Researcher: ND Page 1 5/5/24
OLR Bill Analysis
sHB 5411 (as amended by House "A")*
AN ACT CONCERNING REQUESTS FOR HEALTH RECORDS AND
THE FEES CHARGED FOR ACCESS TO SUCH RECORDS.
SUMMARY
This bill makes various changes to deadlines, fees, and penalties
related to patient health records requests. Principally, it:
1. authorizes workers’ compensation administrative law judges to
penalize physicians, or third-party vendors acting on their
behalf, who fail to submit medical reports for workers’
compensation cases within 30 days after they are completed;
2. allows an entity acting on a provider’s or institution’s behalf to
fulfill a patient’s written health records request instead of the
provider or institution;
3. replaces current law’s patient health records fee of 65 cents per
page with fees that vary based on who requests the records, their
format (i.e., paper or electronic), and number of pages;
4. allows providers, institutions, and entities acting on their behalf
to charge an additional fee of $100 if the requestor wants the
records within 15 days after requesting them;
5. specifies that providers and institutions are not required to
supply records under certain conditions (e.g., if doing so would
violate HIPAA) and cannot charge records fees that exceed those
allowed under HIPAA;
6. requires the Department of Public Health (DPH) commissioner
to publish patient health records fees on the DPH website and,
starting January 1, 2026, annually adjust the fees based on
changes to the national consumer price index; 2024HB-05411-R01-BA.DOCX
Researcher: ND Page 2 5/5/24
7. requires providers, institutions, and entities that represent them
that fail to supply patient health records within 30 days after
receiving a request to reduce the fees that they charge; and
8. prohibits providers and institutions from charging fees for health
records requests needed to support workers’ compensation
claims.
The bill also makes technical and conforming changes.
*House Amendment “A” replaces the underlying bill (File 514) and
(1) allows, rather than requires, workers’ compensation administrative
law judges to impose specified penalties; (2) prohibits health care
providers and institutions from charging fees for records requests
related to workers’ compensation claims; (3) establishes a new medical
records fee structure based on the requestor and format of the records;
(4) specifies conditions under which providers and entities are not
required to supply health records; (5) increases the fee from $50 to $100
for certain expedited records requests and lengthens the amount of time
providers have to respond to these requests from 72 hours to 15 days;
(6) eliminates the requirement that providers, institutions, and entities
give a requestor electronic copies of health records, if preferred; and (7)
eliminates the additional $50 fee for requests to make redactions to
records.
EFFECTIVE DATE: October 1, 2024
§ 1 — WORKERS’ COMPEN SATION MEDICAL REPOR TS
The bill authorizes workers’ compensation administrative law judges
to penalize practicing physicians, or third-party vendors acting on their
behalf, who fail to submit medical reports for workers’ compensation
cases within 30 days after they are completed as required under existing
law. Under the bill, penalties may include the following:
1. a written noncompliance notice to the physician or third-party
vendor or
2. an order requiring the physician or third-party vendor to appear 2024HB-05411-R01-BA.DOCX
Researcher: ND Page 3 5/5/24
at a hearing and explain the reasons for not meeting the report
deadline.
For the latter, the bill allows an administrative law judge to impose a
fine of up to $500 payable to the workers’ compensation claimant if a
physician or third-party vendor fails to appear at a hearing.
Existing law requires workers’ compensation claimants, when
seeking or receiving compensation, to submit to a physician evaluation
when an administrative law judge orders it, or an employer reasonably
requests it. Physicians must submit all medical reports for these
claimants within 30 days after the date they are completed to the
employer and the employee (claimant), or the employee’s attorney.
§§ 2 & 3 — ACCESS TO PATIENT HEALTH RECORDS
Records Requests
Under current law, patients (or their attorneys or authorized
representatives) can generally obtain copies of their health records by
asking a provider or health care institution (e.g., hospital, outpatient
clinic, or long-term care facility) in writing. The bill replaces the term
“authorized representative” with “personal representative” to align
with federal regulations. (Under federal regulations, someone is a
“personal representative” if they can legally act on a person’s behalf in
making health care decisions.)
Existing law requires providers and institutions to give the health
records to the requestor within 30 days after the request is made. For
institutions, if the request was received less than 30 days from the
patient’s discharge, they must provide the record when it is completed.
The bill requires records requests to be complete and in a form
required by the provider or an entity acting on the provider’s behalf if
the form was given to the requestor.
Under current law and the bill, a provider, institution, or entity
cannot refuse to return to a patient original or copied health records
from another provider. 2024HB-05411-R01-BA.DOCX
Researcher: ND Page 4 5/5/24
The bill specifies that providers and institutions are not (1) required
to supply a requested health record until they receive a HIPAA-
compliant medical authorization form (presumably from the patient, or
patient’s attorney or personal representative); (2) required to supply
records in violation of HIPAA; (3) permitted to limit legally allowed
disclosures; or (4) allowed to charge fees for health records that exceed
those allowed under HIPAA.
By law, health records include bills, x-rays, copies of lab report
results, prescriptions, contact lens specifications under certain
conditions, and other technical information used to assess the patient’s
health condition.
Fees
Current law allows a health care provider or institution to charge up
to 65 cents per page, including any applicable research or handling fees,
related costs, and first-class postage, to supply a patient’s health record.
Patients may also be charged an additional amount necessary to cover
the cost of material for (1) providing a copy of an x-ray or (2) furnishing
an original retained slide or tissue block or a new section cut from a
retained tissue block.
The bill instead establishes fees based on who makes the request and
the format in which the health record is provided as described below.
Requests by Patients or Their Personal Representatives. If a
written records request is made directly by the patient or patient’s
personal representative, the bill allows the provider or institution to
charge the same fees as allowed under federal law. (Federal law allows
charging reasonable, cost-based fees that include only the cost of related
labor, supplies, and postage.) Under the bill, these fees cover the cost of
material for providing copies of medical records and x-rays as well as
furnishing tissue blocks as described above.
Requests by Other Parties. For requests made from someone other
than the patient or patient’s personal representative, providers and
institutions may charge up to the following amounts: 2024HB-05411-R01-BA.DOCX
Researcher: ND Page 5 5/5/24
1. for paper copies, $1 per page for the first 50 pages, an additional
50 cents per page for pages 51 and beyond, and the actual cost of
postage, and
2. for electronic copies, $1 per page for the first 50 pages, an
additional 50 cents per page for pages 51 and beyond (up to a
maximum of $215), and the actual cost of any required postage.
Reduction in Fees for Late Delivery. Under the bill, providers,
institutions, or entities acting on their behalf that fail to supply health
records within 30 days after they receive the request must reduce the
fees they charge as follows:
1. by 50%, if they fail to provide the records within 30 days after
they receive the request;
2. by 75%, if they fail to do so within 60 days after they receive the
request; and
3. by 90%, if they fail to do so within 90 days after they receive the
request.
Under the bill, a provider, institution, or entity is exempt from the
above fee reductions if good cause is shown.
Expedited Requests. The bill allows providers, institutions, or
entities to charge an additional fee of up to $100 if the requestor wants
the records within 15 days after requesting them. An expedited records
request must include a statement (1) that a statute of limitation or repose
may expire within 120 days of the request or (2) showing other good
cause for needing the expedited copy. If the provider, institution, or
entity fails to provide the records within the expedited deadline, they
must provide the records free of charge.
Workers’ Compensation Claims
The bill prohibits providers and institutions from charging fees for
health records requests that are necessary to support a workers’
compensation claim. Existing law already prohibits them from charging 2024HB-05411-R01-BA.DOCX
Researcher: ND Page 6 5/5/24
fees for records requests that are necessary for a documented claim or
appeal for Social Security or veterans’ benefits.
COMMITTEE ACTION
Judiciary Committee
Joint Favorable
Yea 35 Nay 0 (04/01/2024)