Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must disclose information to applicants or individuals who want to review their case records for information used in the eligibility determination. Advisors 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 or status of pending criminal prosecution.

TANF and Medical Programs

Advisors must disclose information about applicants or individuals to federal, state, or local agencies, if the information is directly connected with:

  • administration of a program approved under any of the following titles of the Social Security Act:
    • Title IV-A (Temporary Assistance for Needy Families [TANF]/Choices)
    • Title IV-B (Child Protective Services [CPS])
    • Title IV-D (Child Support)
    • Title IV-E (Foster Care and Adoption Assistance)
    • Title XVI (Supplemental Security Income [SSI])
    • Title XIX (Medicaid)
    • Title XX (Social Services/Child Care)

Disclosure of information is permitted for any case audits, reviews of expenditure reports, financial reviews, investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of these programs.

  • administration of any other federal or federally assisted program that provides assistance directly to individuals on the basis of need.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

Advisors must disclose information about applicants or individuals to Medicaid providers or their contractors that is needed for the providers to submit claims for reimbursement of Medicaid services provided to individuals. See the list of releasable data items in B-1230, Releasable Information for Medicaid Providers and Their Contractors.

SNAP

Advisors must disclose information about applicants or individuals to persons or agencies directly connected to the administration or enforcement of:

  • the Supplemental Nutrition Assistance Program (SNAP);
  • food distribution programs for households on Indian reservations; or
  • other federal assistance programs or federally aided programs that base assistance on an individual's income and resources.

    Such programs include, but are not limited to: Women, Infants, and Children (WIC); TANF; Medicaid; Child Protective Services; and SSI.

Advisors must disclose information about applicants or individuals to employees of the U.S. Comptroller General's Office for audit purposes.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

 

B—1211 Reporting Abuse and Neglect

Revision 15-4; Effective October 1, 2015  

All Programs

Policies on confidentiality do not prohibit reporting abuse or neglect that threatens the health or welfare of a child or an elderly adult or adult with disabilities. Advisors must report instances of suspected:

  • physical or mental injury,
  • sexual abuse,
  • exploitation, and
  • neglect.

Exception: Advisors are not required to report family violence.

Advisors must inform adults or their personal representative (PR) when reporting abuse or neglect of an adult, unless the advisor believes that informing the individual or PR would place the individual at risk of serious harm.

 

B—1212 Personal Representatives

Revision 15-4; Effective October 1, 2015  

All Programs

Only the individual's PR can exercise the individual's rights with respect to individually identifiable health information. Therefore, only an individual's PR may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual. 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.

Note: An authorized representative (AR) is not automatically a PR.

 

B—1212.1 Adults and Emancipated Minors

Revision 15-4; Effective October 1, 2015  

All Programs

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. Advisors follow regional procedures to contact the regional attorney for approval.

 

B—1212.2 Unemancipated Minors

Revision 15-4; Effective October 1, 2015  

All Programs

A parent is the personal representative for a minor child except when:

  • the minor child can consent to medical treatment by him or herself. Under these circumstances, do not disclose to a parent information about the medical treatment to which the minor child can consent. A minor child may consent to medical treatment by him or herself when the:
    • minor is on active duty with the US military;
    • minor is age 16 or older, lives separately from the parents and manages his own financial affairs;
    • consent involves diagnosis and treatment of disease that must be reported to the local health officer or the Texas Department of State Health Services;
    • minor is unmarried and pregnant and the treatment (other than abortion) relates to the pregnancy;
    • minor is age 16 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 physician 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 a parent or to the minor child. Under these circumstances, the advisor must not disclose to a parent information about the health care decisions not made by the parent.

 

B—1212.3 Deceased Individuals

Revision 15-4; Effective October 1, 2015  

All Programs

The PR 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 individuals include:

  • an executor, including an independent executor;
  • an administrator, including a temporary administrator;
  • a surviving spouse;
  • a child;
  • a parent; and
  • an heir.

Advisors may consult the regional attorney with questions about whether a particular person is the PR of an applicant or individual.

 

B—1213 Establishing Identity for Contact Outside the Interview Process

Revision 15-4; Effective October 1, 2015  

All Programs

All information the Texas Health and Human Services Commission (HHSC) has about an individual or any person on the individual's case must be kept confidential. Confidential information includes, but is not limited to, individually identifiable health information.

Before discussing or releasing information about an individual or any person on the individual's case, steps must be taken to reasonably ensure that the person receiving the confidential information is either the individual or a person the individual authorized to receive confidential information (such as an attorney or personal representative).

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.1 Telephone Contact

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must establish a person's identity when contacting the individual, AR or PR by telephone. Refer to A-2020, Authenticating a Caller, for identity authentication policy.

Advisors must establish the identity of attorneys or legal representatives by asking the individual to provide Form H1826, Case Information Release, completed and signed by the individual. Advisors refer to B-1220, Specific Information That May Be Released, for authorization requirements.

Establish the identity of legislators or their staff by following regional procedures.

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.2 In-Person Contact

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must establish the identity of a person who presents himself as an individual or individual's representative at a local eligibility determination office by:

  • driver's license,
  • date of birth,
  • Social Security number (SSN), or
  • other identifying information.

Advisors must establish the identity of other staff, federal agency staff, researchers, or contractors by:

  • employee badge, or
  • government-issued identification card with a photograph.

Advisors must identify the need for other staff, federal staff, research staff, or contractors to access confidential information through:

  • official correspondence or phone call from state or regional offices, or
  • contact with a regional attorney.

Advisors must contact appropriate regional or state office staff when federal agency staff, contractors, researchers, or other staff, etc., come to the office without prior notification or adequate identification and request permission to access HHSC records.