N.J. Admin. Code § 11:24B-1.7

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24B-1.7 - CODS: confidentiality of information regarding covered persons

(a) A CODS shall maintain confidentially any data or information relating to the diagnosis, treatment, or health of a carrier's covered persons, or prospective covered persons, obtained from the carrier, a provider, or from the individual, and shall not disclose such information to any person except:

1. To the extent it may be necessary to carry out the purposes of the Act or this chapter, including investigation of complaints by a carrier, the Department, and adjudication of claims or other reimbursement by a carrier or its agent;

2. Upon the express consent of the covered person or prospective covered person, or his or her legal representative, if the covered person or prospective covered person is incapacitated or a minor;

3. Pursuant to statute or court order for the production of evidence or the discovery thereof;

4. In the event of a claim or litigation between a covered person or prospective covered person and the CODS or carrier wherein the data or information is relevant to the claim or litigation. A CODS shall be entitled to claim any statutory privilege against disclosure that a provider or carrier that furnished the information to the CODS is entitled to claim;

5. For epidemiological and outcomes research when the identity of the covered person, prospective covered person, or contract holder is protected through the use of anonymized information, as defined at N.J.S.A. 17:48H-30e; or

6. Upon the informed consent of the covered person, prospective covered person, or contract holder (but only when the contract holder is a natural person, and is providing consent solely on his or her own behalf), which consent has been obtained for research approved by an institutional review board in accordance with Federal requirements for informed consent pursuant to 21 CFR Part 50 or 45 CFR Part 46.

(b) The Department and carriers shall maintain any information obtained from a CODS relating to the diagnosis, treatment or health of a covered person, or prospective covered person, confidentially to the same extent as the information is required by this subsection to be maintained confidential by the CODS, and shall not make any public disclosure of such information.

(c) Notwithstanding (a) and (b) above, nothing in this chapter shall be construed to prohibit the collection and dissemination of data that has been aggregated and otherwise stripped of personal identifiers of former, current and prospective covered persons.

N.J. Admin. Code § 11:24B-1.7

Amended by 55 N.J.R. 1186(a), effective 6/5/2023