Domestic Diversions

Michigan enacted the Medical Records Access Act, effective April 1, 2004. The Act sets forth uniform statewide procedures for patients (and parents of minor children, except for records of procedures or services for which parental consent was not required), or their “authorized representative”, to follow to get copies of their records from health care providers and facilities. Most importantly, the Act sets the maximum fees that can be charged for the copies, and time limits for providing them.
Until now, the fees charged for copies only had to be “reasonable”, fluctuated widely, and often were prohibitively expensive. This caused problems for patients, especially low income patients who need affordable access to their records to apply for various federal, state and employment related benefits, disputing insurance benefit payments, applying for insurance policy coverage, documenting disability for special education services, changing service providers, when referred to specialists, and when consulting attorneys to determine whether civil actions for damages should be filed. Another problem was simply finding the records, especially when the original service provider stored them off site, or hired document storage agencies to maintain the records.
The new Medical Records Access Act applies whether or not a civil action is pending, but does not apply to pharmacists, psychiatrists, psychologists, social workers, or professional counselors who provide only mental health services. In situations where the Medical Records Access Act applies, the medical records custodian may charge a fee for supplying the information that is not more than the amounts specified in the Act: (1) an initial fee of $20.00 per request (no initial fee may be charged to a patient); (2) for paper copies, $1.00 per page for the first 20 pages, $.50 per page for pages 21 through 50, and $.25 per page for pages 51 and over; (3) the actual cost of producing a duplicate of a nonpaper record; (4) postage and shipping costs; and (5) the actual cost of retrieving records more than seven years old that are not maintained or accessible on site. However, the custodian of the records shall waive all fees for the first set of records requested by a medically indigent patient.
Under the Medical Records Access Act the medical records custodian must respond within 30 days to a written request that is dated and signed not more than 60 days before being submitted to the custodian or, if the medical record is not maintained on site, not more than 60 days after receipt of the request. The Act does not mention creation of a “form” request, and it is not certain that the current SCAO court rule form (see SCAO Form MC 315) used by lawyers in discovery proceedings during civil damage actions will work, as that form has different time frames, lacks permitted responses under the new Act, and other differences. Presumably, a simple letter request from the patient (or from the patient’s attorney, accompanied by an information release) will be sufficient. In addition to making the records available or providing a copy, the provider may respond to the request by stating that the records cannot be found or do not exist, by providing the name and address (if known) of the records custodian, or by denying a request for a medical record obtained from another health care provider under a confidentiality agreement. The records custodian can not ask why the copies are being requested.