Notice of Privacy Practices (use and disclosure of PHI)
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Describes Molina Healthcare's practices for using and disclosing members' protected health information (PHI), members' rights regarding their PHI, and situations when PHI may be used or shared without written authorization. Applies to Molina Healthcare's affiliated health plans and their members.
No material clinical or coverage changes in this revision.
Permitted Uses, Disclosures, and Member Rights
Permitted uses and disclosures
Permitted uses and disclosures of PHI without member authorization include the following categories and examples.
ALL of the following
- Treatment: Use or sharing of PHI to provide or arrange medical care, including referrals and communications between providers (e.g., sharing health condition with a specialist).
- Payment: Use or sharing of PHI to make payment decisions, including claims, approvals for treatment, billing information and informing providers about member benefits and amounts payable by Molina.
- Health Care Operations: Use or sharing of PHI to run the health plan, including quality improvement, health programs and outreach, medical review, legal services (including fraud and abuse detection), audits, member services, reminders, and other business needs; PHI may be shared with business associates performing plan functions.
- Public Health and Oversight: Disclosure to public health authorities and government agencies for disease control, reporting, audits, and other oversight activities as permitted or required by law.
- Research, Legal, Law Enforcement, Safety, and Government Functions: Disclosure for approved research, legal proceedings, law enforcement purposes, prevention of imminent threats to health or safety, and certain government functions, as allowed by law.
- Other Disclosures: Limited disclosures such as to funeral directors or coroners and for workers' compensation purposes as allowed by law.
- Additional Legal Protections: Certain types of information (for example, substance use disorder records, biometric data, abuse/neglect reports, HIV, mental health, genetic information, minor or reproductive health information, and STD records) may have stricter protections; Molina will follow the more protective law when applicable.
- When Authorization Is Required: Most uses beyond these listed categories require written authorization — notably psychotherapy notes, marketing uses and disclosures, and the sale of PHI; authorizations may be revoked but revocation does not affect actions already taken.
Member PHI rights and request procedures
Member rights regarding their PHI and how to exercise them
ALL of the following
- Request Restrictions: You may request that Molina not share your PHI for treatment, payment, or health care operations or with specified persons involved in your care; requests must be in writing; Molina is not required to agree.
- Confidential Communications: You may request that Molina communicate PHI to you in a specific way or at a specific location to protect your privacy; reasonable requests will be followed, especially if disclosure could put you at risk; requests must be in writing.
- Access — Review and Copy: You have the right to review and obtain a copy of PHI Molina holds related to your membership (records used for coverage, claims, and other decisions). Requests must be in writing; reasonable fees for copying and mailing may apply; Molina may deny in certain cases and does not hold complete medical records — contact your provider for full medical records.
- Amendment: You may request amendment of PHI maintained by Molina (limited to records Molina maintains about you as a member); requests must be in writing; if Molina denies the request you may submit a statement of disagreement.
- Accounting of Disclosures: You may request a list of certain disclosures of your PHI made in the six years prior to the request, excluding disclosures for treatment, payment, operations, disclosures to individuals about their own PHI, disclosures made with your authorization, certain incidents, national security/intelligence disclosures, and limited data set disclosures; a reasonable fee applies for more than one request in a 12-month period.
Codes and Coding Notes
Authorization Requirements and Provider Responsibilities
Written authorization required for psychotherapy notes, marketing, and sale of PHI
We need the member's written authorization before disclosing PHI for most uses and disclosures of psychotherapy notes, for uses and disclosures for marketing purposes, and for uses and disclosures that involve the sale of PHI. Authorizations may be revoked, but revocation does not affect actions already taken based on the authorization.
When written authorization is required and effect of revocation
Obtain a written authorization any time the disclosure is for (1) most psychotherapy notes, (2) marketing purposes, or (3) sale of PHI; members may cancel authorizations prospectively, but cancellation does not undo disclosures already made.
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.