Bill Text: NJ A4144 | 2012-2013 | Regular Session | Amended
Bill Title: Establishes certain requirements, including allowable fees, for provision of medical records to patients, legally authorized representatives, and authorized third parties.*
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-01-06 - Assembly Floor Amendment Passed (Benson) [A4144 Detail]
Download: New_Jersey-2012-A4144-Amended.html
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
SYNOPSIS
Establishes certain requirements, including allowable fees, for provision of medical records to patients, legally authorized representatives, and authorized third parties.
CURRENT VERSION OF TEXT
As reported by the Assembly Health and Senior Services Committee on December 12, 2013, with amendments.
An Act concerning medical records and supplementing Titles 26 and 45 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. 1[If] Except as provided in subsection d. of this section, if1 a patient of a general, special, or psychiatric hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) 1[or] ,1 the patient's legally authorized representative 1, or an authorized third party1 requests, in writing, a copy of the patient's medical record, the hospital shall provide a legible paper or electronic reproduction of the medical record from each individual admission within the dates requested to the patient 1[or] ,1 the patient's legally authorized representative 1, or the authorized third party1 within 30 days of the request, in accordance with the following:
(1) The fee for reproducing an individual admission record shall 1[be] not exceed1 $1 per page or $100 per individual admission record for the first 100 pages 1, whichever is less1. For individual admission records that contain more than 100 pages, a copying fee of 1no more than1 $0.25 per page 1[shall] may1 be charged for pages in excess of the first 100 pages, up to a maximum of $200 for each admission record. In addition, a hospital or its business associate, as defined by the federal 1["Health Insurance Portability and Accountability Act," Pub.L.104-191] health privacy rule set forth at 45 CFR Parts 160 and 1641, shall charge the actual costs for delivering records in any medium, plus sales tax, if applicable.
(2) Delivery of an electronic reproduction of a patient's medical record shall be required only if: (a) the entire request can be reproduced from an electronic health record system; (b) the medical record is specifically requested to be delivered in electronic format; and (c) the medical record can be delivered electronically.
(3) In addition to per-page and delivery fees, a hospital shall apply the following charges:
(a) a search fee of 1no more than1 $10 per patient per request. Although the patient may have had more than one admission, and thus more than one individual admission record is provided, only one search fee shall be charged for each request per patient. The search fee shall apply even if no individual admission record is found as a result of the search;
(b) a fee for the reproduction of x-rays or any other material within an individual admission record that cannot be routinely copied or duplicated on a commercial photocopy machine, which shall be 1[equal to] no more than1 the actual cost of the duplication of the materials, plus an administrative fee of the lesser of $10 or 10 percent of 1[the] that1 cost 1[of reproduction to compensate for office personnel time spent retrieving or reproducing the materials]. The actual cost of duplication shall include: cost of materials; time spent by office personnel for retrieving, duplicating, and refiling the materials;1 and overhead costs; and
(c) a fee for certification of a copy of a medical record of 1no more than1 $10 per certification. 1[A patient or patient's legally authorized representative shall have the right to receive a full or certified copy of the medical record.]1
(4) The fees established in 1this1 subsection 1[a. of section 1 of this act]1 shall be charged for electronic reproductions as well as paper copies of medical records.
(5) The hospital shall establish a policy assuring access to copies of medical records for patients who do not have the ability to pay for the copies.
(6) The hospital shall establish a fee policy providing an incentive for the use of abstracts or summaries of medical records 1; however, a patient, a patient's legally authorized representative, or an authorized third party shall have the right to receive a full or certified copy of the medical record1.
(7) 1[For the purposes of this subsection] As used in P.L. , c. (C. ) (pending before the Legislature as this act)1, "legally authorized representative" means the following:
(a) the patient's spouse, domestic partner, or civil union partner;
(b) the patient's immediate next of kin;
(c) the patient's legal guardian;
(d) the patient's attorney;
(e) the patient's third party insurer; or
(f) the patient's worker's compensation carrier, where access is permitted by contract or law, but limited only to that portion of the medical record that is relevant to the specific work-related incident at issue in the worker's compensation claim.
1(8) As used in P.L. , c. (C. ) (pending before the Legislature as this act), "authorized third party" shall mean a third party with a valid authorization, subpoena, or court order granting access to a patient's medical records.1
b. Access to a copy of a patient's medical record shall be limited only to the extent necessary to protect the patient. The patient's attending physician shall provide a verbal explanation for any denial of access to the patient 1[or] ,1 legally authorized representative, 1or authorized third party,1 and shall document 1[this] the denial and explanation1 in the medical record. In the event that direct access to a copy by the patient is medically contraindicated, as documented by a physician in the patient's medical record, the hospital shall make the medical record available to a legally authorized representative of the patient 1, an authorized third party,1 or the patient's attending physician.
c. 1[Commencing January 1, 2014, the Commissioner of Health shall annually adjust the amounts set forth in section 1 of this act based on the most recent changes in the consumer price index for medical care services reported annually by the Bureau of Labor Statistics of the United States Department of Labor.
d.]1 A hospital shall not assess any fees or charges 1[to provide] for1 a copy of a patient's medical records 1as provided herein1 other than those provided for in this section.
1d. The fees authorized by this section shall not be imposed on:
(1) A patient who does not have the ability to pay and who presents either: (a) a statement certifying to annual income at or below 250 percent of the federal poverty level; or (b) proof of eligibility for, or enrollment in, a State or federal assistance program including, but not limited to: the federal Supplemental Nutrition Assistance Program established pursuant to the "Food and Nutrition Act of 2008," Pub.L.110-246 (7 U.S.C. s.2011 et seq.); the federal Supplemental Security Income program established pursuant to Title XVI of the federal Social Security Act, Pub.L.92-603 (42 U.S.C. s.1381 et seq.); the National School Lunch Program established pursuant to the "Richard B. Russell National School Lunch Act," P.L.79-396 (42 U.S.C. s.1751 et seq.); the federal special supplemental food program for women, infants, and children established pursuant to Pub.L.95-627 (42 U.S.C. s.1786); the State Medicaid program established pursuant to the "New Jersey Medical Assistance and Health Services Act," P.L.1968, c.413 (C.30:4D-1 et seq.); the NJ FamilyCare Program established pursuant to the "Family Health Care Coverage Act," P.L.2005, c.156 (C.30:4J-8 et al.); the Work First New Jersey program, established pursuant to the "Work First New Jersey Act," P.L.1997, c.38 (C.44:10-55 et seq.); the New Jersey Supplementary Food Stamp Program, established pursuant to the "New Jersey Supplementary Food Stamp Program Act," P.L.1998, c.32 (C.44:10-79 et seq.); any successor program; or any other State or federal assistance program now or hereafter established by law;
(2) A not-for-profit corporation indicating in writing that it is representing a patient; or
(3) An attorney representing a patient on a pro bono basis, provided that the attorney submits with the request a certification that the attorney is representing the patient on a pro bono basis. An attorney representing a patient on a contingency fee basis shall be assessed the ordinary fees to obtain a copy of the patient's records.1
2. A person licensed to practice a health care profession regulated by the State Board of Medical Examiners shall provide copies of professional treatment records, including records from other health care providers that are part of a patient's record, to a patient 1[or] ,1 the patient's authorized representative 1, or an authorized third party1 in accordance with the following:
a. No later than 30 days from receipt of a request from a patient 1[or] ,1 a patient's authorized representative, 1or an authorized third party,1 the licensee shall provide an electronic copy or photocopy of the professional treatment records, billing records, or both, as requested. The record shall include all pertinent, objective data, including test results and x-ray results, as applicable, and subjective information.
b. Unless otherwise required by law, a licensee may elect to provide a summary of the record in lieu of providing the electronic copy or photocopy required pursuant to subsection a. of this section, so long as that summary adequately reflects the patient's history and treatment. A licensee may charge a reasonable fee for the preparation of a summary that has been provided in lieu of the actual record, which shall not exceed the cost allowed pursuant to subsection 1[d] d.1 of this section; however, a patient 1[or] ,1 a patient's legally authorized representative 1, or an authorized third party1 shall have the right to receive a full or certified copy of the medical record. The fee for certification shall be 1no more than1 $10 per certification.
c. If, in the exercise of the licensee's professional judgment, a licensee has reason to believe that the patient's mental or physical condition will be adversely affected upon being made aware of the subjective information contained in the professional treatment record or a summary of the record, the licensee may refuse to provide the record or summary to the patient. The licensee shall include in the record a notice setting forth the reasons for the original refusal. The licensee shall, however, provide a copy of the record or summary upon request to:
(1) the patient's attorney;
(2) another licensed health care professional;
(3) the patient's health insurance carrier through an employee thereof; 1[or]1
(4) a governmental reimbursement program or an agent thereof, with responsibility to review utilization or quality of care 1; or
(5) an authorized third party1.
d. A licensee may require a record request to be in writing and 1, except as provided in subsection j. of this section,1 may charge a fee for:
(1) The reproduction of patient records, which shall be 1no more than1 $1 per page or $200 for the entire record, whichever is less. 1[If the record requested is less than 10 pages, the licensee may charge up to $10 to cover the miscellaneous costs associated with retrieval of the record.]1 In addition, a licensee or the licensee's business associate, as defined by the federal 1["Health Insurance Portability and Accountability Act," Pub.L.104-191] health privacy rule set forth at 45 CFR Parts 160 and 1641, shall charge the actual costs for delivering records in any medium, plus sales tax, if applicable. If the licensee elects to provide a summary in lieu of the actual record, the charge for the summary shall not exceed the cost that would be charged for the actual record; 1[and]1
(2) The reproduction of x-rays or any other material within a patient record that cannot be routinely copied or duplicated on a commercial photocopy machine, which shall be no more than the actual cost of the duplication of the materials, 1[or the fee charged to the licensee for duplication,]1 plus an administrative fee of the lesser of $10 or 10 percent of 1[the] that1 cost 1[of reproduction to compensate for office personnel time spent retrieving or reproducing the materials] . The actual cost of duplication shall include: cost of materials; time spent by office personnel for retrieving, duplicating, and refiling the materials;1 and overhead costs 1; and
(3) A search for records. The search fee shall be no more than $10 per patient per request. Although the patient may have had more than one admission, and thus more than one individual admission record is provided, only one search fee shall be charged for each request per patient. The search fee shall apply even if no individual admission record is found as a result of the search.
A licensee shall not assess any fees or charges for a copy of a patient's records as provided herein other than those provided for in this section1.
e. The fees established in subsection d. of 1this1 section 1[2 of this act]1 shall be charged for electronic copies as well as paper copies of medical records.
f. Delivery of an electronic copy of a patient record to the requestor shall be required only if:
(1) the entire request can be reproduced from an electronic health record system;
(2) the patient record is specifically requested to be delivered in electronic format; and
(3) the patient record can be delivered electronically.
g. A licensee shall not charge a patient for a copy of the patient's record when:
(1) the licensee has affirmatively terminated a patient from practice in accordance with the requirements of N.J.A.C.13:35-6.22; or
(2) the licensee leaves a practice that the licensee was formerly a member of, or associated with, and the patient requests that the patient's medical care continue to be provided by that licensee.
h. If the patient or a subsequent treating health care professional is unable to read the treatment record, either because it is illegible or prepared in a language other than English, the licensee shall provide a transcription or translation, as applicable, at no cost to the patient.
i. The licensee shall not refuse to provide a professional treatment record on the grounds that the patient owes the licensee an unpaid balance if the record is needed by another health care professional for the purpose of rendering care.
j. 1[Commencing January 1, 2014, the State Board of Medical Examiners shall annually adjust the amounts set forth in this section based on the most recent changes in the consumer price index for medical care services reported annually by the Bureau of Labor Statistics of the United States Department of Labor] The fees authorized by this section shall not be imposed on:
(1) A patient who does not have the ability to pay and who presents either: (a) a statement certifying to annual income at or below 250 percent of the federal poverty level; or (b) proof of eligibility for, or enrollment in, a State or federal assistance program including, but not limited to: the federal Supplemental Nutrition Assistance Program established pursuant to the "Food and Nutrition Act of 2008," Pub.L.110-246 (7 U.S.C. s.2011 et seq.); the federal Supplemental Security Income program established pursuant to Title XVI of the federal Social Security Act, Pub.L.92-603 (42 U.S.C. s.1381 et seq.); the National School Lunch Program established pursuant to the "Richard B. Russell National School Lunch Act," P.L.79-396 (42 U.S.C. s.1751 et seq.); the federal special supplemental food program for women, infants, and children established pursuant to Pub.L.95-627 (42 U.S.C. s.1786); the State Medicaid program established pursuant to the "New Jersey Medical Assistance and Health Services Act," P.L.1968, c.413 (C.30:4D-1 et seq.); the NJ FamilyCare Program established pursuant to the "Family Health Care Coverage Act," P.L.2005, c.156 (C.30:4J-8 et al.); the Work First New Jersey program, established pursuant to the "Work First New Jersey Act," P.L.1997, c.38 (C.44:10-55 et seq.); the New Jersey Supplementary Food Stamp Program, established pursuant to the "New Jersey Supplementary Food Stamp Program Act," P.L.1998, c.32 (C.44:10-79 et seq.); any successor program; or any other State or federal assistance program now or hereafter established by law;
(2) A not-for-profit corporation indicating in writing that it is representing a patient; or
(3) An attorney representing a patient on a pro bono basis, provided that the attorney submits with the request a certification that the attorney is representing the patient on a pro bono basis. An attorney representing a patient on a contingency fee basis shall be assessed the ordinary fees to obtain a copy of the patient's records1.
3. The Commissioner of Health and the State Board of Medical Examiners, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations as necessary to effectuate the purposes of this act.
4. This act shall take effect on the first day of the seventh month next following the date of enactment, except that the Commissioner of Health and the State Board of Medical Examiners may take such anticipatory administrative action in advance thereof as may be necessary for the implementation of this act.
