228.1 DEFINITIONS.
As used in this chapter:
1. "Administrative information" means an individual's name,
identifying number, age, sex, address, dates and character of
professional services provided to the individual, fees for the
professional services, third-party payor name and payor number of a
patient, if known, name and location of the facility where treatment
is received, the date of the individual's admission to the facility,
and the name of the individual's attending physician or attending
mental health professional.
2. "Data collector" means a person, other than a mental
health professional or an employee of or agent for a mental health
facility, who regularly assembles or evaluates mental health
information.
3. "Diagnostic information" means a therapeutic
characterization of the type found in the diagnostic and statistical
manual of mental disorders of the American psychiatric association or
in a comparable professionally recognized diagnostic manual.
4. "Mental health facility" means a community mental health
center, hospital, clinic, office, health care facility, infirmary, or
similar place in which professional services are provided.
5. "Mental health information" means oral, written, or
recorded information which indicates the identity of an individual
receiving professional services and which relates to the diagnosis,
course, or treatment of the individual's mental or emotional
condition.
6. "Mental health professional" means an individual who has
all of the following qualifications:
a. The individual holds at least a master's degree in a
mental health field, including but not limited to, psychology,
counseling and guidance, nursing, and social work, or the individual
is a physician and surgeon or an osteopathic physician and surgeon.
b. The individual holds a current Iowa license if practicing
in a field covered by an Iowa licensure law.
c. The individual has at least two years of post-degree
clinical experience, supervised by another mental health
professional, in assessing mental health needs and problems and in
providing appropriate mental health services.
7. "Peer review organization" means a utilization and quality
control peer review organization that has a contract with the federal
secretary of health and human services pursuant to Title XI, part B,
of the federal Social Security Act to review health care services
paid for in whole or in part under the Medicare program established
by Title XVIII of the federal Social Security Act, or another
organization of licensed health care professionals performing
utilization and quality control review functions.
8. "Professional services" means diagnostic or treatment
services for a mental or emotional condition provided by a mental
health professional.
9. "Self-insured employer" means a person which provides
accident and health benefits or medical, surgical, or hospital
benefits on a self-insured basis to its own employees or to employees
of an affiliated company or companies and which does not otherwise
provide accident and health benefits or medical, surgical, or
hospital benefits.
10. "Third-party payor" means a person which provides
accident and health benefits or medical, surgical, or hospital
benefits, whether on an indemnity, reimbursement, service, or prepaid
basis, including but not limited to, insurers, nonprofit health
service corporations, health maintenance organizations, governmental
agencies, and self-insured employers. Section History: Recent Form
86 Acts, ch 1082, § 1; 88 Acts, ch 1226, § 2, 3; 95 Acts, ch 120,
§2
Referred to in § 125.82, 125.86, 229.15, 229.24, 230A.13, 235A.17
228.2 MENTAL HEALTH INFORMATION DISCLOSURE PROHIBITED
-- EXCEPTIONS -- RECORD OF DISCLOSURE.
1. Except as specifically authorized in section 228.3, 228.5,
228.6, 228.7, or 228.8, a mental health professional, data collector,
or employee or agent of a mental health professional, of a data
collector, or of or for a mental health facility shall not disclose
or permit the disclosure of mental health information.
2. a. Upon disclosure of mental health information pursuant
to section 228.3, 228.5, 228.6, 228.7, or 228.8, the person
disclosing the mental health information shall enter a notation on
and maintain the notation with the individual's record of mental
health information, stating the date of the disclosure and the name
of the recipient of mental health information.
b. The person disclosing the mental health information shall
give the recipient of the information a statement which informs the
recipient that disclosures may only be made pursuant to the written
authorization of an individual or an individual's legal
representative, or as otherwise provided in this chapter, that the
unauthorized disclosure of mental health information is unlawful, and
that civil damages and criminal penalties may be applicable to the
unauthorized disclosure of mental health information.
3. A recipient of mental health information shall not disclose
the information received, except as specifically authorized for
initial disclosure in section 228.3, 228.5, 228.6, 228.7, or 228.8.
However, mental health information may be transferred at any time to
another facility, physician, or mental health professional in cases
of a medical emergency or if the individual or the individual's legal
representative requests the transfer in writing for the purposes of
receipt of medical or mental health professional services, at which
time the requirements of subsection 2 shall be followed. Section History: Recent Form
86 Acts, ch 1082, § 2; 88 Acts, ch 1226, § 4, 5; 90 Acts, ch 1079,
§ 2; 2009 Acts, ch 41, §263
Referred to in § 228.5
See also §622.10
228.3 VOLUNTARY DISCLOSURES.
1. An individual eighteen years of age or older or an
individual's legal representative may consent to the disclosure of
mental health information relating to the individual by a mental
health professional, data collector, or employee or agent of a mental
health professional, of a data collector, or of or for a mental
health facility, by signing a voluntary written authorization. The
authorization shall:
a. Specify the nature of the mental health information to be
disclosed, the persons or type of persons authorized to disclose the
information, and the purposes for which the information may be used
both at the time of the disclosure and in the future.
b. Advise the individual of the individual's right to inspect
the disclosed mental health information at any time.
c. State that the authorization is subject to revocation and
state the conditions of revocation.
d. Specify the length of time for which the authorization is
valid.
e. Contain the date on which the authorization was signed.
2. A copy of the authorization shall:
a. Be provided to the individual or to the legal
representative of the individual authorizing the disclosure.
b. Be included in the individual's record of mental health
information. Section History: Recent Form
86 Acts, ch 1082, § 3; 88 Acts, ch 1226, § 6, 7, 9
Referred to in § 228.2, 228.9
228.4 REVOCATION OF DISCLOSURE AUTHORIZATION.
An individual or an individual's legal representative may revoke a
prior authorization by providing a written revocation to the
recipient named in the authorization and to the mental health
professional, data collector, or employee or agent of a mental health
professional, of a data collector, or of or for a mental health
facility previously authorized to disclose the mental health
information. The revocation is effective upon receipt of the written
revocation by the person previously authorized to disclose the mental
health information. After the effective revocation date, mental
health information shall not be disclosed pursuant to the revoked
authorization. However, mental health information previously
disclosed pursuant to the revoked authorization may be used for the
purposes stated in the original written authorization. Section History: Recent Form
86 Acts, ch 1082, § 4
228.5 ADMINISTRATIVE DISCLOSURES.
1. An individual or an individual's legal representative shall be
informed that mental health information relating to the individual
may be disclosed to employees or agents of or for the same mental
health facility or to other providers of professional services or
their employees or agents if and to the extent necessary to
facilitate the provision of administrative and professional services
to the individual.
2. a. If an individual eighteen years of age or older or an
individual's legal representative has received a written notification
that a fee is due a mental health professional or a mental health
facility and has failed to arrange for payment of the fee within a
reasonable time after the notification, the mental health
professional or mental health facility may disclose administrative
information necessary for the collection of the fee to a person or
agency providing collection services.
b. If a civil action is filed for the collection of the fee,
additional mental health information shall not be disclosed in the
litigation, except to the extent necessary to respond to a motion of
the individual or the individual's legal representative for greater
specificity or to dispute a defense or counterclaim.
3. A mental health professional or an employee of or agent for a
mental health facility may disclose mental health information if
necessary for the purpose of conducting scientific and data research,
management audits, or program evaluations of the mental health
professional or mental health facility, to persons who have
demonstrated and provided written assurances of their ability to
ensure compliance with the requirements of this chapter. The persons
shall not identify, directly or indirectly, an individual in any
report of the research, audits, or evaluations, or otherwise disclose
individual identities in any manner. A disclosure under this section
is not subject to the requirements of section 228.2, subsection 2,
with the exception that a person receiving mental health information
under this section shall be provided a statement prohibiting
redisclosure of information unless otherwise authorized by this
chapter.
4. Mental health information relating to an individual may be
disclosed to other providers of professional services or their
employees or agents if and to the extent necessary to facilitate the
provision of administrative and professional services to the
individual. Section History: Recent Form
86 Acts, ch 1082, § 5; 88 Acts, ch 1226, § 8; 96 Acts, ch 1213, §
33, 34; 2009 Acts, ch 41, §263
Referred to in § 228.2
228.6 COMPULSORY DISCLOSURES.
1. A mental health professional or an employee of or agent for a
mental health facility may disclose mental health information if and
to the extent necessary, to meet the requirements of section 229.24,
229.25, 230.20, 230.21, 230.25, 230.26, 230A.13, 232.74, or 232.147,
or to meet the compulsory reporting or disclosure requirements of
other state or federal law relating to the protection of human health
and safety.
2. Mental health information acquired by a mental health
professional pursuant to a court-ordered examination may be disclosed
pursuant to court rules.
3. Mental health information may be disclosed by a mental health
professional if and to the extent necessary, to initiate or complete
civil commitment proceedings under chapter 229.
4. Mental health information may be disclosed in a civil or
administrative proceeding in which an individual eighteen years of
age or older or an individual's legal representative or, in the case
of a deceased individual, a party claiming or defending through a
beneficiary of the individual, offers the individual's mental or
emotional condition as an element of a claim or a defense.
5. An individual eighteen years of age or older or an
individual's legal representative or any other party in a civil,
criminal, or administrative action, in which mental health
information has been or will be disclosed, may move the court to
denominate, style, or caption the names of all parties as "JOHN OR
JANE DOE" or otherwise protect the anonymity of all of the parties.
Section History: Recent Form
86 Acts, ch 1082, § 6
Referred to in § 228.2, 237.21
228.7 DISCLOSURES FOR CLAIMS ADMINISTRATION AND PEER
REVIEW -- SAFEGUARDS -- PENALTY.
1. Mental health information may be disclosed, in accordance with
the prior written consent of the patient or the patient's legal
representative, by a mental health professional, data collector, or
employee or agent of a mental health professional, a data collector,
or a mental health facility to a third-party payor or to a peer
review organization if the third-party payor or the peer review
organization has filed a written statement with the commissioner of
insurance in which the filer agrees to:
a. Instruct its employees and agents to maintain the
confidentiality of mental health information and of the penalty for
unauthorized disclosure.
b. Comply with the limitations on use and disclosure of the
information specified in subsection 2 of this section.
c. Destroy the information when it is no longer needed for
the purposes specified in subsection 2 of this section.
2. a. An employee or agent of a third-party payor or of a
peer review organization shall not use mental health information or
disclose mental health information to any person, except to the
extent necessary to administer claims submitted or to be submitted
for payment to the third-party payor, to conduct a utilization and
quality control review of mental health care services provided or
proposed to be provided, to conduct an audit of claims paid, or as
otherwise authorized by law.
b. Employees of a self-insured employer, and agents of a
self-insured employer which have not filed a statement with the
commissioner of insurance pursuant to subsection 1, shall not be
granted routine or ongoing access to mental health information unless
the employees or agents have signed a statement indicating that they
are aware that the information shall not be used or disclosed except
as provided in this subsection and that they are aware of the penalty
for unauthorized disclosure.
3. An employee or agent of a third-party payor or a peer review
organization who willfully uses or discloses mental health
information in violation of subsection 2 of this section is guilty of
a serious misdemeanor, and, notwithstanding section 903.1, the
sentence for a person convicted under this subsection is a fine not
to exceed five hundred dollars in the case of a first offense, and
not to exceed five thousand dollars in the case of each subsequent
offense. Section History: Recent Form
88 Acts, ch 1226, §1; 2009 Acts, ch 41, §263
Referred to in § 228.2
228.8 DISCLOSURES TO FAMILY MEMBERS.
1. A mental health professional or an employee of or agent for a
mental health facility may disclose mental health information to the
spouse, parent, adult child, or adult sibling of an individual who
has chronic mental illness, if all of the following conditions are
met:
a. The disclosure is necessary to assist in the provision of
care or monitoring of the individual's treatment.
b. The spouse, parent, adult child, or adult sibling is
directly involved in providing care to or monitoring the treatment of
the individual.
c. The involvement of the spouse, parent, adult child, or
adult sibling is verified by the individual's attending physician,
attending mental health professional, or a person other than the
spouse, parent, adult child, or adult sibling who is responsible for
providing treatment to the individual.
2. A request for mental health information by a person authorized
to receive such information under this section shall be in writing,
except in an emergency as determined by the mental health
professional verifying the involvement of the spouse, parent, adult
child, or adult sibling.
3. Unless the individual has been adjudged incompetent, the
person verifying the involvement of the spouse, parent, adult child,
or adult sibling shall notify the individual of the disclosure of the
individual's mental health information under this section.
4. Mental health information disclosed under this section is
limited to the following:
a. A summary of the individual's diagnosis and prognosis.
b. A listing of the medication which the individual has
received and is receiving and the individual's record of compliance
in taking medication prescribed for the previous six months.
c. A description of the individual's treatment plan. &nbsb>Section History: Recent Form
90 Acts, ch 1079, §1
Referred to in § 228.2
228.9 DISCLOSURE OF PSYCHOLOGICAL TEST MATERIAL.
Except as otherwise provided in this section, a person in
possession of psychological test material shall not disclose the
material to any other person, including the individual who is a
subject of the test. In addition, the test material shall not be
disclosed in any administrative, judicial, or legislative proceeding.
However, upon the request of an individual who is the subject of a
test, all records associated with a psychological test of that
individual shall be disclosed to a psychologist licensed pursuant to
chapter 154B designated by the individual. An individual's request
for the records shall be in writing and shall comply with the
requirements of section 228.3, relating to voluntary disclosures of
mental health information, except that the individual shall not have
the right to inspect the test materials. Section History: Recent Form
94 Acts, ch 1159, §1