Amendments	Fiscal Memos
SA0331	Amendment 1-0 to SB1313

	Amendments	Fiscal Memos
HA0398	Amendment 1-1 to HB0647
HA0426	Amendment 2- to HB0647
HA0589	Amendment 3-2 to HB0647

NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

Fiscal Summary

NOT SIGNIFICANT

Bill Summary

Present law requires a healthcare provider to furnish to a patient, or a patient's authorized representative, a copy or summary of such patient's medical records, at the option of the healthcare provider, within 10 working days upon request in writing by the patient or such representative. Present law provides that the party requesting the records is responsible to the provider for the reasonable costs of copying and mailing such records. For other than records involving workers' compensation cases, such reasonable costs must not exceed $20 for records five pages or less in length and 50 cents per page for each page copied after the first five pages plus the actual cost of mailing.

This bill revises the cost limitations by providing, instead, that other than for records involving workers’ compensation cases, the reasonable costs must not exceed the cost of the following:

(1) Labor for copying the protected health information requested by the individual;

(2) Supplies for creating the paper copy, or electronic media, if the individual requests that the electronic copy be provided on portable media; and

(3) Postage, when the individual has requested the copy, or the summary or explanation, be mailed.

This bill further provides that (1)-(3) are the limits to what can be included in calculating the permissible costs that may be charged for copying and mailing the records and that the total charges must not exceed $25.

ON APRIL 13, 2023, THE HOUSE ADOPTED AMENDMENT #1 AND RE-REFERRED HOUSE BILL 647 TO THE HEALTH COMMITTEE.

AMENDMENT #1 makes the following changes to this bill:

(1) Adds that for records other than those involving workers' compensation cases, the party requesting the patient's medical records in paper format is responsible to the provider or the provider's third-party release of information provider for the reasonable costs of copying and mailing the patient's records;

(2) Adds that such reasonable costs must not exceed $25 for paper copies of medical records five pages or less in length; 50 cents per page for each page copied after the first five pages; the actual cost of mailing; and, for producing radiology images in hard copy, no more than $20 per printed film;

(3) Adds that the party requesting the patient's records in electronic format is responsible to the provider or the provider's third-party release of information provider for the reasonable fees for fulfilling a patient's request for the patient's own records are governed by HIPAA, and other federal law and implementing regulations;

(4) Requires that, for all other requesters, the total fees for electronic medical records provided via portable media, electronic mail, or medical record portal, must comply with the following: the total charges must be no more than $25 for records 10 pages or less in length; the total charges must be no more than 25 cents per page for each page after the first 10 pages, up to $90; the actual mailing costs and applicable taxes, if any; the fee for producing electronic copies of radiology images must be no more than $25 per request for CD, DVD, or USB, or $15 per request for electronic files emailed or sent via medical record portal; a certification or notary fee, if certification or notarization is requested, in the amount of $20; and charges for copying paper records or faxing paper records are subject to the limits set in (2) above;

(5) Requires, upon request, a person providing records pursuant to this bill to provide the records in electronic form unless the records are not kept in electronic form in the usual course of business; and

(6) Adds that the fees charged for reproducing records of patients involved in a claim or appeal of denial for social security disability benefits is a flat fee of $20, regardless of whether the records are produced on paper or electronically.

ON MARCH 14, 2024, THE HOUSE FURTHER CONSIDERED HOUSE BILL 647, ADOPTED AMENDMENT #3, AND PASSED HOUSE BILL 647, AS AMENDED.

AMENDMENT #3 rewrites the bill to make the changes described below to law regarding costs of reproduction, copying, or mailing of records.

Present law provides that the party requesting the patient's records is responsible to the provider for the reasonable costs of copying and mailing such patient's records. For records other than those involving workers' compensation cases, such reasonable costs must not exceed $20 for medical records five pages or less in length and 50 cents per page for each page copied after the first five pages and the actual cost of mailing. Any third-party provider of record copying and related services must be subject to the reasonable cost limits and must not impose any charge or fee for such services in excess of such cost limits. The costs charged for reproducing records of patients involved in a workers' compensation claim must be as defined in workers' compensation law. A healthcare provider must not charge a fee for copying or notarizing a medical record when requested by the department of health pursuant to a complaint, inspection or survey. This amendment deletes these provisions entirely.

This amendment provides that for records other than those involving workers' compensation cases, the party requesting the patient's medical records in paper format is responsible to the provider or the provider's third-party release of information provider for the reasonable costs of copying and mailing the patient's records. Such reasonable costs must not exceed (i) $25 for paper copies of medical records five pages or less in length; (ii) 50 cents per page for each page copied after the first five pages; (iii) the actual cost of mailing; (iv) for producing radiology images in hard copy, no more than $20 per printed film; and (v) a certification or notary fee, if certification or notarization is requested, must be charged as a flat fee of $20.

This amendment provides that for records other than those involving workers' compensation cases, the party requesting the patient's records in electronic format is responsible to the provider or the provider's third-party release of information provider for the following fees:

(1) The reasonable fees for fulfilling a patient's request for the patient's own records are governed by HIPAA, and the Health Information Technology for Economic and Clinical Health (HITECH) Act, and those acts implementing regulations, which must not exceed the cost of the (i) labor for copying the protected health information requested by the individual; (ii) supplies for creating the paper copy, or electronic media if the individual requests that the electronic copy be provided on portable media; and (iii) postage, when the individual has requested the copy or summary or explanation, be mailed; and

(2) For all other requesters, the total fees for electronic medical records provided via portable media, electronic mail, or medical record portal, must comply with the following: (i) the total charges must be no more than $25 for records 10 pages or less in length; (ii) the total charges must be no more than 25 cents per page for each page after the first 10 pages, up to $90; (iii) the mailing costs and applicable taxes, if any, must be the actual mailing costs and applicable taxes; (iv) the fee for producing electronic copies of radiology images must be no more than $25 per request for CD, DVD, or USB, or $15 per request for electronic files emailed or sent via medical record portal; (v) a certification or notary fee, if certification or notarization is requested, must be charged as a flat fee of $20; (vi) charges for copying paper records or faxing paper records must not exceed $25 for paper copies of medical records five pages or less in length, 50 cents per page for each page copied after the first five pages, the actual cost of mailing, for producing radiology images in hard copy, no more than $20 per printed film, and a certification or notary fee, if certification or notarization is requested, must be charged as a flat fee of $20; and (vii) the fees charged for reproducing records of patients involved in a claim or appeal of denial for social security disability benefits must be a flat fee of $20, only when the records are produced electronically.

Upon request, this amendment requires a person providing a copy or summary of a patient's medical records to provide the records in electronic form unless the records are not kept in electronic form in the usual course of business.

This amendment provides that a third-party release of information provider of record copying and related services is subject to the fee limits contained in this amendment and must not impose a charge or fee for such service in excess of such fee limits. The fees charged for reproducing records of patients involved in a workers' compensation claim are as specified in existing workers' compensation laws. A healthcare provider must not charge a fee for copying or notarizing a medical record when requested by the department of health pursuant to a complaint, inspection, or survey.