A. Chapter Contents

This chapter contains the following topics:

Topic

1601.00 Language Interpretation and Translation

1601.01 Language Interpretation

1601.02 Arizona Relay Service

1601.03 Translation Services

1602.00 Confidentiality

1602.01 Definitions

1602.02 Safeguarding Information

1602.03 Obtaining Confidential Information

1602.04 Reviewing Information Before Release

1602.05 Authorizing the Release of Information

1602.06 Release of Information for Official Purposes

1602.07 Adoption Information

1602.08 Handling Requests for Information

1603.00 Non-Discrimination

1604.00 Written Notices

1604.01 Approval Notices

1604.02 Denial Notices

1604.03 Discontinuance Notices

1604.04 Change Notices

1605.00 AHCCCS Rules and Regulations

B. Introduction

This chapter contains information about the rights of an AHCCCS customer.

C. Overview

The customer has the right to:

• Have language interpretation and translation services provided by AHCCCS (MS 1601.00)

• Have all information provided to AHCCCS kept confidential (MS 1602.00);

• Be treated without discrimination (MS 1603.00);

• Be notified in writing on an agency form of eligibility, ineligibility, changes in eligibility or changes in the amount the customer must pay (MS 1604.00);

• Review manuals containing the rules and regulations of the AHCCCS programs (MS 1605.00).

In addition, the customer has the following rights that are addressed in other chapters:

• The right to apply for AHCCCS Health Insurance at any time (MS 1300.00).

• The right to request an eligibility fair hearing if:

o        He or she does not agree with adverse action taken by the AHCCCS Administration (MS 1700.00); or 

o        A decision is not made on an application within 45 days (or 90 days if a disability determination is required) and the delay is due to the agency (MS 1700.00); and

A. Overview

In this section you will learn how to:

• Obtain an interpreter when a non-English speaking customer calls you on the phone or you place a call to a non-English speaking customer;

• Obtain an interpreter for an interview for a non-English speaking customer;

• Access relay services for the hearing impaired and obtain a sign language interpreter;

• Obtain translation of Agency documents; and

• Obtain translation of incoming documents.

B. Policy

When a customer does not speak or understand English, AHCCCS offers:

• An oral language or sign language interpreter for conversation and interviews; and

• Translation of written material, as needed.

When you have an in-person or telephone contact with a person who has limited ability to speak or understand English, offer and provide an interpreter. Even if the customer initially provides his or her own interpreter, he or she may later choose to have the agency provide an interpreter. 

If local office staff is available and have the ability to provide interpretation and/or translation, it is acceptable to use them to interpret and/or translate.

C. Legal Authorities

In June 2002, the final Balanced Budget Act (BBA) regulations were published which include large portions pertaining to information requirements for managed care programs. AHCCCS must comply with the BBA regulations (with exceptions for certain waivers). 

The Civil Rights Act of 1964 provides that:

"No person in the United States shall on the ground of race, color, or national origin, be excluded from participation in, denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance." 

The following chart shows the BBA and Civil Rights Act legal authorities that AHCCCS is required to comply with pertaining to Limited English Proficiency.

Reference

Legal Authority

BBA

42 CFR 438.10

Civil Rights Act

Section 601 of the Title VI of the Civil Rights Act

D. Is the customer required to use our interpreter services?

The customer is not required to accept use of our interpreter. If he/she is more comfortable speaking through a friend or family member, that is acceptable. However, if you think that the customer is not getting the information he/she needs from their interpreter, or if it appears that the interpreter does not understand the communication, follow your office procedures for obtaining an interpreter. If the customer wants their interpreter to be present during the phone call or the interview, that is acceptable. 

Document on the Comments Window in ACE the offer to provide an interpreter and the customer's preference in accepting or rejecting the service.

Need to call a Hearing Impaired customer to:

• Follow up on a Request for Information; or

• Schedule an interview

Call the Arizona Relay Service at 1-800- 842-6520 and tell the agent the following:

• Your name;

• Where you are calling from (AHCCCS); and

• The purpose of your phone call.

Give the agent the customer's phone number for the agent to call; and when the customer is on the line, tell the agent to ask the customer:

• For permission to communicate his/her confidential information via the Relay Service; or

• If he/she wants us to arrange for a sign language interpreter. If YES, follow the procedures in How to Obtain an Interpreter for an Interview to arrange a sign language interpreter service.

A. The Language Identification Card

Each office must have a supply of Language Identification Cards. To order more cards, complete a Forms Requisition (AZ-99) and send it to MD 2400. 

The Language Identification Card lists the languages most frequently encountered in North America, which are grouped by the geographical region where they are commonly spoken. 

If you do not know what language the customer speaks, use the Language Identification Card in a face-to-face situation so the customer can point to the language he/she speaks. 

Follow the steps below when using the Language Identification Card.

Step

Action

1

Locate the geographical region for which you believe the non-English speaking customer may be from.

2

Show the customer the languages listed for that geographical region. The message underneath each language reads: "Point to your language. An interpreter will be called".

Note: If you do not point to a geographic region, the customer should be able to point to his/her language because the text of the message is written in the language.

B. Language Line

Language Line is an over-the-phone interpretation service that provides professional interpretation from English into more than 140 languages, twenty-four hours a day. 

Use the following links to access instructions for using Language Line services:

If you need. . .

Then use. . .

Dialing instructions and tips on how to use Language Line

How to Contact Language Line

To obtain an interpreter for a phone call to or from a non-English speaking customer

How to Obtain an Interpreter for a Phone Call

To obtain an interpreter for an interview

How to Obtain an Interpreter for an Interview

C. Using An Interpreter Service

The table below shows answers to questions that may arise when using any interpreter service.

Question

Answer

How should you prepare to converse with the interpreter?

Group thoughts or questions to help the conversation flow quickly; and

Give the interpreter specific questions to relay to the customer.

How long are phone calls that involve interpreter participation expected to last?

Interpreters convey meaning-for- meaning, not word-for-word. Concepts familiar to English speakers often require explanation or elaboration in other languages or cultures. Expect interpreted comments to run a bit longer than English phrases.

D. Interpreter/ Translation Log

Each time you use an interpreter/translation service, complete the Interpreter/Translation Log (DE-642). As you use the service, be sure to document the following:

• The date you use the service;

• The time you begin to use the service and the end time of the service;

• Customer name;

• Case number;

• Language interpreted;

• Name of the interpreter/translation service; and

• The type of service (in-person, telephone or translation). 

Update the Interpreter/Translation Log the same day you use the interpreter/translation service, or the next workday you are in the office, and submit it to your supervisor. Be sure to have the person who authorized use of the service initial the log. 

Your supervisor submits this log monthly to the DMS Division Purchasing Liaison who compares the information to the bill to ensure appropriate allocation of expenditures.  

If your office receives the bill from the interpreter service, write your Cost Center and the customer's ACN on the bill. Send the bill to the DMS Division Purchasing Liaison, Mail Drop 2500.

A. Identifying Hearing Impaired Customers

If the customer writes "TTY" as part of his/her phone number on the application, then the customer is hearing impaired.

B. Using the Arizona Relay Service

The Arizona Relay Service is a communications service that links people who are deaf, hard of hearing or speech impaired with hearing people via the telephone.

IF you. . .

THEN. . .

Receive a phone call from the Arizona Relay Service on behalf of a hearing impaired customer

Verify the customer is authorizing this person to interpret/speak for him her by asking the following confidential information about the customer:

• SSN;

• Date of birth; and

• Address.

Need to contact a hearing impaired customer to request additional information

Mail the customer a Pending Notice or a Request for Information and a Permission to Release Information (DE-201) to authorize use of the Arizona Relay Service

Need to call a hearing impaired customer to:

• Follow up on a Request for Information; or

• Schedule an interview

Call the Arizona Relay Service at 1-800-842-6520 and tell the agent the following:

• Your name;

• Where you are calling from (AHCCCS); and

• The purpose of your phone call;

Give the agent the customer's phone number for the agent to call; and

When the customer is on the line, tell the agent to ask the customer:

• For permission to communicate his/her confidential information via the Relay Service; or

• If he/she wants to arrange for a sign language interpreter. If the customer prefers an interpreter, schedule an interview appointment and follow the procedures in B to arrange for sign language interpreter service.

A. Translation of Agency Documents

AHCCCS provides action notices and agency forms in Spanish. Look in your Medicaid Forms Manual to find the English and Spanish versions. 

If a customer requests a notice or form in a different language, arrange for the document to be translated using an interpreter by following the instructions in How to Obtain Translation of Agency Documents.

B. Translation of Incoming Documents

The customer may provide verification documents that are not in English. If you receive a document that is not in English, request translation of the document by following the procedure in How to Obtain Translation of Incoming Documents.

A. Overview

This section contains information about how to:

• Identify confidential information;

• Safeguard information; and

• How to release information.

B. Law

Title XIX of the Social Security Act requires the AHCCCS Administration to provide safeguards, which restrict the release of information about Medicaid applicants and recipients that is considered confidential. Confidential information can be released to others only in accordance with Federal and State laws, regulations and administrative policy. 

The Health Insurance Portability and Accountability Act become law in 1996. This federal law is commonly referred to as HIPAA. The law has standardization, privacy and security requirements that apply to health care facilities and providers, including AHCCCS. Privacy requirements were effective April 14, 2003. The AHCCCS Privacy and Security Policy Manual (APSPM) presents Administration-level policies and procedures. 

Inmost cases, Federal Medicaid laws and State laws that are more stringent than HIPAA regulations take precedence over HIPAA. 

The health care facilities and medical providers with whom field office staff routinely communicates are required to follow HIPAA policies. Therefore it is important for field office staff to be aware of the HIPAA policies that these providers must follow to safeguard their patient' protected health information.

C. Case Record  Information

Throughout this chapter, confidential information will be referred to as belonging to one of three categories:

• non-medical,
• medical records; and
• PAS information.

The table below describes each category.

A. Adjudicate

To hear and settle a matter by administrative or judicial procedure.

B. Authorized  Disclosure

The release of confidential information about an customer to a third party who is authorized by law or regulation, or who has specific written authorization from a person who has the authority to authorize disclosure to others to view or obtain copies of the customer's confidential information. 

Persons or agencies that are authorized to have access for official purposes are described in MS 1602.06.B.

Persons who are authorized by law or regulation because of their status or because they have specific written authorization are described in MS 1602.05.C.

C. Authorized  Representative

A person authorized by the customer, legal representative, or responsible relative of the customer to act on the customer's behalf in the AHCCCS eligibility process.

D. Competent  Individual

A person who is capable of handling his/her own affairs and whom a court has not declared incompetent.

E. Conservator

A person appointed by a court when only financial management assistance is required. When oversight is necessary, the conservator acts in the best financial interest of the conservatee. The conservator manages all funds and resources of the conservatee.

F. Custodial  Parent

The parent (if sole custody) or parents (if joint custody) to whom the court has awarded legal custody irrespective of physical custody.

G. Disclosure

Disclosure is the release, transfer or provision of access to or divulgence in any other manner of confidential information to parties outside the entity holding the information.

H. Durable Power of       Attorney

Durable power of attorney allows an individual (the "grantor") to authorize someone (the "agent") to act on behalf even if the grantor later becomes disabled. The authority that the grantor gives the agent can be as broad (e.g., handling grantor's financial and medical matters) to as narrow (e.g., handling grantor's financial or portion of grantor's financial matters) as the grantor chooses to make it.

I. Emancipated  Minor

A minor who meets at least one of these conditions:

• Married or divorced;

• Enlisted in military service;

• The subject of a court order declaring the minor to be emancipated; or

• Parent(s) have signed a notarized affidavit:

• Indicating that the minor is no longer under parental support and control;
• The parent's have surrendered the state and federal tax dependency deductions provided that the minor is not living with a parent or a specified relative who is the legal guardian or acting as guardian; and
• A court has not awarded custody to another person or agency.

J. Foster Parent

Any person licensed by the Department of Economic Security (DES) or an Arizona tribe to provide out-of-home care for a foster child.

K. Incompetent  Individual

A person who has been legally declared incapable of pursuing his own interest and for whom a legal guardian has been appointed.

L.   Legal Guardian

A person who has been appointed by a court to act as a representative for an individual and has been charged with the duty of taking care of the person and managing the property and rights of that individual who is considered incapable of administering his own affairs. A guardian can also be one who legally has the care and management of the person, or the estate, or both, of a minor child.

M. Medical         Power  of Attorney

Medical power of attorney authorizes another to make medical decisions for an individual when that individual is unable to make decisions for himself/herself including the decision not to receive or continue artificial life support when there is no reasonable expectation of recovery.

N. Minor

A person under the age of eighteen years.

O. Non-Custodial  Parent

The parent(s) not awarded legal custody of his or her child by the court, even though that parent may have physical custody of that child.

P. Protected Health Information (PHI)

 Protected health information (PHI) is health and demographic information about an individual that is transmitted or maintained in any medium where the information:

• Is created or received by a health care component of a health care provider, health plan, employer or health care clearinghouse; and

• Relates to the past, present or future physical or mental health condition of an individual, provision of health care to an individual, or payment for the provision of health care to an individual.

Q. Reasonable Safeguarding

Covered entities must make reasonable efforts to prevent uses and disclosures of confidential information not permitted by HIPAA policy.

R. Safeguarding

To protect or to keep safe.

A. General
Rule

No information about an A/R or other person involved in the application process may be disclosed except as permitted by Federal or State law, regulations or procedures described in this chapter. 

Confidential information may be released to individuals or agencies not authorized according to the policy in this chapter, only with the written approval of the AHCCCS Administration after a review by the AHCCCS Privacy Officer. 

Confidential information concerning other persons must also be safeguarded.

B. Confidential  Information

The following is confidential information and must be safeguarded:

• Name, addresses, zip codes, phone numbers, date of birth and Social Security numbers;

• Social and economic conditions or circumstances;

• Agency evaluation of personal information;

• Medical data (PHI) and services, including diagnosis and history of disease or disability;

• Information received from the Arizona Department of Economic Security;

• Information received from computer matching (system checks i.e., INS, GUIDE, AZTECS, ASSIST, Numident, WTPY, BENDIX, SDX, UI);

• Information received from third party sources (e.g., Bureau of Vital Statistics, Social Security Administration (excluding information from BEER computer match), medical professionals, DES, private-sector employers, etc.);

• Any information regarded as harmful, or if revealed, detrimental to the A/R or others;

• Information received in connection with identification of legally liable 3^rd party sources; and

• Information pertaining to Alcohol or Drug Abuse, Communicable Disease, Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), Behavioral Health, Developmental Disability (DD) or Genetic Testing Information (MS 1305.D).

C. Non- Confidential     Information

Non-confidential information does not need to be safeguarded.

Information is not confidential if it does not identify a specific applicant, recipient, or other personally identifiable information (i.e., statistical report).

D. Workplace Practices to Safeguard Confidential Information

Eligibility offices must take reasonable steps to safeguard information from any intentional or unintentional use or disclosure that is in violation of the privacy policies described in this Subsection. Information maybe in any medium, including paper, electronic media or oral or visual representations.

• Managers and supervisors in each division, office, unit and are responsible for ensuring compliance by staff with these requirements;

• Store files and documents to ensure the safeguarding of confidential information;

• Ensure that files and documents awaiting disposal or destruction in desk-site containers, storage rooms or centralized waste/shred bins, are appropriately labeled and disposed of on a regular basis. All reasonable measures must be taken to minimize access;

• Ensure that the shredding of files and documents is performed on a timely basis, consistent with record retention schedules;

• When members of the public are in non-public areas of AHCCCS facilities, they must be accompanied by an AHCCCS staff person;

• Each AHCCCS employee must ensure that confidential information on the computer screen at their workstation is not visible to unauthorized persons;

• AHCCCS staff must take all necessary precautions to ensure that confidential information on paper documents at their workstation is shielded form casual view and stored securely during extended absences form the workstation, such as meeting away form the office or overnight;

• AHCCCS staff must take reasonable steps to protect the privacy of all verbal exchanges or discussions of confidential information, regardless of where the discussion occurs.

A. Interviewing

When conducting interviews, follow the steps below to ensure the customer's confidentiality.

Step

Action

1

Conduct the interview in a private area, if possible.

If the interview is

Then

Conducted in a shared hospital room or nursing home room

• Explain to the customer the right to a confidential interview and

• Reschedule the interview if the customer requests to do so.

Conducted in an office or interview room

Close the door unless the customer requests otherwise.

Scheduled in a public location at the customer's or representative's request

• Explain that it may not be possible to maintain confidentiality because of the public location and

• Inform the customer that it may be necessary to speak in low tones to avoid others hearing the interview.

2

Remove other person's case record or confidential information from the view of the person being interviewed.

3

Ensure that computer information pertaining to other individuals is not in view or accessible by unauthorized individuals.

4

Make another person's confidential information unreadable (block-out or black-out) when listed on documents filed in a customer's case record.

B. Requesting  Information     from a Third  Party

Although AHCCCS may allow someone other than the customer or the customer's legal representative to act on behalf of the customer in the eligibility determination process, other agencies or entities might not allow these same individuals to authorize release of information concerning the customer from their records. 

A customer or representative can give permission to release information to AHCCCS by signing the:

• Part II application. This form authorizes AHCCCS to investigate and contact any source necessary to establish eligibility.

• Authorization to release information forms. Several forms have been created to request specific information needed to determine eligibility from a third party source. Authorization can be given by signing the individual forms, or a signature can be obtained on the Permission to Release Information form (DE-201), or on the general Release of Information Authorization form (DE-200).

NOTE: AHCCCS verification forms designed to be sent to third parties allow either the customer or the authorized representative to sign. However, some verification sources may require the signature of the customer (or the customer's legal representative).

• Form DE-202, (Authorization for the Disclosure of Protected Health Information to the AHCCCS Administration). This is used by AHCCCS to obtain the customer's medical information for the PAS and eligibility determination. It may also be used for a disability determination.

• Form DE-222 (Authorization for the Disclosure of Psychotherapy Notes to the AHCCCS Administration). This form is used only when the customer's medical records include psychotherapy notes that could affect the PAS determination.

NOTE: The DE-202 and DE-222 may be signed by an authorized representative (legal or otherwise). However, the signature of the legal representative is preferable because the DE-202 and DE-222 also authorizes the release of medical information that has specific protection under Federal or State law. This information cannot be released to AHCCCS without first obtaining the specific written authorization from the person it pertains to or as otherwise permitted by law (MS 1602.05).

A. Review Non-Medical

Before disclosing information in a case record, you must remove confidential information pertaining to anyone other than the A/R or make the information unreadable. If the confidential information pertaining to the other person is relevant to the A/R's eligibility and is on the same page as other information that can be disclosed, make a copy of the page before making the information unreadable.

B. Review PAS  Information and Medical     Records

Medical record and PAS information may contain information that cannot be released because it is detrimental or harmful or has specific protection under Federal or State law. Therefore, a special review must take place before you can release medical record or PAS information to an authorized source.

The persons listed below participate in the review process.

Reviewer

Task

If ALTCS, PAS Assessor in consultation with the supervisor/manager

If SSI-MAO, EI in consultation with the supervisor/manager

Reviews the medical records or the PAS information to determine if the information could be:

• Detrimental or harmful information to the A/R or another person; or

• Information that is protected regarding confidentiality under Federal or State law.

Supervisor/manager in consultation with the Regional/Branch Manager or the ALTCS Medical Eligibility Manager, if ALTCS or with the Acute Care Administrator, if SSI-MAO

Determines if the medical records or the PAS information can be released to an authorized individual. If not, remove the information that cannot be released or make a copy and make the portion that cannot be released unreadable.

Office of Administrative Legal Services Privacy Officer

Gives guidance to the Manager if there is a question.

C. Detrimental  and Harmful

Medical information that is detrimental or harmful if revealed includes:

• Terminal illness that the patient has not been told about; and

• Behavior notations (i.e., agitation, belligerence) that may aggravate the doctor-patient relationship.

D. Protected Under Law

Medical information with specific protection under Federal or State law includes:

A. Who Can  Authorize

The following individuals may authorize AHCCCS to release non-medical, medical records and PAS information.

• An adult customer who is competent;

• The customer's legal guardian;

• An emancipated minor customer, if competent; and

• The custodial parent of a minor customer