Section 108.01. Safeguarded information.

 

(1)  Except for purposes directly related to direct program administration, the department may not use or disclose any information concerning past or present applicants and recipients of MA.

(2)  In this section, "direct program administration" means:

(a) Determining initial eligibility of the applicant and continuing eligibility of the recipient;

(b) Determining appropriate services to be covered;

(c) Providing services for recipients;

(d) Processing provider claims for reimbursement;

(e) Auditing provider claims for reimbursement;

(f) Investigating or prosecuting criminal or civil proceedings conducted in connection with program administration;

(g) Seeking third-party payment for services provided to a recipient; and

(h) Other activities determined by the department to be necessary for proper and efficient administration of MA.

(3)  The department shall request the attorney general to institute appropriate action when necessary to enforce provisions of this section.

(4)  Safeguarded information concerning an individual applicant or recipient shall include but not be limited to:

(a) Name and address;

(b) Social data, including but not limited to:

1. Marital status;

2. Age;

3. Race;

4. Names and MA numbers of family members;

5. Paternity status of children; and

6. Unique identifying characteristics;

(c) Economic data, including but not limited to:

1. Assets;

2. Amount of assistance received;

3. Amount of medical expenses incurred;

4. Sources of payment or support;

5. Past or present employment;

6. Income, regardless of source;

7. Social security number; and

8. Income expense deductions;

(d) Agency evaluation information, including but not limited to:

1. Verification of client information; and

2. Identity of verification sources; and

(e) Medical data, including but not limited to:

1. Past history and medical record content;

2. Diagnosis;

3. Drugs prescribed;

4. Course of treatment prescribed; and

5. Name of provider.

(5)  For purposes of direct program administration, the department may permit disclosure to, or use of safeguarded information by, legally qualified persons or agency representatives outside the department. Governmental authorities, the courts, and law enforcement officers are persons outside the department who shall comply with sub. (6) .

(6)  Persons or agency representatives outside the department to whom the department may disclose or permit use of safeguarded information shall meet the following qualifications:

(a) The purpose for use or disclosure shall involve direct program administration; and

(b) The person or the person's agency shall be bound by law or other legally enforceable obligation to observe confidentiality standards comparable to those observed by the department.

(7)  Unless it is related to direct program administration, the department shall respond to a subpoena for a case record or for agency representative testimony regarding an applicant or recipient as follows:

(a) The department shall provide the court and all parties to the proceeding with a copy of this section;

(b) The department shall request that the attorney general intervene in the proceeding in a manner which will give effect to this section; and

(c) The department shall notify in writing applicants or recipients affected by a subpoena for safeguarded information.

(8)  The department shall publicize this section as follows:

(a) Publication in the Wisconsin administrative code;

(b) Incorporation by reference in certification procedures for all providers; and

(c) Incorporation in information provided to recipients regarding their rights and responsibilities.

(9)  The secretary or a designee shall determine the appropriate application of this section to circumstances not covered expressly by this section. Use or disclosure not expressly provided for in this section may not occur prior to this determination.