PRIA, Government Policy, Made Personal

Summary

Allows federal or state agencies and some private groups to give data they hold that helps decide Medicaid eligibility to the state Medicaid agency. Examples are Express Lane eligibility files, state birth records, and certain other federal program records. Sharing can only happen if a few rules are met. The person named in the data (or their parent, guardian, caretaker, or authorized representative) either agrees ahead of time or was told in advance and did not object. The information can only be used to find, enroll, or check people for Medicaid. There must be a formal agreement that follows the Secretary’s privacy and security standards, stops unauthorized use, and requires the state to try to enroll people using the data. Private organizations that unlawfully share data face a $10,000 civil penalty for each violation; willful unlawful sharing can bring up to $10,000 in fines, up to 1 year in jail, or both, for each violation. These rules do not stop other data sharing that federal law already allows.

Title 42, §1396w–2

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Notwithstanding any other provision of law, a Federal or State agency or private entity in possession of the sources of data directly relevant to eligibility determinations under this subchapter (including eligibility files maintained by Express Lane agencies described in section 1396a(e)(13)(F) of this title, information described in paragraph (2) or (3) of section 1320b–7(a) of this title, vital records information about births in any State, and information described in section 653(i) and 1396a(a)(25)(I) of this title) is authorized to convey such data or information to the State agency administering the State plan under this subchapter, to the extent such conveyance meets the requirements of subsection (b).

(b)Data or information may be conveyed pursuant to subsection (a) only if the following requirements are met:

(1)The individual whose circumstances are described in the data or information (or such individual’s parent, guardian, caretaker relative, or authorized representative) has either provided advance consent to disclosure or has not objected to disclosure after receiving advance notice of disclosure and a reasonable opportunity to object.

(2)Such data or information are used solely for the purposes of—

(A)identifying individuals who are eligible or potentially eligible for medical assistance under this subchapter and enrolling or attempting to enroll such individuals in the State plan; and

(B)verifying the eligibility of individuals for medical assistance under the State plan.

(3)An interagency or other agreement, consistent with standards developed by the Secretary—

(A)prevents the unauthorized use, disclosure, or modification of such data and otherwise meets applicable Federal requirements safeguarding privacy and data security; and

(B)requires the State agency administering the State plan to use the data and information obtained under this section to seek to enroll individuals in the plan.

(c)(1)A private entity described in the 11 So in original. subsection (a) that publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section is subject to a civil money penalty in an amount equal to $10,000 for each such unauthorized publication or disclosure. The provisions of section 1320a–7a of this title (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1320a–7a(a) of this title.

(2)A private entity described in the 1 subsection (a) that willfully publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section shall be fined not more than $10,000 or imprisoned not more than 1 year, or both, for each such unauthorized publication or disclosure.

(d)The limitations and requirements that apply to disclosure pursuant to this section shall not be construed to prohibit the conveyance or disclosure of data or information otherwise permitted under Federal law (without regard to this section).

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Authorization for States Electing Express Lane Option To Receive Certain Data Directly Relevant to Determining Eligibility and Correct Amount of Assistance Pub. L. 111–3, title II, § 203(e), Feb. 4, 2009, 123 Stat. 49, provided that: “The Secretary shall enter into such agreements as are necessary to permit a State that elects the Express Lane option under section 1902(e)(13) of the Social Security Act [42 U.S.C. 1396a(e)(13)] to receive data directly relevant to eligibility determinations and determining the correct amount of benefits under a State child health plan under CHIP or a State plan under Medicaid from the following: “(1) The National Directory of New Hires established under section 453(i) of the Social Security Act (42 U.S.C. 653(i)). “(2) Data regarding enrollment in insurance that may help to facilitate outreach and enrollment under the State Medicaid plan, the State CHIP plan, and such other programs as the Secretary may specify.” [For definitions of “CHIP”, “Medicaid”, and “Secretary”, see section 1(c) of Pub. L. 111–3, set out as a Definitions note under section 1396 of this title.]

§1396w–2 Authorization to Receive Relevant Information

Summary

Title 42, §1396w–2

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Citations & Metadata