eligibility for specified public benefit programs. Existing law makes a violation of these provisions by certain health care providers an infraction.

This bill would make those health care providers provide those patients with a copy of those health records at no charge to support a claim for eligibility for a public benefit program. The bill would specify additional public benefit programs to which these requirements would apply. The bill would make related conforming changes. By making the existing criminal penalties applicable to additional duties of a health care provider, the bill would impose a state-mandated local program.

This bill would incorporate additional changes to Section 123110 of the Health and Safety Code proposed by SB 241 to be operative only if this bill and SB 241 are enacted and this bill is enacted last.

(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

(1)Existing law generally governs a patients access to his or her health records. Existing law requires a health care provider to provide any patient, former patient, or the representative of a patient or former patient a copy, at no charge, of the relevant portion of the patients health records upon presenting to the health care provider a written request and proof that the health records are needed to support an appeal regarding eligibility for specified public benefit programs. Existing law makes a violation of these provisions by certain health care providers an infraction.

This bill would make those health care providers provide those patients with a copy of those health records at no charge to support a claim for eligibility for a public benefit program. The bill would specify additional public benefit programs to which these requirements would apply. The bill would make related conforming changes. By making the existing criminal penalties applicable to additional duties of a health care provider, the bill would impose a state-mandated local program.

This bill would incorporate additional changes to Section 123110 of the Health and Safety Code proposed by SB 241 to be operative only if this bill and SB 241 are enacted and this bill is enacted last.

(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

(1)Existing law generally governs a patients access to his or her health records. Existing law requires a health care provider to provide any patient, former patient, or the representative of a patient or former patient a copy, at no charge, of the relevant portion of the patients health records upon presenting to the health care provider a written request and proof that the health records are needed to support an appeal regarding eligibility for specified public benefit programs. Existing law makes a violation of these provisions by certain health care providers an infraction.

This bill would make those health care providers provide those patients with a copy of those health records at no charge to support a claim for eligibility for a public benefit program. The bill would specify additional public benefit programs to which these requirements would apply. The bill would make related conforming changes. By making the existing criminal penalties applicable to additional duties of a health care provider, the bill would impose a state-mandated local program.

(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

(1)Existing law generally governs a patients access to his or her health records. Existing law requires a health care provider to provide any patient, former patient, or the representative of a patient or former patient a copy, at no charge, of the relevant portion of the patients health records upon presenting to the health care provider a written request and proof that the health records are needed to support an appeal regarding eligibility for specified public benefit programs. Existing law makes a violation of these provisions by certain health care providers an infraction.

This bill would make those health care providers provide those patients with a copy of those health records at no charge to support a claim for certain other public benefit programs. eligibility for a public benefit program. The bill would specify additional public benefit programs to which these requirements would apply. The bill would make related conforming changes. By making the existing criminal penalties applicable to additional duties of a health care provider, the bill would impose a state-mandated local program.

(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

(1)Existing law generally governs a patients access to his or her health records. Existing law requires a health care provider to provide any patient, former patient, or the representative of a patient or former patient a copy, at no charge, of the relevant portion of the patients health records upon presenting to the health care provider a written request and proof that the health records are needed to support an appeal regarding eligibility for specified public benefit programs. Existing law makes a violation of these provisions by certain health care providers an infraction.

This bill would make those health care providers provide those patients with a copy of those health records at no charge to support a claim for certain other public benefit programs. By making the existing criminal penalties applicable to additional duties of a health care provider, the bill would impose a state-mandated local program.

(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 UNFINISHED BUSINESS  

Bill No: SB 575

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 6-0, 3/29/17

AYES: Hernandez, Leyva, Mitchell, Monning, Newman, Nielsen

NO VOTE RECORDED: Nguyen, Atkins, Roth

SENATE JUDICIARY COMMITTEE: 6-0, 4/25/17

AYES: Jackson, Anderson, Hertzberg, Monning, Stern, Wieckowski

NO VOTE RECORDED: Moorlach

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SENATE FLOOR: 33-5, 5/15/17

AYES: Allen, Atkins, Beall, Berryhill, Bradford, Cannella, De León, Dodd, Galgiani, Glazer, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leyva, McGuire, Mendoza, Mitchell, Monning, Moorlach, Newman, Nguyen, Nielsen, Pan, Portantino, Roth, Skinner, Stern, Wieckowski, Wiener, Wilk

NOES: Anderson, Bates, Fuller, Morrell, Stone

NO VOTE RECORDED: Gaines, Vidak

ASSEMBLY FLOOR: 79-0, 9/14/17 - See last page for vote

SUBJECT:

SOURCE: Western Center on Law and Poverty

DIGEST:

This bill expands a provision of law that entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to support an appeal regarding eligibility for certain public benefit programs, by including initial applications in addition to appeals, and by expanding the list of public benefit programs to include In-Home Supportive Services, the California Work Opportunity and Responsibility to Kids program, CalFresh, and certain veterans related benefits.

Assembly Amendments add double-jointing amendments that incorporate changes made by SB 241 (Monning) in order to prevent chaptering out conflicts.

ANALYSIS:

Existing law:

1. Requires, under the Patient Access to Health Records (PAHR) law, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to be entitled to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available.
2. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request of the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $.25 per page of $.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available.
3. Requires a patient or the representative of a patient to be entitled to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, or Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits. For purposes of this provision, existing law also:
   1. Defines “relevant portion” as those records regarding services rendered to the patient from the date of the patient’s initial application for public benefits up to and including the date that a final determination is made by the public benefits program;
   2. Excludes from this provision any patient who is represented by a private attorney, who is not employed by a nonprofit legal services entity, who is paying for the costs related to the patient’s appeal, pending the outcome of that appeal; and
   3. Permits a health care provider to bill the patient, at the rates specified in 2) above, for the copies of the medical records previously provided free of charge if the patient’s appeal regarding eligibility for a public benefit program is successful.
4. Defines “patient records” as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient.
5. Defines “health care provider” as a licensed health facility, clinic, or home health agency, or a licensed health care professional, as specified.
6. Makes any licensed health care professional that willfully violates PAHR guilty of unprofessional conduct. Makes any health facility, clinic, or home health agency that willfully violates PAHR guilty of an infraction punishable by a fine of not more than $100. Requires the state agency, board, or commission that issued the provider’s professional or institutional license to consider a violation as grounds for disciplinary action with respect to the licensure, including suspension or revocation of the license.

This bill expands a provision of law that entitles a patient or a patient’s representative to a copy, at no charge, of the relevant portion of the patient’s records that are need to support an appeal regarding eligibility for certain public benefit programs, by doing the following:

1. Expanding the list of public benefit program to include In-Home Supportive Services (IHSS) program, the California Work Opportunity and Responsibility to Kids (CalWORKS) program, CalFresh, and federal veterans service-connected compensation and non-service connected pension disability benefits;
2. Applying this provision of law to initial claims for the public benefit programs, not just appeals;
3. Including the ability to get supporting forms from the provider free of charge, in addition to relevant patient records; and,
4. Deleting the definition of “relevant portion of the patient’s records,” which limited records to only those from the date of the patient’s initial application for public benefits up to the date of a final determination, thereby removing a time period limitation on the relevant patient records.

Comments

1. Author’s statement. According to the author, this bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low income Californians to spend needed cash to even apply for public benefits. Safety net services, such as Medi-Cal, SSI/SSP, CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.
2. Public Benefits Program. This bill expands the provision of free medical records to applicants to the following benefit programs:
   1. IHSS. The IHSS Program helps pay for services so that the eligible person can remain safely in their own home. To be eligible, you must be over 65 years of age, or disabled, or blind. IHSS is an alternative to out-of-home care such as nursing homes. Services authorized under IHSS are housecleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision for the mentally impaired. Prior to IHSS services being authorized, a health care certification form is required to be submitted, in which a licensed health care provider must certify that the applicant is unable to perform some activity of daily living independently, and that without IHSS the individual would be at risk of placement in out-of-home care;
   2. CalFresh. CalFresh (federally known as the Supplemental Nutrition Assistance Program or SNAP) is a federally mandated, state-supervised, and county-operated government entitlement program that provides monthly food benefits to assist low-income households in purchasing the food they need to maintain adequate nutritional levels. Everyone who gets CalFresh benefits must register to work unless they are exempt, and being physically or mentally unable to work may qualify for an exemption from work requirements, and if requesting an exemption, the county may ask for documentation.
   3. CalWORKs. CalWORKS is a public assistance program that provides cash aid and services to eligible families that have a child in the home. The program serves all 58 counties in the state and is operated locally by county welfare departments. If a family has little or no cash and needs housing, food, utilities, clothing or medical care, they may be eligible to receive immediate short-term help. Families that apply and qualify for ongoing assistance receive money each month to help pay for housing, food and other necessary expenses. The amount of a family's monthly assistance payment depends on a number of factors, including the number of people who are eligible and the special needs of any of those family members. Generally, individuals are limited to 48 months of aid and are required to participate in welfare-to-work activities as a condition of receiving aid, unless exempt. Being physically or mentally unable to work may qualify for an exemption from work activities and the time limit for receiving aid, and if requesting an exemption, the county may ask for documentation.
   4. Veterans compensation benefits. Veterans service-connected disability compensation is a monetary benefit paid to veterans who are determined by the Veterans Administration to be disabled by an injury or illness that was incurred or aggravated during active military service. Monthly disability compensation varies with the degree of disability and the number of dependents, and veterans with certain severe disabilities may be eligible for additional special monthly compensation. Veterans non-service connected disability is a needs-based benefit paid to wartime veterans who meet certain age or non-service connected disability requirements.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Assembly Appropriations Committee, negligible state fiscal impact.

SUPPORT: (Verified 9/12/17)

Western Center on Law and Poverty (source)

American Federation of State, County and Municipal Employees, AFL-CIO

Asian Law Alliance

Bay Area Legal Aid

California Advocates for Nursing Home Reform

California Association of Food Banks

California Food Policy Advocates

California Pan-Ethnic Health Network

CaliforniaHealth+ Advocates

Jewish Family Services of Los Angeles

Justice in Aging

Legal Aid Society of San Diego

National Association of Social Workers, California Chapter

National Health Law Program

Project Inform

Public Interest Law Project

St. Anthony Foundation

St. Mary’s Center

OPPOSITION: (Verified 9/12/17)

None received

ARGUMENTS IN SUPPORT: This bill is sponsored by the Western Center on Law and Poverty (WCLP), which states that this bill would expand free medical record access beyond Medi-Cal, SSI/SSP, and social security disability benefits to include IHSS, veterans benefits, CalFresh and CalWORKS. WCLP states that applying for many of these benefit programs requires careful review of medical records to make a disability determination, and to bring forth their best application, applicants include medical records and supporting documentation to support their disability claim. WCLP states that some applicants report difficulty obtaining their medical records so may submit an application that does not adequately demonstrate their disability claim, resulting in a denial that leads to a lengthy appeal process. WCLP states that patients are entitled to their own medical records and provider fees should not be a barrier to applying for public benefit programs. WCLP cites U.S. Department of Health and Human Services guidance on this issue, which states, “While covered entities should forgo fees for all individuals, not charging fees is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. WCLP states that in addition, beginning next year, adults under age 50 without children will have their CalFresh food benefits cut off after a limited time if they are not working unless the individual has a medical condition that limits

their ability to meet work requirements. Supporters include Bay Area Legal Aid, the Public Interest Law Project, Justice in Aging, the Asian Law Alliance, and California Advocates for Nursing Home Reform, which make similar arguments.

ASSEMBLY FLOOR: 79-0, 9/14/17

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

Prepared by:

9/15/17 9:11:26

**** END ****

SENATE THIRD READING

STR Bill Id:SB 575

Author:(Leyva)

As Amended Ver:September 7, 2017

Majority vote

SENATE VOTE: 33-5

SUMMARY: Entitles a patient to a copy, at no charge, of the relevant portion of the patient's records that are needed to support a claim regarding eligibility for specified public benefit programs. Adds to the list of public benefit programs the In-Home Supportive Services (IHSS) program, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, federal veterans' service-connected compensation and nonservice connected pension disability benefits, and CalFRESH. Contains language to avoid chaptering out this bill with SB 241 (Monning) should both bills become enacted since both bills amend the same code sections. Makes other clarifying, technical and non-substantive changes.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS: According to the author, this bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low income Californians to spend needed cash to even apply for public benefits. Safety net services, such as Medi-Cal, Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP), CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.

1. Eligible Public Benefits Program. Existing law entitles a patient or the representative of a patient to a copy, at no charge, of the relevant portion of the patient's records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, and SSI/SSP benefits. This bill expands the provision of free medical records to applicants to the following benefit programs:
   1. IHSS. The IHSS Program helps pay for services so that the eligible person can remain safely in their own home. To be eligible, you must be over 65 years of age, or disabled, or blind. Disabled children are also potentially eligible for IHSS. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities. Prior to IHSS services being authorized, a health care certification form is required to be submitted, in which a licensed health care provider must certify that the applicant is unable to perform some activity of daily living independently, and that without IHSS the individual would be at risk of placement in out-of-home care.
   2. CalFresh. CalFresh is a federally mandated, state-supervised, and county-operated government entitlement program that provides monthly food benefits to assist low-income households in purchasing the food they need to maintain adequate nutritional levels. Everyone who gets CalFresh benefits must register to work unless they are exempt, and being physically or mentally unable to work may qualify for an exemption from work requirements, and if requesting an exemption, the certifying county may ask for documentation. If an individual only receives CalFresh and does not have minor children, there is another work rule requirement unless waived by the certifying county. At this time, this work rule is waived in all counties until at least December 31, 2017. Exemptions include individuals under 18, over age 49, pregnant, living in a CalFresh household with a minor child, and for other reasons a county can explain.
   3. CalWORKs. CalWORKs is a public assistance program that provides cash aid and services to eligible families that have a child in the home. Being physically or mentally unable to work may qualify for an exemption from work activities and the time limit for receiving aid, and if requesting an exemption, the county may ask for documentation.
   4. Veteran's benefits. Veterans of the U.S. Armed Forces may be eligible for a broad range of benefits and services provided by the U.S. Department of Veterans Affairs. Veterans' service-connected disability compensation is a monetary benefit paid to veterans who are determined by the Veterans Administration to be disabled by an injury or illness that was incurred or aggravated during active military service.
2. Federal guidance. The U.S. Department of Health and Human Services issued guidance which state in part, while the Privacy Rule permits a limited fee as described; covered entities should provide individuals who request access to their information with copies of their personal health information free of charge. While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. Providing individuals with access to their health information is a necessary component of delivering and paying for health care.
3. Other states. There are approximately 13 states that require health care providers to provide medical records at no charge if the copies are for various specified claims, including health insurance, disability benefits, or continuation of the patient's medical care.

Western Center on Law and Poverty (WCLP), sponsor of this bill, states that some applicants report difficulty obtaining their medical records and when their applications for public benefit programs does not adequately demonstrate their disability claim, a claim denial can lead to a lengthy appeal process. WCLP contends that patients are entitled to their own medical records and provider fees should not be a barrier to applying for a public benefit program. Senior & Disability Action writes that they believe this bill will bring us closer to its vision of a world in which all people are treated with dignity, and have access to basic needs.

There is no known opposition to this bill.

Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097 FN: 0002025

SENATE THIRD READING

STR Bill Id:SB 575

Author:(Leyva)

As Amended Ver:April 3, 2017

Majority vote

SENATE VOTE: 33-5

SUMMARY: Entitles a patient to a copy, at no charge, of the relevant portion of the patient's records that are needed to support a claim regarding eligibility for specified public benefit programs. Adds to the list of public benefit programs the In-Home Supportive Services (IHSS) program, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, federal veterans' service-connected compensation and nonservice connected pension disability benefits, and CalFRESH. Makes other clarifying, technical and non-substantive changes.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS: According to the author, this bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low income Californians to spend needed cash to even apply for public benefits. Safety net services, such as Medi-Cal, Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP), CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.

1. Eligible Public Benefits Program. Existing law entitles a patient or the representative of a patient to a copy, at no charge, of the relevant portion of the patient's records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, and SSI/SSP benefits. This bill expands the provision of free medical records to applicants to the following benefit programs:
   1. IHSS. The IHSS Program helps pay for services so that the eligible person can remain safely in their own home. To be eligible, you must be over 65 years of age, or disabled, or blind. Disabled children are also potentially eligible for IHSS. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities. Prior to IHSS services being authorized, a health care certification form is required to be submitted, in which a licensed health care provider must certify that the applicant is unable to perform some activity of daily living independently, and that without IHSS the individual would be at risk of placement in out-of-home care.
   2. CalFresh. CalFresh is a federally mandated, state-supervised, and county-operated government entitlement program that provides monthly food benefits to assist low-income households in purchasing the food they need to maintain adequate nutritional levels. Everyone who gets CalFresh benefits must register to work unless they are exempt, and being physically or mentally unable to work may qualify for an exemption from work requirements, and if requesting an exemption, the certifying county may ask for documentation. If an individual only receives CalFresh and does not have minor children, there is another work rule requirement unless waived by the certifying county. At this time, this work rule is waived in all counties until at least December 31, 2017. Exemptions include individuals under 18, over age 49, pregnant, living in a CalFresh household with a minor child, and for other reasons a county can explain.
   3. CalWORKs. CalWORKs is a public assistance program that provides cash aid and services to eligible families that have a child in the home. Being physically or mentally unable to work may qualify for an exemption from work activities and the time limit for receiving aid, and if requesting an exemption, the county may ask for documentation.
   4. Veteran's benefits. Veterans of the U.S. Armed Forces may be eligible for a broad range of benefits and services provided by the U.S. Department of Veterans Affairs. Veterans' service-connected disability compensation is a monetary benefit paid to veterans who are determined by the Veterans Administration to be disabled by an injury or illness that was incurred or aggravated during active military service.
2. Federal guidance. The U.S. Department of Health and Human Services issued guidance which state in part, while the Privacy Rule permits a limited fee as described; covered entities should provide individuals who request access to their information with copies of their personal health information free of charge. While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. Providing individuals with access to their health information is a necessary component of delivering and paying for health care.
3. Other states. There are approximately 13 states that require health care providers to provide medical records at no charge if the copies are for various specified claims, including health insurance, disability benefits, or continuation of the patient's medical care.

Western Center on Law and Poverty (WCLP), sponsor of this bill, states that some applicants report difficulty obtaining their medical records and when their applications for public benefit programs does not adequately demonstrate their disability claim, a claim denial can lead to a lengthy appeal process. WCLP contends that patients are entitled to their own medical records and provider fees should not be a barrier to applying for a public benefit program. Senior & Disability Action writes that they believe this bill will bring us closer to its vision of a world in which all people are treated with dignity, and have access to basic needs.

There is no known opposition to this bill.

Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097 FN: 0001103

Date of Hearing: June 28, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

SBPCA Bill Id:SB 575

Author:(Leyva) – As Amended Ver:April 3, 2017

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill allows a patients to receive their medical records free of charge to support an application for public benefit programs (an expansion of a current-law right to receive medical records free of charge to support an appeal), and specifies the additional public benefit programs to which these requirements apply.

FISCAL EFFECT:

Negligible state fiscal impact.

Providing free medical records to support an application could theoretically assist eligible persons in claiming benefits, but any effect of this bill on expenditures in such benefit programs is speculative. For the most part, private providers would absorb the cost of providing records. State-employed providers, such as those employed by the correctional system or state hospitals, would also be required to comply, but additional expense is not expected to be significant.

COMMENTS:

1. Purpose. This bill is intended to help people who are applying to public benefit programs get documentation of their medical condition without cost. This bill is sponsored by the Western Center on Law and Poverty.
2. Background. Current law specifies medical records are available free of charge for persons who can show the records are needed to support an appeal of an eligibility determination for Medi-Cal, social security disability insurance benefits, or Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP). Because medical documentation is also needed to support a person's initial claim, this bill also allows persons to access their records to support such a claim. In addition, this bill also allows persons to receive medical records free of charge for purposes of applying to, or appealing, an eligibility determination for the following programs:
   1. In-Home Supportive Services (IHSS).
   2. California Work Opportunity and Responsibility to Kids (CalWORKs).
   3. Federal veterans service-connected compensation and non-service connected pension disability benefits.
   4. CalFresh.

This bill is consistent with U.S. Department of Health and Human Services (HHS) guidance that although charging fees is permissible, healthcare providers should provide individuals who request access to their medical information with copies of their protected health information (PHI) free of charge, particularly individuals who would have difficulty paying a fee.

1. Related Legislation. SB 241 (Monning) conforms state law to federal law with respect to patients' rights to medical records. SB 241 is also being heard today in this committee. SB 241 amends the same code section as SB 575. Furthermore, AB 1119 (Limon), related to records of individuals with disabilities who are detained, also amends the same code section. These bills will likely require amendments in order to avoid chaptering-out issues.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: June 20, 2017

ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION

Ed Chau, Chair

SBPCA Bill Id:SB 575

Author:(Leyva) – As Amended Ver:April 3, 2017

SENATE VOTE: 33-5

SUBJECT: Patient access to health records

SUMMARY: Expands patients’ rights under current law to get a free copy of their medical records when they file a claim or appeal for certain public benefit programs. Specifically, this bill:

1. Entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to file a claim or appeal regarding eligibility for the following public benefit programs:
2. In-Home Supportive Services (IHSS);
3. California Work Opportunity and Responsibility to Kids (CalWORKs);
4. Federal veterans service-connected compensation and nonservice connected pension disability benefits; and
5. CalFresh (federally known as the Supplemental Nutrition Assistance Program).
6. Entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to file a claim for eligibility for the following public benefit programs:
7. Medi-Cal Medi-Cal program;
8. Social security disability insurance benefits; and
9. Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits.
10. Makes other clarifying, technical and non-substantive changes.

EXISTING LAW:

1. Permits, under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), that if an individual requests a copy of the individual’s protected health information or agrees to a summary or explanation of such information, certain health care providers and plans may impose a reasonable, cost-based fee, provided that the fee includes only the cost of:
   1. Labor for copying the protected health information requested by the individual, whether in paper or electronic form;
   2. Supplies for creating the paper copy or electronic media if the individual requests that the electronic copy be provided on portable media;
   3. Postage, when the individual has requested the copy, or the summary or explanation, be mailed; and,
   4. Preparing an explanation or summary of the protected health information, if agreed to by the individual. (45 Code of Federal Regulations Section 164.524(c)(4).)
2. Requires, under the state Patient Access to Health Records (PAHR) law, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to be entitled to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available. (Health and Safety (H&S) Code Section 123100 et seq.)
3. Defines “health care provider,” for purposes of PAHR, as a licensed health facility, clinic, or home health agency, or a licensed health care professional, as specified. (H&S 123105(a))
4. Defines “patient records,” for purposes of PAHR, as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient. (H&S 123105(d))
5. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request of the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $.25 per page of $.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available. (H&S 123110(b))
6. Requires a patient or the representative of a patient to be entitled to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, or SSI/SSP benefits. (H&S 123110(d))

FISCAL EFFECT:

According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, any additional state costs are not significant, and do not and will not require the appropriation of additional state funds, and the bill will cause no significant reduction in revenues.

COMMENTS:

1. Purpose of this bill: This bill is intended to help people who are applying to (or appealing benefit decisions from) public benefit programs get documentation of their medical condition for eligibility without cost. This bill is sponsored by the Western Center on Law and Poverty.
2. Author's statement: According to the author, “This bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low-income Californians to spend needed cash to apply for public benefits. Safety net services, such as Medi-Cal, SSI/SSP, CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.”
3. Access as a privacy principle: The United States Federal Trade Commission (FTC) Fair Information Practice Principles (FIPPs) are widely-accepted recommendations for maintaining privacy-friendly, consumer-oriented data collection practices online. Fair information practices were first developed by the U.S. Department of Health and Human Service in 1973 in response to the growing use of automated data systems containing information about individuals. The FTC later developed guiding principles that have helped shape privacy laws and industry practices throughout the United States because they serve as a framework for thinking about how to approach privacy and data protection.
   
   Relative to this bill, one of the FIPPs is '”individual participation,” which means to "involve the individual in the process of using personally identifying information (PII) by allowing an individual access to their PII and, to the extent practicable, seeking consent for the collection, use, dissemination, and maintenance of PII."

While current law guarantees access to free copies of their medical records when patients need to appeal a denial of eligibility for specific public benefits programs, including Medi-Cal, social security disability insurance benefits, and the SSI/SSP, the law does not guarantee patient access to records for filing an initial claim for those programs or for filing an initial claim or an appeal to other public benefit programs.

This bill honors the FIPPs principles by ensuring that low-income patients, who may not be able to afford to pay for copies of their medical records, can still have access for the purpose of their initial application to Medi-Cal, social security disability insurance benefits, and the SSI/SSP. The bill also adds several other public benefit programs to the list, guaranteeing patients will have access when they apply for or appeal a benefits decision from several other programs, including IHSS; CalWORKs); federal veterans service-connected compensation and nonservice connected pension disability benefits; and CalFresh.

1. Arguments in support: According to the sponsor, Western Center on Law and Poverty, “Applying for […] public benefit programs is a complicated process that requires careful review of medical records to make a disability determination. To bring forth their best application, applicants include medical records and supporting documentation to support their disability claim. Some applicants report difficulty obtaining their medical records so may submit an application that does not adequately demonstrate their disability claim, resulting in a claim denial that leads to a lengthy appeal process.”

Justice in Aging argues in support of the measure that “Free access to medical records is vital when applying to many public benefit programs. Current law limits access to appeals for Medi-Cal; Supplemental Security Income/State Supplementary Program for the Aged, Blind, and Disabled (SSI/SSP); and Social Security Disability Insurance (SSDI). This bill would make three major improvements to current law: (1) it allows applicants to access their medical records during the determination process; (2) it expands the number of eligible programs to include In-Home Supportive Services (IHSS); Veteran Benefits; CalFresh; and CalWORKs; and (3) it allows applicants and beneficiaries to get supporting forms completed free of charge.”

1. Chaptering issues: This bill is currently in conflict with AB 1119 (Limón) and SB 241 (Monning), which in part amend the same code sections as this bill. According to the author’s office, when all three bills are in final form the author will accept amendments to avoid a chaptering-out issue, which would otherwise occur when the bills are signed into law.
2. Related legislation: AB 1119 (Limón) authorizes the disclosure of patient information and records of individuals with developmental and mental health disabilities who are voluntarily or involuntarily detained, including those detained under the Lanterman-Petris-Short Act, during the provision of emergency services and care, as defined. AB 1119 is pending before the Senate Judiciary Committee.

SB 241 (Monning) revises and recasts provisions of law governing the right of patients to access a copy of their medical records by conforming these requirements to HIPAA. SB 241 passed the Assembly Health Committee on a 14-0 vote and is now pending before this Committee.

1. Prior legislation: AB 1337 (Linder, Chapter 528, Statutes of 2015) amended the Evidence Code to create an authorization form for disclosure of health information by medical providers, and required electronic medical records requested prior to the filing of any action or appearance of a defendant in an action to be provided electronically if requested in an electronic format, and if it is readily producible in that format.
   
   AB 1311 (Goldberg, Chapter 325, Statutes of 2001) required a health care provider, within 30 days of a written request from a patient, former patient, or patient's representative, to provide a free copy of that portion of the patient's medical records relevant to the patient's appeal from the denial of eligibility for a public benefit program, as specified.
2. Double-referral: This bill was double-referred to the Assembly Health Committee where it passed on a 14-0 vote.

REGISTERED SUPPORT / OPPOSITION:

Support

Western Center on Law and Poverty (sponsor)

American Federation of State, County and Municipal Employees, AFL-CIO

Asian Law Alliance

Bay Area Legal Aid

California Advocates for Nursing Home Reform

California Association of Food Banks

California Food Policy Advocates

California Pan-Ethnic Health Network

California Health+ Advocates

Community Clinic Association of Los Angeles County

Jewish Family Service of Los Angeles

Justice in Aging

Legal Aid Foundation of Los Angeles

Legal Aid Society of San Diego, Inc.

National Association of Social Workers, California Chapter

National Health Law Program

Project Inform

Public Interest Law Project

Senior & Disability Action

St. Anthony Foundation

Opposition

None on file.

Analysis Prepared by: Jennie Bretschneider / P. & C.P. / (916) 319-2200

Date of Hearing: June 13, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 575

Author:(Leyva) – As Amended Ver:April 3, 2017

SENATE VOTE: 33-5

SUBJECT: Patient access to health records.

SUMMARY: Entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to support a claim regarding eligibility for specified public benefit programs. Adds to the list of public benefit programs the In-Home Supportive Services (IHSS) program, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, federal veterans service-connected compensation and nonservice connected pension disability benefits, and CalFRESH. Makes other clarifying, technical and non-substantive changes.

EXISTING LAW:

1. Establishes under federal law Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards for privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances.
2. Entitles any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available.
3. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request to the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $0.25 per page or $0.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available.
4. Entitles a patient or the representative of a patient to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, and Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits.
5. Defines relevant portion as those records regarding services rendered to the patient from the date of the patient’s initial application for public benefits up to and including the date that a final determination is made by the public benefits program with which the patient’s application is pending.
6. Limits the patient or patient’s representative to no more than one copy of any relevant portion of his or her record free of charge.
7. Excludes from this provision any patient who is represented by a private attorney, who is not employed by a nonprofit legal services entity, who is paying for the costs related to the patient’s appeal, pending the outcome of that appeal.
8. Permits a health care provider to bill the patient for the copies of the medical records previously provided free of charge if the patient’s appeal regarding eligibility for a public benefit program is successful.
9. Defines patient records as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient.
10. Defines a health care provider as a licensed health facility, clinic, or home health agency, or a licensed health care professional, as specified.
11. Makes any licensed health care professional that willfully violates the provisions in 2) above guilty of unprofessional conduct. Makes any health facility, clinic, or home health agency that willfully violates the provisions in 2) above guilty of an infraction punishable by a fine of not more than $100. Requires the state agency, board, or commission that issued the provider’s professional or institutional license to consider a violation as grounds for disciplinary action with respect to the licensure, including suspension or revocation of the license.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low income Californians to spend needed cash to even apply for public benefits. Safety net services, such as Medi-Cal, SSI/SSP, CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.
2. BACKGROUND.
   1. Eligible Public Benefits Program. Existing law entitles a patient or the representative of a patient to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, and SSI/SSP benefits. This bill expands the provision of free medical records to applicants to the following benefit programs:
      1. IHSS. The IHSS Program helps pay for services so that the eligible person can remain safely in their own home. To be eligible, you must be over 65 years of age, or disabled, or blind. Disabled children are also potentially eligible for IHSS.  IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities. The types of services which can be authorized through IHSS are housecleaning, meal preparation, laundry, grocery shopping, personal care services (such as bowel and bladder care, bathing, grooming, and paramedical services), accompaniment to medical appointments, and protective supervision for the mentally impaired. Prior to IHSS services being authorized, a health care certification form is required to be submitted, in which a licensed health care provider must certify that the applicant is unable to perform some activity of daily living independently, and that without IHSS the individual would be at risk of placement in out-of-home care.
      2. CalFresh. CalFresh is a federally mandated, state-supervised, and county-operated government entitlement program that provides monthly food benefits to assist low-income households in purchasing the food they need to maintain adequate nutritional levels. Everyone who gets CalFresh benefits must register to work unless they are exempt, and being physically or mentally unable to work may qualify for an exemption from work requirements, and if requesting an exemption, the certifying county may ask for documentation. If an individual only receives CalFresh and does not have minor children, there is another work rule requirement unless waived by the certifying county.  At this time, this work rule is waived in all counties until at least December 31, 2017. Exemptions include individuals under 18, over age 49, pregnant, living in a CalFresh household with a minor child, and for other reasons a county can explain.
      3. CalWORKs. CalWORKs is a public assistance program that provides cash aid and services to eligible families that have a child in the home. The program serves all 58 counties in the state and is operated locally by county welfare departments. If a family has little or no cash and needs housing, food, utilities, clothing, or medical care, they may be eligible to receive immediate short-term help. Families that apply and qualify for ongoing assistance receive money each month to help pay for housing, food and other necessary expenses.  The amount of a family's monthly assistance payment depends on a number of factors, including the number of people who are eligible and the special needs of any of those family members. Generally, individuals are limited to 48 months of aid and are required to participate in welfare-to-work activities as a condition of receiving aid, unless exempt. Being physically or mentally unable to work may qualify for an exemption from work activities and the time limit for receiving aid, and if requesting an exemption, the county may ask for documentation.
      4. Veteran’s benefits. Veterans of the U.S. Armed Forces may be eligible for a broad range of benefits and services provided by the U.S. Department of Veterans Affairs. Veterans service-connected disability compensation is a monetary benefit paid to veterans who are determined by the Veterans Administration to be disabled by an injury or illness that was incurred or aggravated during active military service. Monthly disability compensation varies with the degree of disability and the number of dependents, and veterans with certain severe disabilities may be eligible for additional special monthly compensation. Veterans non-service connected disability is a needs-based benefit paid to wartime veterans who meet certain age or non-service connected disability requirements.
   2. Federal guidance. The U.S. Department of Health and Human Services issued guidance which state in part, while the Privacy Rule permits a limited fee as described; covered entities should provide individuals who request access to their information with copies of their personal health information free of charge.  While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee.  Providing individuals with access to their health information is a necessary component of delivering and paying for health care.
   3. Other states. There are approximately 13 states that require health care providers to provide medical records at no charge if the copies are for various specified claims, including health insurance, disability benefits, or continuation of the patient’s medical care.
3. SUPPORT. Western Center on Law and Poverty (WCLP), sponsor of this bill, states that some applicants report difficulty obtaining their medical records and when their applications for public benefit programs does not adequately demonstrate their disability claim, a claim denial can lead to a lengthy appeal process. WCLP contends that patients are entitled to their own medical records and provider fees should not be a barrier to applying for a public benefit program. Senior & Disability Action writes that they believe this bill will bring us closer to its vision of a world in which all people are treated with dignity, and have access to basic needs.
4. RELATED LEGISLATION. SB 241 (Monning) revises provisions of law governing the right of patients to access and copy their medical records by conforming these requirements to HIPAA requirements, including requiring health care providers to provide the records in an electronic format if they are maintained electronically and if the patient requests the records in an electronic format, more clearly specifying the reasonable clerical costs that can by charged by the providers, and by making other technical, clarifying and conforming changes. SB 241 is pending in Assembly Health Committee.
5. PREVIOUS LEGISLATION.
   1. AB 1337 (Linder), Chapter 528, Statutes of 2015, creates an authorization form for disclosure of health information by medical providers, and requires electronic medical records requested prior to the filing of any action or appearance of a defendant in an action to be provided electronically if requested in an electronic format, and if it is readily producible in that format.
   2. SB 588 (Emmerson) of 2013 would have provided that, where the records are delivered to the attorney or the attorney’s representative for inspection or copying at the record custodian’s place of business and if any portion of the patient’s medical records is stored on paper, the fee for complying with the authorization would be $15 dollars, plus actual costs, as specified. If any portion of the records is stored electronically and is inaccessible for inspection or copying, the health care provider, in its sole discretion, would have been authorized to produce a paper copy of the electronic records for the attorney to inspect and copy, and to charge specified fees. SB 588 was held in the Senate Judiciary Committee.
   3. SB 1543 (Emmerson) of 2012 would have prescribed the fees for a health care provider or medical records management company to charge when providing copies of medical records to an attorney. SB 1543 was held in the Senate Judiciary Committee.
   4. AB 1311 (Goldberg), Chapter 325, Statutes of 2001, requires a health care provider, within 30 days of a written request from a patient, former patient, or patient's representative, to provide a free copy of that portion of the patient's medical records relevant to the patient's appeal from the denial of eligibility for a public benefit program, as specified.
6. DOUBLE REFERRAL. This bill is double referred, upon passage of this committee; it will be referred to the Assembly Privacy and Consumer Protections Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

Western Center of Law and Poverty (sponsor)

American Federation of State, County and Municipal Employees, AFL-CIO

Asian Law Alliance

Bay Area Legal Aid

California Advocates for Nursing Home Reform

California Association of Food Banks

California Food Policy Advocates

CaliforniaHealth+ Advocates

California Pan-Ethnic Health Network

Congress of California Seniors

Disability Rights California

Jewish Family Service of Los Angeles

Justice in Aging

Legal Aid Foundation of Los Angeles

Legal Aid Society of San Diego

National Association of Social Workers, California Chapter

National Health Law Program

Positive Resource Center

Project Inform

Public Interest Law Project

Senior & Disability Action

St. Anthony Foundation

Opposition

None on file.

Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 575

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 6-0, 3/29/17

AYES: Hernandez, Leyva, Mitchell, Monning, Newman, Nielsen

NO VOTE RECORDED: Nguyen, Atkins, Roth

SENATE JUDICIARY COMMITTEE: 6-0, 4/25/17

AYES: Jackson, Anderson, Hertzberg, Monning, Stern, Wieckowski

NO VOTE RECORDED: Moorlach

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT:

SOURCE: Western Center on Law and Poverty

DIGEST:

This bill expands a provision of law that entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are need to support an appeal regarding eligibility for certain public benefit programs, by including initial applications in addition to appeals, and by expanding the list of public benefit programs to include In-Home Supportive Services, the California Work Opportunity and Responsibility to Kids program, CalFresh, and certain veterans related benefits.

ANALYSIS:

Existing law:

1. Requires, under the Patient Access to Health Records (PAHR) law, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to be entitled to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available.
2. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request of the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $.25 per page of $.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available.
3. Requires a patient or the representative of a patient to be entitled to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, or Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits. For purposes of this provision, existing law also:
   1. Defines “relevant portion” as those records regarding services rendered to the patient from the date of the patient’s initial application for public benefits up to and including the date that a final determination is made by the public benefits program;
   2. Excludes from this provision any patient who is represented by a private attorney, who is not employed by a nonprofit legal services entity, who is paying for the costs related to the patient’s appeal, pending the outcome of that appeal; and
   3. Permits a health care provider to bill the patient, at the rates specified in 2) above, for the copies of the medical records previously provided free of charge if the patient’s appeal regarding eligibility for a public benefit program is successful.
4. Defines “patient records” as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient.
5. Defines “health care provider” as a licensed health facility, clinic, or home health agency, or a licensed health care professional, as specified.
6. Makes any licensed health care professional that willfully violates PAHR guilty of unprofessional conduct. Makes any health facility, clinic, or home health agency that willfully violates PAHR guilty of an infraction punishable by a fine of not more than $100. Requires the state agency, board, or commission that issued the provider’s professional or institutional license to consider a violation as grounds for disciplinary action with respect to the licensure, including suspension or revocation of the license.

This bill expands a provision of law that entitles a patient or a patient’s representative to a copy, at no charge, of the relevant portion of the patient’s records that are need to support an appeal regarding eligibility for certain public benefit programs, by doing the following:

1. Expanding the list of public benefit program to include In-Home Supportive Services program, the California Work Opportunity and Responsibility to Kids (CalWORKS) program, CalFresh, and federal veterans service-connected compensation and non-service connected pension disability benefits;
2. Applying this provision of law to initial claims for the public benefit programs, not just appeals;
3. Including the ability to get supporting forms from the provider free of charge, in addition to relevant patient records; and,
4. Deleting the definition of “relevant portion of the patient’s records,” which limited records to only those from the date of the patient’s initial application for public benefits up to the date of a final determination, thereby removing a time period limitation on the relevant patient records.

Comments

1. Author’s statement. According to the author, this bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low income Californians to spend needed cash to even apply for public benefits. Safety net services, such as Medi-Cal, SSI/SSP, CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.
2. Public Benefits Program. This bill expands the provision of free medical records to applicants to the following benefit programs:
   1. IHSS. The IHSS Program helps pay for services so that the eligible person can remain safely in their own home. To be eligible, you must be over 65 years of age, or disabled, or blind. IHSS is an alternative to out-of-home care such as nursing homes. Services authorized under IHSS are housecleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision for the mentally impaired. Prior to IHSS services being authorized, a health care certification form is required to be submitted, in which a licensed health care provider must certify that the applicant is unable to perform some activity of daily living independently, and that without IHSS the individual would be at risk of placement in out-of-home care;
   2. CalFresh. CalFresh (federally known as the Supplemental Nutrition Assistance Program or SNAP) is a federally mandated, state-supervised, and county-operated government entitlement program that provides monthly food benefits to assist low-income households in purchasing the food they need to maintain adequate nutritional levels. Everyone who gets CalFresh benefits must register to work unless they are exempt, and being physically or mentally unable to work may qualify for an exemption from work requirements, and if requesting an exemption, the county may ask for documentation.
   3. CalWORKs. CalWORKS is a public assistance program that provides cash aid and services to eligible families that have a child in the home. The program serves all 58 counties in the state and is operated locally by county welfare departments. If a family has little or no cash and needs housing, food, utilities, clothing or medical care, they may be eligible to receive immediate short-term help. Families that apply and qualify for ongoing assistance receive money each month to help pay for housing, food and other necessary expenses. The amount of a family's monthly assistance payment depends on a number of factors, including the number of people who are eligible and the special needs of any of those family members. Generally, individuals are limited to 48 months of aid and are required to participate in welfare-to-work activities as a condition of receiving aid, unless exempt. Being physically or mentally unable to work may qualify for an exemption from work activities and the time limit for receiving aid, and if requesting an exemption, the county may ask for documentation.
   4. Veterans compensation benefits. Veterans service-connected disability compensation is a monetary benefit paid to veterans who are determined by the Veterans Administration to be disabled by an injury or illness that was incurred or aggravated during active military service. Monthly disability compensation varies with the degree of disability and the number of dependents, and veterans with certain severe disabilities may be eligible for additional special monthly compensation. Veterans non-service connected disability is a needs-based benefit paid to wartime veterans who meet certain age or non-service connected disability requirements.

Related/Prior Legislation

AB 1337 (Linder, Chapter 528, Statutes of 2015) amended the Evidence Code to create an authorization form for disclosure of health information by medical providers, and required electronic medical records requested prior to the filing of any action or appearance of a defendant in an action to be provided electronically if requested in an electronic format, and if it is readily producible in that format.

AB 1311 (Goldberg, Chapter 325, Statutes of 2001) required a health care provider, within 30 days of a written request from a patient, former patient, or patient's representative, to provide a free copy of that portion of the patient's medical records relevant to the patient's appeal from the denial of eligibility for a public benefit program, as specified.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 5/10/17)

Western Center on Law and Poverty (source)

American Federation of State, County and Municipal Employees, AFL-CIO

Asian Law Alliance

Bay Area Legal Aid

California Advocates for Nursing Home Reform

California Association of Food Banks

California Food Policy Advocates

California Pan-Ethnic Health Network

CaliforniaHealth+ Advocates

Jewish Family Services of Los Angeles

Justice in Aging

Legal Aid Society of San Diego

National Association of Social Workers, California Chapter

National Health Law Program

Project Inform

Public Interest Law Project

St. Anthony Foundation

St. Mary’s Center

OPPOSITION: (Verified 5/10/17)

None received

ARGUMENTS IN SUPPORT: This bill is sponsored by the Western Center on Law and Poverty (WCLP), which states that this bill would expand free medical record access beyond Medi-Cal, SSI/SSP, and social security disability benefits to include IHSS, veterans benefits, CalFresh and CalWORKS. WCLP states that applying for many of these benefit programs requires careful review of medical records to make a disability determination, and to bring forth their best application, applicants include medical records and supporting documentation to support their disability claim. WCLP states that some applicants report difficulty obtaining their medical records so may submit an application that does not adequately demonstrate their disability claim, resulting in a denial that leads to a lengthy appeal process. WCLP states that patients are entitled to their own medical records and provider fees should not be a barrier to applying for public benefit programs. WCLP cites U.S. Department of Health and Human Services guidance on this issue, which states, “While covered entities should forgo fees for all individuals, not charging fees is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. WCLP states that in addition, beginning next year, adults under age 50 without children will have their CalFresh food benefits cut off after a limited time if they are not working unless the individual has a medical condition that limits

their ability to meet work requirements. Supporters include Bay Area Legal Aid, the Public Interest Law Project, Justice in Aging, the Asian Law Alliance, and California Advocates for Nursing Home Reform, which make similar arguments.

Prepared by:

5/10/17 15:31:02

**** END ****

SENATE JUDICIARY COMMITTEE

Senator Hannah-Beth Jackson, Chair

2017-2018 Regular Session

Bill No: SB 575 (Author:Leyva)

Version: April 3, 2017

Hearing Date: April 25, 2017

Fiscal: Yes

Urgency: No

Consultant: CK

SUBJECT

Patient access to health records

DESCRIPTION

This bill would provide free access to medical records needed for applications or appeals of denials for benefits under specified public benefit programs.

BACKGROUND

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its attendant regulations serve to protect the privacy and security of patients’ health information but also serve as a patient bill of rights. One of the core rights that HIPAA and its underlying regulations provide individuals is the ability to access and obtain a copy of a patient’s personal health information. With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans. The Privacy Rule permits certain health plans and health care providers to charge a limited fee to an individual for copies of the individual’s health care records.

Public benefit programs require applicants to submit various supporting materials with their applications. Often health records are either required for, or would significantly bolster, an application. If an applicant submits insufficient documentation to support an application, the public benefit program will deny the application. This often leads to an appeals process, a process that can be lengthy and costly for both the applicant and the program. Generally, the individuals applying for these programs have extremely limited resources and are unable to secure the materials necessary to submit the strongest application possible. Therefore, many otherwise meritorious applications are denied because an applicant has not been able to gather the proper documents.

Existing law provides that if an individual is denied benefits from certain programs, namely Medi-Cal, SSI/SSP, and SSDI, the individual shall be provided access to free medical records in conjunction with a subsequent appeal. This provision ensures that limited financial resources will not be a barrier for individuals to get medical records that may be critical in successfully qualifying for these programs, which provide a safety net of subsidized health care and/or a critical stream of income. Free access to these records at the initial application phase, rather than after denial, could obviate the need to go through the lengthy appeals process and avoid the attendant costs. This bill would address the issue by extending eligibility to applicants who need the records for an initial claim, thereby enabling individuals to put together the strongest application at the outset.

Additionally, this bill would include new public benefit programs that would be eligible for the statute’s provisions—the In-Home Supportive Services Program, the California Work Opportunity and Responsibility to Kids program, federal veterans service-connected compensation and nonservice connected pension disability benefits, and CalFresh. Access to free records would continue to be restricted from applicants who are represented by a private attorney who is funding the costs of the application or appeal process pending the outcome of that application or appeal.

CHANGES TO EXISTING LAW

Existing law provides individuals and their representatives a right to inspect and to receive copies of their patient records from their health care providers. Providers are authorized to charge patients fees to defray the costs of copying and other, reasonable clerical costs incurred in making the records available. (Health & Saf. Code Sec. 123110(a)-(c).)

Existing law provides that individuals are entitled to copies of the relevant portions of their records at no charge if the records are needed to support an appeal regarding eligibility for specified public benefit programs—Medi-Cal, social security disability insurance benefits (SSDI), and Supplemental Security Income/State Supplementary Program for the Aged, Blind, and Disabled (SSI/SSP). Individuals need to present a written request along with proof that the records are so needed. (Health & Saf. Code Sec. 123110(d)(1).)

Existing law does not extend access to records free of charge if a patient is represented by a private attorney who is paying for the costs related to the patient's appeal, pending the outcome of that appeal. (Health & Saf. Code Sec. 123110(d)(3).)

Existing law provides that if an individual’s appeal regarding eligibility for a public benefit program is successful, the individual may be charged for the records previously provided free of charge. (Health & Saf. Code Sec. 123110(e).)

This bill would provide individuals with free access to the portions of their patient records that are necessary for an initial claim for specified public benefit programs.

This bill would expand the number of eligible, public benefit programs for which individuals could access their patient records free of charge. This bill would include the In-Home Supportive Services Program (IHSS), the California Work Opportunity and Responsibility to Kids program (CalWORKs), federal veterans service-connected compensation and nonservice connected pension disability benefits, and CalFresh.

COMMENT

1. Stated need for the bill

According to the author:

Existing law covers free access to medical records for appeals of Medi-Cal, SSI/SSP, and SSDI, but does not cover free medical record access for the initial application. To prepare their most reliable application, applicants include medical records and supporting documentation to support their need to receive public benefits. Low income applicants may resort to submitting an application that does not adequately demonstrate their disability claim, resulting in a claim denial that leads to a lengthy appeal process. These delays do not save the state because payments are backdated to initial application but may cause irreparable harm to the waiting applicant.

SB 575 would allow Californians to receive access to medical records at no charge upon presenting proof that the records or supporting forms are needed to support a claim or appeal regarding eligibility for a public benefit program. This bill would expand the eligible public benefit programs to include Medi-Cal, IHSS, CalWORKS, CalFresh, SSI/SSP, SSDI, and veterans benefits.

2. The economic basis for extending the statute

All of the programs, for which individuals could access their medical records without charge, provide income, health insurance, and/or food assistance to those who are financially qualified for it. Eligible applicants are therefore necessarily struggling financially and would not likely have disposable resources to pay the fees charged for medical records. As discussed above, this lack of access often leads to insufficiently supported benefits applications and subsequent denials. The programs and the denied applicants are then forced through the appeals process. The additional time and costs of this process can subject these applicants to longer waiting periods for the benefits they critically need. This results in longer periods of financial instability, hunger, and the threat of uncovered medical treatment.

On the other side of the equation, the program and its funding source, California or the federal government, does not save any money through this process. The appeals process drains the already limited resources of these programs, and when appeals are successful, the benefits paid are often retroactive to the initial application.

Writing in support, the American Federation of State, County, and Municipal Employees, AFL-CIO, states that existing law does not do enough because the individuals applying for these programs cannot afford, but need, their medical records for their initial applications. It argues that this makes individuals’ applications “more likely to be denied, which either prevents the applicant from receiving benefits altogether or starts them down a lengthy appeals process that can last years and cost taxpayers money that could have been spared.”

3. Guidance and examples from other states and at the national level

The United States Department of Health and Human Services (HHS) has issued guidance to health care professionals regarding patients’ rights relating to access to health records. HHS details the fees that can be charged to individuals seeking copies of their records. However, HHS recommends that health care providers forgo charging these fees and suggests they provide individuals free copies of their health records. HHS emphasizes that “not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee.” Those applying for and eligible to receive benefits from public benefit programs are necessarily in stressed financial situations where fees for access to medical records could provide an insurmountable barrier.

Currently, 12 states provide free access to copies of medical records in conjunction with claims for health insurance, disability benefits, or continuation of medical care—Connecticut, Georgia, Kentucky, Massachusetts, Nebraska, Nevada, New York, Rhode Island, Texas, Vermont, West Virginia, and Wyoming. For example, Connecticut provides free records if necessary for any claim or appeal under the Social Security Act. Massachusetts does the same, and adds claims or appeals for any federal or state, financial needs-based benefit program.

Georgia prohibits charging fees for records requested in order to make or complete an application for a disability benefits program. Nebraska prohibits charging fees for medical records necessary for an application or appeal of a denial for benefits under certain state programs and programs under the Social Security Act. Nevada provides free access to medical records necessary for a Social Security disability or SSI claim or appeal. Michigan restricts the fees that can be charged to any “medically indigent individual.”

Notably, Kentucky provides a free copy of a patient’s medical record regardless of the purpose, and New York provides that a patient cannot be denied access to medical records based on an inability to pay.

Support: American Federation of State, County, and Municipal Employees, AFL-CIO; Asian Law Alliance; California Association of Food Banks; CaliforniaHealth+ Advocates; Disability Rights California; Justice in Aging; Jewish Family Service of Los Angeles; Legal Aid Society of San Diego, Inc.; National Association of Social Workers; National Health Law Program

Opposition: None Known

HISTORY

Source: Western Center on Law & Poverty

Related Pending Legislation:

SB 241 (Monning, 2017) would change the basis of the fee that a health care provider is authorized to charge from clerical costs to specified costs for labor, supplies, postage, and preparing an explanation or summary of the patient record. The bill would require the health care provider to provide the patient or patient’s personal representative with a copy of the records in a paper or electronic copy, in the form or format requested if the records are readily producible in that form or format. This bill passed out of the Senate Health Committee and is currently in the Senate Judiciary Committee.

Prior Legislation:

SB 588 (Emmerson, 2013) would have made significant adjustments to the fees charged for copies of medical records and amended the requirements for access. It was held in the Senate Judiciary Committee.

SB 1543 (Emmerson, 2012) would have made adjustments to the fees charged for patient records. It was held in the Senate Judiciary Committee.

AB 1311 (Goldberg, Ch. 325, Stats. 2001) amended Section 123110 of the Health and Safety Code to require a health care provider, within 30 days of a written request from a patient, former patient, or patient's representative, to provide a free copy of that portion of the patient's medical records relevant to the patient's appeal from the denial of eligibility for a public benefit program, as specified.

Prior Vote: Senate Health Committee (Ayes 6, Noes 0)

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SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 575

SUBJECT: Patient access to health records

SUMMARY:

Expands a provision of law that entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are need to support an appeal regarding eligibility for certain public benefit programs, by including initial applications in addition to appeals, and by expanding the list of public benefit programs to include In-Home Supportive Services, the California Work Opportunity and Responsibility to Kids program, CalFresh, and certain veterans related benefits.

Existing law:

1. Requires, under the Patient Access to Health Records (PAHR) law, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to be entitled to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available.
2. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request of the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $.25 per page of $.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available.
3. Requires a patient or the representative of a patient to be entitled to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider proof that the records are needed to support an appeal regarding eligibility for the Medi-Cal program, social security disability insurance benefits, or Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits. For purposes of this provision, existing law also:
   1. Defines “relevant portion” as those records regarding services rendered to the patient from the date of the patient’s initial application for public benefits up to and including the date that a final determination is made by the public benefits program;
   2. Excludes from this provision any patient who is represented by a private attorney, who is not employed by a nonprofit legal services entity, who is paying for the costs related to the patient’s appeal, pending the outcome of that appeal; and
   3. Permits a health care provider to bill the patient, at the rates specified in 2) above, for the copies of the medical records previously provided free of charge if the patient’s appeal regarding eligibility for a public benefit program is successful.
4. Defines “patient records” as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient.
5. Defines “health care provider” as a licensed health facility, clinic, or home health agency, or a licensed health care professional, as specified.
6. Makes any licensed health care professional that willfully violates PAHR guilty of unprofessional conduct. Makes any health facility, clinic, or home health agency that willfully violates PAHR guilty of an infraction punishable by a fine of not more than $100. Requires the state agency, board, or commission that issued the provider’s professional or institutional license to consider a violation as grounds for disciplinary action with respect to the licensure, including suspension or revocation of the license.

This bill:

1. Expands a provision of law that entitles a patient or a patient’s representative to a copy, at no charge, of the relevant portion of the patient’s records that are need to support an appeal regarding eligibility for certain public benefit programs, by doing the following:
2. Expanding the list of public benefit program to include In-Home Supportive Services program, the California Work Opportunity and Responsibility to Kids (CalWORKS) program, CalFresh, and federal veterans service-connected compensation and non-service connected pension disability benefits;
3. Applying this provision of law to initial claims for the public benefit programs, not just appeals;
4. Including the ability to get supporting forms from the provider free of charge, in addition to relevant patient records; and,
5. Deleting the definition of “relevant portion of the patient’s records,” which limited records to only those from the date of the patient’s initial application for public benefits up to the date of a final determination, thereby removing a time period limitation on the relevant patient records.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, this bill would support low income Californians when applying for public benefit programs that can help them survive. Applying for safety net services is a complicated process that requires careful review of medical records to make a determination of eligibility. Some providers charge patients to receive copies of their own medical records, which then forces low income Californians to spend needed cash to even apply for public benefits. Safety net services, such as Medi-Cal, SSI/SSP, CalFresh, and CalWORKS support some of the most vulnerable populations in California, including seniors and veterans. By expanding free access to medical records for this vulnerable population, this bill will help to protect the health and wellbeing of Californians who may be prevented from applying for these benefits to which they are rightfully entitled.
2. Public Benefits Program. This bill expands the provision of free medical records to applicants to the following benefit programs:
3. IHSS. The IHSS Program helps pay for services so that the eligible person can remain safely in their own home. To be eligible, you must be over 65 years of age, or disabled, or blind. IHSS is an alternative to out-of-home care such as nursing homes. Services authorized under IHSS are housecleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision for the mentally impaired. Prior to IHSS services being authorized, a health care certification form is required to be submitted, in which a licensed health care provider must certify that the applicant is unable to perform some activity of daily living independently, and that without IHSS the individual would be at risk of placement in out-of-home care;
   
4. CalFresh. CalFresh (federally known as the Supplemental Nutrition Assistance Program or SNAP) is a federally mandated, state-supervised, and county-operated government entitlement program that provides monthly food benefits to assist low-income households in purchasing the food they need to maintain adequate nutritional levels. Everyone who gets CalFresh benefits must register to work unless they are exempt, and being physically or mentally unable to work may qualify for an exemption from work requirements, and if requesting an exemption, the county may ask for documentation.
5. CalWORKs. CalWORKS is a public assistance program that provides cash aid and services to eligible families that have a child in the home. The program serves all 58 counties in the state and is operated locally by county welfare departments. If a family has little or no cash and needs housing, food, utilities, clothing or medical care, they may be eligible to receive immediate short-term help. Families that apply and qualify for ongoing assistance receive money each month to help pay for housing, food and other necessary expenses. The amount of a family's monthly assistance payment depends on a number of factors, including the number of people who are eligible and the special needs of any of those family members. Generally, individuals are limited to 48 months of aid and are required to participate in welfare-to-work activities as a condition of receiving aid, unless exempt. Being physically or mentally unable to work may qualify for an exemption from work activities and the time limit for receiving aid, and if requesting an exemption, the county may ask for documentation.
6. Veterans compensation benefits. Veterans service-connected disability compensation is a monetary benefit paid to veterans who are determined by the Veterans Administration to be disabled by an injury or illness that was incurred or aggravated during active military service. Monthly disability compensation varies with the degree of disability and the number of dependents, and veterans with certain severe disabilities may be eligible for additional special monthly compensation. Veterans non-service connected disability is a needs-based benefit paid to wartime veterans who meet certain age or non-service connected disability requirements.
7. Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Judiciary Committee.
8. Related legislation. SB 241 (Monning) Revises and recasts provisions of law governing the right of patients to access and copy their medical records by conforming these requirements to the federal Health Information Portability and Accountability Act of 1996 (HIPAA) requirements, including requiring health care providers to provide the records in an electronic format if they are maintained electronically and if the patient requests the records in an electronic format, more clearly specifying the reasonable clerical costs that can by charged by the providers, and by making other technical, clarifying and conforming changes. SB 241 is pending in Senate Health Committee.
9. Prior legislation. AB 1337 (Linder, Chapter 528, Statutes of 2015) amended the Evidence Code to create an authorization form for disclosure of health information by medical providers, and required electronic medical records requested prior to the filing of any action or appearance of a defendant in an action to be provided electronically if requested in an electronic format, and if it is readily producible in that format.
   
   AB 1311 (Goldberg, Chapter 325, Statutes of 2001) required a health care provider, within 30 days of a written request from a patient, former patient, or patient's representative, to provide a free copy of that portion of the patient's medical records relevant to the patient's appeal from the denial of eligibility for a public benefit program, as specified.
10. Support. This bill is sponsored by the Western Center on Law and Poverty (WCLP), which states that this bill would expand free medical record access beyond Medi-Cal, SSI/SSP, and social security disability benefits to include IHSS, veterans benefits, CalFresh and CalWORKS. WCLP states that applying for many of these benefit programs requires careful review of medical records to make a disability determination, and to bring forth their best application, applicants include medical records and supporting documentation to support their disability claim. WCLP states that some applicants report difficulty obtaining their medical records so may submit an application that does not adequately demonstrate their disability claim, resulting in a denial that leads to a lengthy appeal process. WCLP states that patients are entitled to their own medical records and provider fees should not be a barrier to applying for public benefit programs. WCLP cites U.S. Department of Health and Human Services guidance on this issue, which states, “While covered entities should forgo fees for all individuals, not charging fees is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. WCLP states that in addition, beginning next year, adults under age 50 without children will have their CalFresh food benefits cut off after a limited time if they are not working unless the individual has a medical condition that limits their ability to meet work requirements. Supporters include Bay Area Legal Aid, the Public Interest Law Project, Justice in Aging, the Asian Law Alliance, and California Advocates for Nursing Home Reform, which make similar arguments.
11. Policy comments.
    1. Is applying law to “supporting forms” appropriate? This bill is amending a section of law authorizing inspection and copying of medical records. For purposes of this provision of law, “medical records” are defined as “records in any form or medium maintained by, or in the custody or control of, a health care provider” relating to the health history of a patient. The author and sponsor indicate that the reason for including “supporting forms” in the law is that some applications for public programs require forms to be filled out by a medical provider, such as certifying a disabling condition. However, it is unclear whether requesting a physician or other health care provider to fill out a supporting form meets the definition of a record “maintained by, or in the custody or control of” a health provider. Should the author wish to require providers to fill out supporting forms to support an applicant for a benefit program, it might be more appropriate to add a new section of law rather than amending the law governing access to medical records.
    2. Should exclusion of patients represented by private attorneys apply to claims? Under existing law, the ability of a patient to get copies of medical records free of charge is limited to the appeal of a denial for certain public programs. In addition to expanding the list of programs to which this applies, this bill also expands this law to new applications for benefits, not just appeals. However, existing law excludes any patient from the ability to get free copies who is represented by a private attorney who is paying for the costs related to the patient’s appeal, unless the attorney is employed by a nonprofit legal services entity. This provision is not being amended to include new applications. The committee may wish to consider whether this exclusion of patients represented by private attorneys should also apply to new applications for benefits, in addition to appeals.

SUPPORT AND OPPOSITION:

Support: Western Center on Law and Poverty (sponsor)
American Federation of State, County and Municipal Employees, AFL-CIO

Asian Law Alliance

Bay Area Legal Aid

California Advocates for Nursing Home Reform

Justice in Aging

Project Inform

Public Interest Law Project

St. Anthony Foundation

St. Mary’s Center

Oppose: None received

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