N.M. Admin. Code § 7.1.31.11

Current through Register Vol. 35, No. 21, November 5, 2024

Section 7.1.31.11 - GENERAL PROVISIONS ON ACCESS TO THE CLAIMS DATABASE DATA

A.Access requirements: Data and reports based on the claims database may be obtained only in accordance with the requirements of the HIS Act and this rule. Any request for information that would not be contained in previously prepared and published reports will require a data request from the department.

B.Evaluation of requests: In addition to other requirements stated in this rule, all requests for claims data and reports, other than routine reports, shall be evaluated by the department and shall not be released unless the requests satisfy the following criteria for approval.

(1) The specific intended use of the data shall comport with the purposes of the HIS Act, as stated in 24-14A-3A, NMSA 1978 and rules promulgated pursuant to the HIS Act, including use of data to assist in:

(a) the performance of health planning, policy making functions, and research conducted for the benefit of the public;

(b) informed health care decision making by consumers;

(c) surveillance for the control of disease and conditions of public health significance as required by Public Health Act, Subsection C of 24-1-3 NMSA 1978, and

(d) administration, monitoring, and evaluation of a statewide health plan.

(2) The request shall be consistent with the responsibilities of the department in accomplishing the priorities of the HIS.

C.Request procedures: All requests for data shall be made to the department.

D.Fees: Fees for access to data and reports shall be paid pursuant to the requirements of this rule.

E.Time period to fulfill request: The department will endeavor to fulfill requests within one month of receiving the request, although the time period for fulfillment of a request may vary depending on the complexity of the request and other factors.

F.Restrictions on access to confidential sensitive data: The department shall deny access to information from the claims database where the use or disclosure of the information could result in a violation of health information confidentiality or purposes for which the department has determined is not consistent with the purposes or intent of the act.

G.Compliance with other laws: The department shall ensure that any access to data that is subject to restrictions on use pursuant to state, federal, or tribal law or regulation, or any other legal agreement, complies with those restrictions.

H.Disclaimer: The department shall include a disclaimer in all claims data and reports released pursuant to this rule stating that the accuracy of the original data is the responsibility of the submitting data provider and that the department assumes no responsibility for any use made of or conclusions drawn from the data.

I.Agency contractors:

(1) A state or federal agency that receives claims data or reports under an agreement with the department pursuant to this rule shall be solely responsible for fulfillment of the agreement, including responsibility for the actions of any subcontractor engaged to perform services that require access to claims data or reports.

(2) A state or federal agency subcontractor that is provided access to claims data or reports shall be subject to the full provisions of the HIS Act and this rule.

J.Proprietary and confidential information:

(1) Proprietary information and protected health information shall not be disclosed in or as part of a public health information report by the department.

(2) A data provider that objects to the potential release of its reported data or information derived from its reported data shall submit to the department a written request to exempt its data from such disclosures. By the end of each fiscal year (June 30th), data providers must notify the department in writing regarding data items that they deem proprietary. Application for an exemption must be addressed by a representative of the data provider to the department.

N.M. Admin. Code § 7.1.31.11

Adopted by New Mexico Register, Volume XXXII, Issue 08, April 20, 2021, eff. 4/20/2021