Texas Department of Aging and Disability Services
Case Manager In-Home and Family Support Program Handbook
Effective: August 1, 2011
10100 Confidential Nature of the Case Record
Information collected in determining initial or continuing eligibility is confidential. The restriction on disclosing information is limited to information about individuals. The Department of Aging and Disability Services (DADS) may disclose general information about policies, procedures or other methods of determining eligibility, and any other information that is not about an individual.
An individual may review all information in the case record and in DADS handbooks that contributed to the decision about his eligibility for the In-Home and Family Support Program.
10200 Correcting Information
An individual has a right to correct any information recorded by The Department of Aging and Disability Services (DADS) about the individual and any other individual on the individual's case.
A request for correction must be in writing and must:
- identify the individual requesting the correction;
- identify the disputed information;
- state how the information is incorrect;
- include any proof that the information is incorrect;
- state the correction requested; and
- include a return address, telephone number or email address at which DADS can contact the individual making the request.
If DADS agrees to change individually identifiable health information, the corrected information is added to the case record and the incorrect information remains in the file with a note that the information was amended per the individual's request.
The case manager must notify the individual in writing within 60 days (using current DADS letterhead without the board members' names) that the information is corrected, or will not be corrected, and the justification for the decision. DADS may extend the 60-day period by an additional 30 days to complete the correction process or to obtain additional information. The case manager must inform the individual if DADS needs to extend the 60-day period.
If DADS makes a correction to individually identifiable health information, the case manager must obtain the individual's permission before sharing with third parties. DADS will make a reasonable effort to share the correct information with persons who received the incorrect information from DADS if they may have relied or could rely on it to the disadvantage of the individual. The case manager must follow regional procedures to contact the DADS privacy officer for a record of disclosures.
The case manager must not use this section when the decision regarding a request to correct information is determined by another review process, such as a:
- fair hearing;
- civil rights hearing; or
- other appeal process.
The decision in that review process is the decision on the request to correct information.
10300 Establishing Identity for Contact Outside the Interview Process
Department of Aging and Disability Services (DADS) staff must keep all information confidential that DADS has about an individual or any individual on the individual's case. Confidential information includes, but is not limited to, individually identifiable health information.
Before discussing or releasing information about an individual or any individual on the individual's case, DADS staff must take steps to be reasonably sure the individual receiving the confidential information is either the individual or an individual the individual has authorized to receive confidential information (for example, an attorney or personal representative).
10310 Telephone Contact
Department of Aging and Disability Services (DADS) staff must establish the identity of an individual who identifies himself as an individual by verifying his knowledge of the individual's:
- Social Security number;
- date of birth; or
- other identifying information.
DADS staff may also verify the identity of the individual by making a return call using the individual's contact information listed in the case record.
DADS staff must establish the identity of a personal representative by verifying the individual's knowledge of the individual's:
- Social Security number;
- date of birth; or
- other identifying information.
DADS staff may also verify the identity of the individual by making a return call using the personal representative's contact information listed in the case record or verifying the individual's knowledge of the personal representative's identifying information as listed in the case record.
DADS staff must establish the identity of attorneys or legal representatives by asking the individual to provide Form 1826-D, Case Information Release, completed and signed by the individual.
10320 In-Person Contact
The Department of Aging and Disability Services (DADS) staff must establish the identity of the individual who presents himself at a DADS office as an individual or individual's representative by viewing documentation such as:
- a driver license;
- verification of date of birth;
- proof of Social Security number; or
- other identifying information.
DADS staff must establish the identity of other DADS staff, federal agency staff, researchers or contractors by viewing:
- an employee badge; or
- a government-issued identification card with a photograph.
DADS staff must identify the need for other DADS staff, federal staff, research staff or contractors to access confidential information through:
- official correspondence or a telephone call from a state or regional office; or
- contact with a regional attorney.
DADS staff must contact appropriate regional or state office staff when federal agency staff, contractors, researchers or other DADS staff come to the office without prior notification or adequate identification and request permission to access DADS records.
10330 Verification and Documentation
If disclosing individually identifiable health information outside a face-to-face contact with the applicant or individual, Department of Aging and Disability Services (DADS) staff must document how identity was verified.
DADS staff must verify the identity of a person requesting individually identifiable health information using sources such as:
- a valid driver license or Department of Public Safety ID card;
- birth certificate;
- hospital or birth record;
- adoption papers or records;
- work or school ID card;
- voter registration card;
- wage stubs; or
- U.S. passport.
10400 Safeguarding Personally Identifiable Information
All personally identifiable information obtained from the Social Security Administration (SSA) must be safeguarded. Wire Third Party Query (WTPY) or State On Line Query (SOLQ) information or other SSA documentation is considered SSA-protected and cannot be printed or kept in individual case records.
Staff must not print or file WTPY or SOLQ printouts in individual case records. In the case record, staff must document the:
- date the information from WTPY and/or SOLQ is viewed;
- amount of income verified; and
- source (WTPY, SOLQ, other) used to verify the information.
If a WTPY or SOLQ report must be printed, the document must not be filed in the case record or sent to the vendor for imaging. SSA documents must be stored in a central locked filing cabinet, only accessible by Health and Human Services Commission or Department of Aging and Disability Services authorized staff.
10500 Alternate Means of Communication
The Department of Aging and Disability Services must accommodate an individual's reasonable requests to receive communications by alternative means or at alternate locations.
The individual must specify in writing the alternate mailing address or means of contact and include a statement that using the home mailing address or normal means of contact could:
- endanger the individual; or
- lessen the chances of the individual receiving the communication.
10600 Custody of Records
Records must be safeguarded. Department of Aging and Disability Services (DADS) staff must use reasonable diligence to protect and preserve records and to prevent disclosure of the information they contain, except as provided by DADS regulations.
Reasonable diligence for employees responsible for records includes keeping records:
- in a locked office when the building is closed;
- properly filed during office hours; and
- in the office at all times, except when authorized to remove or transfer them.
10700 Disposal of Records
To dispose of documents with individual specific information, Department of Aging and Disability Services (DADS) staff must follow procedures for destruction of confidential data found in the DADS Operational Handbook.
10800 When and What Information May Be Disclosed
See Section 10810, Confidentiality of Medical Information and HIPAA, for restrictions on the release of an individual's protected health information under privacy regulations adopted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Reasonable efforts must be made to limit the use, request or disclosure of individually identifiable health information. The disclosure of individual medical information from Department of Aging and Disability Services (DADS) records must be limited to the minimum necessary to accomplish the purpose of the requested disclosure. For example, if an individual authorizes release of income verification, including disability income, DADS staff must not release related case medical information unless this is also specifically authorized by the individual.
DADS staff must give individual addresses or other case information only to a person who has written permission from the individual to obtain the information. The individual authorizes the release of information by completing and signing:
- Form 1826-D, Case Information Release; or
- a document containing all of the following information:
- the applicant's or individual's full name (including middle initial) and case number, or full name (including middle initial), and either his date of birth or Social Security number;
- a description of the information to be released. If a general release is authorized, DADS staff must provide the information that can be disclosed to the individual, but must withhold confidential information from the case record, such as names of persons who disclosed information about the household without the household's knowledge and the nature of pending criminal prosecution;
- a statement specifically authorizing DADS to release the information;
- the name of the person or agency to whom the information is being released;
- the purpose of the release;
- an expiration event that is related to the individual, the purpose of the release or an expiration date of the release;
- a statement about whether refusal to sign the release affects eligibility for delivery of services;
- a statement describing the applicant's or individual's right to revoke the authorization to release information;
- the date the document is signed; and
- the signature of the applicant or individual.
If the case information to be released includes individually identifiable health information, the document must also inform the applicant or individual that information released under the document may no longer be private, and may be released further by the person to whom it was released.
Occasionally, requests for information from the case records of deceased individuals are received. In these instances, DADS staff must protect the confidentiality of the former individuals and their survivors. See Section 10843, Deceased Individuals, for information about who can act on behalf of a deceased individual regarding individually identifiable health information.
Regional attorneys and the Office of General Counsel handle questions about the release of information under Government Code, Chapter 552, also known as the Open Records Act or the Public Information Act. Regional staff must contact their regional attorney with any problems or questions concerning the release of information.
10810 Confidentiality of Medical Information and HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that sets additional standards to protect the confidentiality of individually identifiable health information. Individually identifiable health information is information that identifies or could be used to identify an individual and that relates to the:
- past, present or future physical or mental health or condition of the individual;
- provision of health care to the individual; or
- past, present or future payment for the provision of health care to the individual.
10811 Privacy Notice
Department of Aging and Disability Services (DADS) staff must send each individual Form 0401, HIPAA – Privacy Notice, upon certification. Form 0401 explains to the individual:
- his privacy rights;
- the duties of DADS to protect health information; and
- how DADS may use or disclose health information without his authorization. (Examples of use or disclosure include health care operations [e.g., Medicaid], public health purposes, reporting victims of abuse, law enforcement purposes, sharing information with DADS contractors and coordination with other government programs providing benefits.)
10812 Individual Authorization
The individual may authorize the release of his health information from Department of Aging and Disability Services records by using a valid authorization form. Form 1826-D, Case Information Release, includes all the authorization elements required by Health Insurance Portability and Accountability Act privacy regulations. See Section 10800, When and What Information May Be Disclosed, for a description of the elements necessary for a valid authorization.
10820 Minimum Necessary
Reasonable efforts must be made to limit the use, request or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of individual medical information from Department of Aging and Disability Services (DADS) records must be limited to the minimum necessary to accomplish the purpose of the requested disclosure. For example, if an individual authorizes release of income verification, including disability income, DADS staff must not release related case medical information unless specifically authorized by the individual.
10830 Requests for Information Related to a Deceased Individual
Requests for release of information related to deceased applicants/individuals are likely to occur in relation to the Medicaid Estate Recovery Program. There is no Department of Aging and Disability Services form to document when this type of information is requested. In lieu of a form, requests for this type of information may be documented using:
- a release form or statement signed by the applicant/individual prior to death and not revoked by the applicant/individual, authorizing the release of information to the specific person requesting the information;
- a copy of an order from a probate court appointing the requestor as estate administrator or guardian;
- a copy of another type of order from a court authorizing the requestor to administer the affairs of the deceased; or
- documentation demonstrating the requestor has authority under Texas law to act for the deceased.
A person who has authority under Texas law to act on behalf of a deceased applicant/individual or the deceased's estate includes a surviving spouse, an adult child, a parent or an heir.
Staff must ask the requestor to provide an acceptable document as described above. If not available, staff must determine and document if the requestor has authority under Texas law to act for the deceased applicant/individual. The information may be released to the requestor if one of the documentation requirements noted above is met and filed/recorded in the case record.
10840 Personal Representatives
Other than the individual, only the individual's personal representative may exercise the individual's rights with respect to individually identifiable health information. Therefore, only an individual's personal representative may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual.
Exception: The Department of Aging and Disability Services (DADS) is not required to disclose the information to the personal representative if the individual is subjected to domestic violence, abuse or neglect by the personal representative. DADS staff must consult the regional attorney if it is believed that health information should not be released to the personal representative.
A responsible party is not automatically a personal representative.
10841 Adults and Emancipated Minors
If the individual is an adult or emancipated minor, including married minors, the individual's personal representative is a person who has the authority to make health care decisions about the individual and includes a:
- person the individual has appointed under a medical power of attorney, a durable power of attorney with the authority to make health care decisions or a power of attorney with the authority to make health care decisions;
- court-appointed guardian for the individual; or
- person designated by law to make health care decisions when the individual is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication.
Department of Aging and Disability Services staff must follow regional procedures to contact the regional attorney for approval.
10842 Unemancipated Minors
A parent is the personal representative for a minor child except when:
- the minor child can consent to medical treatment by himself. Under these circumstances, do not disclose to the parent information about medical treatment to which the minor child can consent. A minor child can consent to medical treatment when the:
- minor is on active duty with the U.S. military;
- minor is 16 years of age or older, lives separately from the parents and manages his own financial affairs;
- consent involves diagnosis and treatment of a disease that must be reported to the local health officer or the Department of State Health Services;
- minor is unmarried and pregnant and the treatment (other than abortion) relates to the pregnancy;
- minor is 16 years of age or older and the consent involves examination and treatment for drug or chemical addiction, dependency or use at a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
- consent involves examination and treatment for drug or chemical addiction, dependency or use by a medical practitioner or counselor at a location other than a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
- minor is unmarried, is the parent of a child, has actual custody of the child and consents to treatment for the child; or
- consent involves suicide prevention or sexual, physical or emotional abuse.
- a court is making health care decisions for the minor child or has given the authority to make health care decisions for the minor child to an adult other than the parent or to the minor child. Under these circumstances, Department of Aging and Disability Services staff must not disclose to the parent information about health care decisions not made by the parent.
10843 Deceased Individuals
The personal representative for a deceased individual is an executor, administrator or other person with authority to act on behalf of the individual or the individual's estate. These include:
- an executor, including an independent executor;
- an administrator, including a temporary administrator;
- a surviving spouse;
- a child;
- a parent; and
- an heir.
Department of Aging and Disability Services staff must consult the regional attorney with questions about whether a particular person is the personal representative of an applicant or individual.