MEDICAL PRIVACY: Clinton’s Proposal Gets Green Light
House Labor-HHS appropriations subcommittee Chair John Edward Porter (R-IL) said yesterday that contrary to earlier reports, conferees are not attaching a provision to the spending bill that would extend Congress' deadline to craft its own medical privacy legislation. That move would have headed off the Clinton administration's medical privacy regulations, which are expected to be unveiled later this week. Porter said that the "language to delay the regulations was never actually in the bill, although it was 'under discussion'" (Koffler/Rovner/Morrissey, CongressDaily/A.M., 10/26). Sensing the green light, Clinton administration officials yesterday said they will "soon announce sweeping new federal rules" to protect millions of medical records. "We would have preferred that Congress pass bipartisan legislation," said Chris Jennings, health policy coordinator at the White House, adding that "they gave themselves three years to do it. But in the absence of action on Capitol Hill, the president will act." Senate Health, Education, Labor and Pensions Committee members have clashed on several tangential issues, including the right to access minors' abortion records. Under the administration's rules, it would be difficult for the insurer to pass health information to an affiliated company, even for subscribers aware of the company's privacy practices. In most cases, the insurer would have to obtain the patient's permission before releasing the information for purposes unrelated to medical treatment or claims payment. The New York Times reports that the regulations also include these provisions:
- The rules would cover those medical records stored or transmitted electronically, as well as paper printouts of electronic transactions.
- Patients would have a right to review and request copies of their medical records, and to supplement the records or correct mistakes.
- The rules would "establish minimum protections for patients' privacy and would not override any contrary provisions of state law that were 'more stringent' than the federal requirements."
- Physicians releasing data would be required to ensure that only the information needed to fill the request was provided. The rules would prohibit the release of entire patient records when only a portion would suffice.
- Physicians, hospitals and health plans could charge a "reasonable fee" to cover the cost of copying medical records.
How Does It Play?
Federal officials are still investigating the cost of the proposal, which has come under fire from the health care industry. A recent Blue Cross and Blue Shield Association study pegged the cost of compliance at "tens of billions of dollars," in part because providers and health plans would have to "retrain employees, hire privacy experts, rewrite contracts and reprogram computers." Administration officials are currently compiling data that could undercut those estimates. In addition, the rules have drawn the ire of psychiatrists, who say they do not go far enough, and from law enforcement officials, who say they "may go too far." Psychiatrists have indicated that the rules may unintentionally weaken patients' control over their own medical records. Dr. Paul Appelbaum, vice president of the American Psychiatric Association, said the rules would "take away some of the power that patients have traditionally had to decide when and if their records are released to third parties. Under these rules, much information could be disclosed without patients' consent to anybody involved in their care." For their part, law enforcement officials have said that the new rules may require them to secure search warrants to gain access to medical information, which could slow them down in emergency situations (Pear, New York Times, 10/27).