N.M. Admin. Code § 8.8.5.7

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.8.5.7 - DEFINITIONS

A. "Citizen review board" means a body appointed pursuant to 32A-8-1 et seq. NMSA 1978 to review dispositional children's court orders and the department's progress report and to submit its own reports to the court.

B. "Court appointed special advocate" means a person appointed by the children's court judge to assist in any children's court proceeding.

C. "Covered" means department components or workforce whose activities and job duties are within the purview of a HIPAA health plan or health care provider.

D. "De-identified information" means health information that is not individually identifiable and is being used by the department for allowable purposes in an aggregated data set.

E. "Disclosure" means the release, transfer, provision of access to or divulging in any other manner of protected health information outside the department's covered components.

F. "Guardian ad litem" means a person who is appointed by the court to represent a minor or legally incompetent person in legal proceedings.

G. "Health care operations" means conducting quality assessment and improvement activities; population-based activities relating to improving services, costs or mandated reporting activities; reviewing worker competence or qualifications, evaluating performance and conducting training; conducting or arranging for case review, legal services and auditing functions; strategic planning and development; and management and general administrative activities of the department, including, but not limited to implementation and compliance with HIPAA requirements, customer service, resolutions of internal grievances and creating de-identified health information for allowable purposes for which an individual authorization is not required.

H. "Individual" means the person who is the subject of protected health information.

I. "Individually identifiable health information" means information that is created or received by the department, that relates to the past, present or future physical or mental condition of an individual, provision of health care to an individual or the past, present or future payment for health care and that either identifies the individual or can reasonably be believed to identify the individual.

J. "Law enforcement official" means an officer or employee of any agency or authority of the United States, a state, a territory, a political division of a state or territory or an Indian tribe who is empowered by law to investigate or conduct an official inquiry into a potential violation of law or prosecute or otherwise conduct a criminal, civil, or administrative proceeding arising from an alleged violation of law.

K. "Minimum necessary" means the standard adopted by the department when using or disclosing protected health information or when requesting protected health information from another entity in covered circumstances, to make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure or request.

L. "Personal representative" means (1) a person who has legal authority under applicable law to act on behalf of an individual adult or emancipated minor, and (2) a parent, guardian or other person acting in loco parentis who is authorized by law to act on behalf of an individual unemancipated minor, except where the minor is authorized by law to act on his own behalf or via court approval or where the parent guardian or person acting in loco parentis has assented to an agreement of confidentiality between the provider and the minor.

M. "Protected health information" or "PHI" means individually identifiable health information that is transmitted by electronic media, maintained in any medium described in the definition of electronic media at 45 CFR Section 162.103 or transmitted or maintained in any other form or medium. PHI excludes individually identifiable health information in education records covered by the Family Educational Rights and Privacy Act at 20 USC 1232 g, records described at 20 USC 1232 g(a)(4)(B)(iv) and employment records held by the department in its role as employer.

N. "Psychotherapy notes" means notes recorded (in any medium) by a health care provider who is a mental health professional, documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

O. "Records custodian" means the person designated by the department to respond to public records requests pursuant to the Public Records Act, 14-2-1et seq. NMSA 1978.

P. "Required by law" means a mandate contained in law that compels an entity to make a use or disclosure of protected health information and that is enforceable in a court of law. Required by law includes, but is not limited to,

(1) court orders and court-ordered warrants,

(2) subpoenas or summons issued by a court, grand jury, a governmental or tribal inspector general or an administrative body authorized to require the production of information,

(3) a civil or an authorized investigative demand,

(4) medicare conditions of participation with respect to health care providers participating in the program, and

(5) statutes or regulations that require the production of information, including statutes or regulations that require such information if payment is sought under a government program providing public benefits.

Q. "Research" means a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge.

R. "Treatment" means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to an individual; or the referral of a individual for health care from one health care provider to another.

S. "Use" means, with respect to individually identifiable health information, the sharing, employment, application, utilization, examination or analysis of such information within an entity that maintains such information.

T. "Workforce" means employees, volunteers, trainees, and other persons whose conduct, in the performance of work for the department, is under the direct control of the department, whether or not they are paid by the department.

N.M. Admin. Code § 8.8.5.7

8.8.5.7 NMAC - N, 4/30/2003