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Disclosure and Use of Confidential WIC Applicant and Participant Data Part II

Disclosure and Use of Confidential WIC Applicant and Participant Data Part II. Nutrition Services Directors Meeting Date: December 9, 2014 Macon, Georgia. Disclosure of Confidential WIC Applicant/Participant Information – July 22, 2014.

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Disclosure and Use of Confidential WIC Applicant and Participant Data Part II

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  1. Disclosure and Use of Confidential WIC Applicant and Participant Data Part II Nutrition Services Directors Meeting Date: December 9, 2014 Macon, Georgia

  2. Disclosure of Confidential WICApplicant/Participant Information – July 22, 2014 • What is confidential WIC applicant and participant information? • Who is authorized to access confidential WIC applicant and participant information and for what purpose? • Parameters within which confidential WIC applicant and participant information may be used for non-WIC purposes? • Can confidential WIC applicant and participant information be disclosed to private organizations? • How to respond to subpoenas or search warrants for confidential WIC applicant and participant information. • DPH policies pertaining to the release of confidential WIC applicant and participant information for research purposes (data requests and DPH-IRB approved studies).

  3. Disclosure of Confidential WICApplicant/Participant Information • Information may be disclosed for non-WIC purposes to other public organizations that administer programs that serve WIC-eligible individuals for establishing eligibility for other health/welfare programs and for conducing outreach to WIC-eligible persons for such programs. See 7 CFR § 246.26(d)(2) and FNS Instruction 800-1. • The disclosure of such information must be reduced to writing (e.g., data sharing agreement). See 7 CFR § 246.26(d)(2). • Without a written agreement, confidential applicant/participant information may only be released if the affected applicant/participant signs a release form authorizing disclosure. See FNS Instruction 800-1, p. 6; and, 7 CFR § 246.26(d)(4). • Disclosure Statement on Participant Certification form (To satisfy notice requirement that must precede execution of data sharing agreement - 7 CFR § 246.26(h)(2)) • GDPH Authorization to Release Information form • DHS Authorization to Release Information form (used by DFCS) • Other Voluntary release forms

  4. Disclosure of Confidential WIC Participant Information:Who is Authorized to Sign a Release Form? • A WIC applicant/participant may request to see or to obtain a copy the information he/she provided to the WIC Program that is contained in his/her own record. See 7 CFR § 246.26(d)(5). • Access to the record based on a signed release form may be limited. The SWO or local agency does not have to provide applicant/participant information in the record that was provided by third parties (e.g., staff assessments of participant’s condition or behavior) UNLESS required by Federal, State, or local law OR the information supports a State or Local Agency decision being appealed by a participant. • Parent/Caretaker Access to Information on a Minor Participant. • 7 CFR § 246.26(d)(5) provides that “[i]n the case of an applicant or participant who is an infant or child, access may be provided to the parent or guardian of the infant or child, assuming that any issues regarding custody or guardianship have been settled.” • Who has the authority to sign a release form is dependent on State law. • Question #1: Does the individual have legal custody of the minor(s)? • Question #2: Did the individual bring the minor(s) for initial certification? See GA WIC Procedures Manual, p.CT-2 , which provides that “[a] child or infant must be accompanied by the parent/guardian/caretaker/spouse/alternate parent to the WIC Clinic.”

  5. Disclosure of Confidential WIC Participant Information: Voluntary Authorization to Release Information This form is used by local clinic for applicant/participant to authorize the release of his/her confidential information to: Private entities (e.g., private doctors) upon request. Public organizations/agencies for which DPH-WIC does not have a data sharing agreement (e.g., other programs housed at county health department). Release forms authorizing disclosure of information to private physicians or other health care providers may be included as part of the WIC application or certification process. All other release forms MUST be presented and signed after completion of the application and certification process. See 7 CFR § 246.26(d)(4) and FNS Instruction 800-1, p. 6.

  6. Disclosure of Confidential WIC Participant Information:Requests for Minor Participant’s Information by DFCS A complete request will include a copy of the court order granting temporary custody to DFCS Even if the DFCS case manager can obtain the parent’s signature on this form, it MUST be accompanied by the official court order. The max duration of the authorization is one year Who is Authorized to Sign this Form? The individual or entity that has legal custody of the child (e.g., DFCS) There may be instances where DFCS is working with a family, but parent(s) retains custody of the child/ren. Documentation is still needed for the record to substantiate the circumstances in which DFCS needs the confidential information.

  7. Disclosure of Confidential WIC Participant Information: Voluntary Authorization to Release InformationAdjudicatory Order – Juvenile Court

  8. Disclosure of Confidential WIC Participant Information:Requests for Minor Participant Information by DFCS Are Foster Parents Authorized to Sign Release Forms? No. A foster parent is a placement for a foster child/ren. A foster parent enters into a contract with DFCS to provide routine, daily care for a foster child placement. However, legal custody remains with DFCS. See O.C.G.A. § § 15-11-212(a)(2)(B) and 15-11-12(d)). Therefore, a foster parent is not considered an authorized signatory for the release of confidential WIC applicant/participant information contained in a minor participant’s record. A foster parent’s right to access to medical information and other confidential information on a foster child placed with him/her/them is outlined in State law, specifically, OCGA 49-5-41(d) and OCGA 49-5-281, Foster Parent Bill of Rights. Therefore, it is critical that the local DFCS office that has temporary legal custody of a child/ren submit an Authorization for Release of Information Form (DHR Form R5459) – the information becomes a part of its file to which a foster parent has a statutory right to reasonable access AND submit any subsequent ROI to allow a foster parent access to such information.

  9. Disclosure of Confidential WIC Participant Information:Requests for Minor Participant’s Information by DFCS With DHS and DPH’s Authorization for Release of Information Forms, must verify: • Who is the signatory authorizing the release of information? • If seeking information for a minor participant, does the signatory have the authority to sign the release form (See FNS Instruction 800-1) • Parent – does he/she have legal custody of the child? • Parent – Did he/she accompany minor for certification? • What information/records have been requested and for what purpose? • Entire medical record • Records that cover a specific time period • HIV/AIDS related information contained in the record It is critical to contact SWO WIC Legal Team for questions pertaining to the release of confidential participant information, and equally important to speak with your Privacy Officer with respect to medical information sought as part of the release of information form.

  10. Disclosure of Confidential WICParticipant Information - DFCS Foster Parents Foster parents is a placement for a foster child/ren. Legal custody is with DFCS – Juvenile court issues orders of disposition granting or transferring temporary legal custody to DFCS (15-11-212(a)(2)(B); 15-11-12(d)) • ROI form should be completed when the new foster parent wants a copy of the child’s WIC record – 2014 Procedures Manual, p. CT-55 • When DFCS is authorized by parent or by grant of legal custody of a child pursuant to court order, and places a child in a foster care placement that foster parent(s) does not have legal custody ONLY physical custody of the child. Therefore the question becomes: Can local WIC clinics honor a release of information form signed by a foster parent and release a foster child/ren’s WIC record? OCGA 49-5-41(d): An identified foster parent may have reasonable access to non-identifying information from the placement or CPS record complied by the state agency/department that has legal custody of a child and who is placed in the FP’s care. Records include: “reports of abuse of such child and the social history of the child and the child's family, the medical history of such child, including psychological or psychiatric evaluations, . . . . provided that no identifying information is disclosed regarding such child.

  11. Disclosure of Confidential WICParticipant Information - DFCS Foster Parents Bill of Rights OCGA 49-5-281 (a)(9) The right to discuss information regarding the child prior to placement. The Division of Family and Children Services will provide such information as it becomes available as allowable under state and federal laws; (a)(12) The right, at any time during which a child is placed with the foster parent, to receive from the Division of Family and Children Services any and all additional pertinent information relevant to the care of the child; (a)(13) The right to be provided with a written copy of the individual treatment and service plan concerning the child in the foster parent's home and to discuss such plan with the case manager, as well as reasonable notification of any changes to that plan; (a)(17) The right to communicate for the purpose of participating in the case of the foster child with other professionals who work with such child within the context of the professional team, including, but not limited to, therapists, physicians, and teachers, as allowable under state and federal law;

  12. Scenario #1Local WIC clinic receives a DHS Authorization for Release of Information form authorizing the release of a minor participant’s complete medical record. The form is signed by the minor’s parent. The purpose for the request is “case planning”. What should front line staff do? Who is the signatory of this form? What relationship does the signatory have with the individual for which information is to be released? Does the signatory have the authority to sign the release form? Is there an order documenting DFCS’ custody of the minor accompanying this form? What does the complete medical record contain? – Question for Privacy Officer

  13. Scenario #2Local WIC clinic receives a DHS Authorization for Release of Information form authorizing the release of a minor participant’s complete medical record. The form is signed by the foster parent. The purpose of the release is “foster care monitoring”. What should front line staff do? Has a ROI form already been submitted by DFCS for this/these minor WIC participants? Does the signatory have the authority to sign the release form? Is there an order documenting DFCS’ custody of the minor accompanying this form? What does the complete medical record contain? – Question for Privacy Officer

  14. Scenario #3A DFCS caseworker repeatedly calls a local WIC clinic requesting information on a foster child with respect to the child’s appointments to make sure the foster parents are keeping up with the child’s care needs. How should front line staff respond to such requests? • There is no written agreement between the SWO and DFCS and/or its administering State Agency to routinely and systematically share confidential applicant/participant information. THEREFORE: Question 1: Is there a completed Authorization for Release of Information form in the participant file? Question 2: Is there an order attached to the release form documenting DFCS’ temporary legal custody of the foster child/ren for which information is sought? Question 3: Was the signatory of the form authorized to sign it? Please remember: • If DFCS has temporary legal custody of the minor participant, AND has submitted a complete DHS-ROI form, it can request information on the child/ren at any time for the period in which it has temporary legal custody. • DFCS’ legal custody of any foster child runs in 12 month increments. • It is important that confidential information that is disclosed is transmitted securely. QUESTION: How is information released to DFCS case workers in your Districts??

  15. Examples of Other Voluntary Release Forms

  16. Disclosure of Confidential WIC Participant Information:Access to confidential participant information by a proxy during the course of a high risk nutrition visit In limited situations, proxies are allowed to bring a child in for subsequent certifications or half certifications and attend nutrition education classes. See 2014 GA WIC Procedures Manual, p. CT-11 and p.NE-6. Parent/caretaker signs a Statement of Income, Residency, and Identification of Proxy Letter consenting to a proxy accompanying a minor participant to a recertification. See GA WIC Procedures Manual, Certification Section, Attachment CT-12. Challenge: Proxy’s participation in high risk nutrition education contacts exposes them to confidential WIC participant information. Currently, there is no documentation in place for a participant or parent/caretaker to acknowledge a proxy’s potential access to such information in this instance, and to give their formal consent to such access. Solution: SWO is in the process of identifying those documents that will be updated to address these challenges (e.g., Proxy Letter)

  17. GA WIC-Legal: Contact Information Miessha N. Stennis Miessha.Stennis@dph.ga.gov Phone: (404) 657-2740 Ruth M. Pawlak Ruth.Pawlak@dph.ga.gov Phone: (404) 657-2909 Office of Program Integrity and Strategy Shameyrae Miller, Deputy Director (404) 657-2917 Shameyrae.Miller@dph.ga.gov

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