1     
PATIENT MEDICAL RECORD ACCESS AMENDMENTS

2     
2023 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: James A. Dunnigan

5     
Senate Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill modifies the fee an entity may charge for providing medical records if the
10     medical records are not provided in a certain amount of time.
11     Highlighted Provisions:
12          This bill:
13          ▸     modifies the fee an entity may charge for providing medical records if the medical
14     records are not provided in a certain amount of time.
15     Money Appropriated in this Bill:
16          None
17     Other Special Clauses:
18          None
19     Utah Code Sections Affected:
20     AMENDS:
21          78B-5-618, as last amended by Laws of Utah 2022, Chapter 327
22     

23     Be it enacted by the Legislature of the state of Utah:
24          Section 1. Section 78B-5-618 is amended to read:
25          78B-5-618. Patient access to medical records -- Third party access to medical
26     records.
27          (1) As used in this section:

28          (a) "Health care provider" means the same as that term is defined in Section
29     78B-3-403.
30          (b) "Indigent individual" means an individual whose household income is at or below
31     100% of the federal poverty level as defined in Section 26-18-3.9.
32          (c) "Inflation" means the unadjusted Consumer Price Index, as published by the Bureau
33     of Labor Statistics of the United States Department of Labor, that measures the average
34     changes in prices of goods and services purchased by urban wage earners and clerical workers.
35          (d) "Qualified claim or appeal" means a claim or appeal under any:
36          (i) provision of the Social Security Act as defined in Section 67-11-2; or
37          (ii) federal or state financial needs-based benefit program.
38          (2) Pursuant to Standards for Privacy of Individually Identifiable Health Information,
39     45 C.F.R., Parts 160 and 164, a patient or a patient's personal representative may inspect or
40     receive a copy of the patient's records from a health care provider when that health care
41     provider is governed by the provisions of 45 C.F.R., Parts 160 and 164.
42          (3) When a health care provider is not governed by Standards for Privacy of
43     Individually Identifiable Health Information, 45 C.F.R., Parts 160 and 164, a patient or a
44     patient's personal representative may inspect or receive a copy of the patient's records unless
45     access to the records is restricted by law or judicial order.
46          (4) A health care provider who provides a paper or electronic copy of a patient's
47     records to the patient or the patient's personal representative:
48          (a) shall provide the copy within the deadlines required by the Health Insurance
49     Portability and Accountability Act of 1996, Administrative Simplification rule, 45 C.F.R. Sec.
50     164.524(b); and
51          (b) may charge a reasonable cost-based fee provided that the fee includes only the cost
52     of:
53          (i) copying, including the cost of supplies for and labor of copying; and
54          (ii) postage, when the patient or patient's personal representative has requested the copy
55     be mailed.
56          (5) Except for records provided by a health care provider under Section 26-1-37, a
57     health care provider who provides a copy of a patient's records to a patient's attorney, legal
58     representative, or other third party authorized to receive records:

59          (a) shall provide the copy within 30 days after [receipt of notice] the day notice is
60     received; and
61          (b) may charge a reasonable fee for paper or electronic copies, but may not exceed the
62     following rates:
63          (i) $30 per request for locating a patient's records;
64          (ii) reproduction charges may not exceed 53 cents per page for the first 40 pages and 32
65     cents per page for each additional page;
66          (iii) the cost of postage when the requester has requested the copy be mailed;
67          (iv) if requested, the health care provider will certify the record as a duplicate of the
68     original for a fee of $20; and
69          (v) any sales tax owed under Title 59, Chapter 12, Sales and Use Tax Act.
70          (c) Notwithstanding the provisions of Subsection (5)(b), in the event the requested
71     records are not received by the requestor under this Subsection (5):
72          (i) within 30 days after the day notice is received by the health care provider, the health
73     care provider shall waive 50% of the fee; or
74          (ii) within 60 days after the day notice is received by the health care provider, the
75     health care provider must provide the requested records free of charge to the requestor.
76          (d) Time periods for a health care provider's performance under this Subsection (5)
77     shall be extended for periods of time during which the health care provider's performance is
78     prevented due to circumstances beyond the health care provider's control, such as fires, floods,
79     earthquakes, acts of God, lockouts, ransomware, or strikes.
80          (6) (a) Except for records provided under Section 26-1-37, a contracted third party
81     service that provides medical records, other than a health care provider under Subsections (4)
82     and (5), who provides a copy of a patient's records to a patient's attorney, legal representative,
83     or other third party authorized to receive records:
84          [(a)] (i) shall provide the copy within 30 days after the request; and
85          [(b)] (ii) may charge a reasonable fee for paper or electronic copies, but may not
86     exceed the following rates:
87          [(i)] (A) $30 per request for locating a patient's records;
88          [(ii)] (B) reproduction charges may not exceed 53 cents per page for the first 40 pages
89     and 32 cents per page for each additional page;

90          [(iii)] (C) the cost of postage when the requester has requested the copy be mailed;
91          [(iv)] (D) if requested, the health care provider or the health care provider's contracted
92     third party service will certify the record as a duplicate of the original for a fee of $20; and
93          [(v)] (E) any sales tax owed under Title 59, Chapter 12, Sales and Use Tax Act.
94          (b) Notwithstanding the provisions of Subsection (6)(a)(ii), if the requested records are
95     not received by the requestor under this Subsection (6):
96          (i) within 30 days after the day notice is received by the health care provider, the
97     third-party service must waive 50% of the fee; or
98          (ii) within 60 days after the day notice is received by the health care provider, the
99     third-party service must provide the requested records free of charge to the requestor.
100          (iii) Time periods for a third-party service's performance under this Subsection (6) shall
101     be extended for periods of time during which the third-party service's performance is prevented
102     due to circumstances beyond control of the third-party service, such as fires, floods,
103     earthquakes, acts of God, lockouts, ransomware, or strikes.
104          (7) A health care provider or the health care provider's contracted third party service
105     shall deliver the medical records in the electronic medium customarily used by the health care
106     provider or the health care provider's contracted third party service or in a universally readable
107     image such as portable document format:
108          (a) if the patient, patient's personal representative, or a third party authorized to receive
109     the records requests the records be delivered in an electronic medium; and
110          (b) the original medical record is readily producible in an electronic medium.
111          (8) (a) Except as provided in Subsections (8)(b) [and (c),] through (d) the per page fee
112     in Subsections (4)[, (5), and] through (6) applies to medical records reproduced electronically
113     or on paper.
114          (b) The per page fee for producing a copy of records in an electronic medium shall be
115     50% of the per page fee otherwise provided in this section, regardless of whether the original
116     medical records are stored in electronic format.
117          (c) (i) A health care provider or a health care provider's contracted third party service
118     shall deliver the medical records in the electronic medium customarily used by the health care
119     provider or the health care provider's contracted third party service or in a universally readable
120     image, such as portable document format, if the patient, patient's personal representative,

121     patient's attorney, legal representative, or a third party authorized to receive the records,
122     requests the records be delivered in an electronic medium.
123          (ii) An entity providing requested information under Subsection (8)(c)(i):
124          (A) shall provide the requested information within 30 days; and
125          (B) may not charge a fee for the electronic copy that exceeds $150 regardless of the
126     number of pages and regardless of whether the original medical records are stored in electronic
127     format.
128          (d) In the event the requested records under this Subsection (8) are not received by the
129     requestor:
130          (i) within 30 days after the day notice is received by the health care provider, the entity
131     providing requested information may not charge a fee for the electronic copy that exceeds $75
132     regardless of the number of pages and regardless of whether the original medical records are
133     stored in electronic format; or
134          (ii) within 60 days after the day notice is received by the health care provider, the entity
135     providing requested information must provide the requested records free of charge to the
136     requestor.
137          (e) Time periods for the performance of an entity providing the requested information
138     under this Subsection (8) shall be extended for periods of time during which the entity's
139     performance is prevented due to circumstances beyond their control, such as fires, floods,
140     earthquakes, acts of God, lockouts, ransomware, or strikes.
141          (9) (a) On January 1 of each year, the state treasurer shall adjust the following fees for
142     inflation:
143          (i) the fee for providing patient's records under:
144          (A) Subsections (5)(b)(i) [through] and (ii); and
145          (B) Subsections (6)(b)(i) [through] and (ii); and
146          (ii) the maximum amount that may be charged for an electronic copy under Subsection
147     (8)(c)(ii)(B).
148          (b) On or before January 30 of each year, the state treasurer shall:
149          (i) certify the inflation-adjusted fees and maximum amounts calculated under this
150     section; and
151          (ii) notify the Administrative Office of the Courts of the information described in

152     Subsection (9)(b)(i) for posting on the court's website.
153          (10) Notwithstanding Subsections (4) through (6), if a request for a medical record is
154     accompanied by documentation of a qualified claim or appeal, a health care provider or the
155     health care provider's contracted third party service:
156          (a) may not charge a fee for the first copy of the record for each date of service that is
157     necessary to support the qualified claim or appeal in each calendar year;
158          (b) for a second or subsequent copy in a calendar year of a date of service that is
159     necessary to support the qualified claim or appeal, may charge a reasonable fee that may not:
160          (i) exceed 60 cents per page for paper photocopies;
161          (ii) exceed a reasonable cost for copies of X-ray photographs and other health care
162     records produced by similar processes;
163          (iii) include an administrative fee or additional service fee related to the production of
164     the medical record; or
165          (iv) exceed the fee provisions for an electronic copy under Subsection (8)(c); and
166          (c) shall provide the health record within 30 days after the day on which the request is
167     received by the health care provider.
168          (11) (a) Except as otherwise provided in Subsections (4) through (6), a health care
169     provider or the health care provider's contracted third party service shall waive all fees under
170     this section for an indigent individual.
171          (b) A health care provider or the health care provider's contracted third party service
172     may require the indigent individual or the indigent individual's authorized representative to
173     provide proof that the individual is an indigent individual by executing an affidavit.
174          (c) (i) An indigent individual that receives copies of a medical record at no charge
175     under this Subsection (11) is limited to one copy for each date of service for each health care
176     provider, or the health care provider's contracted third party service, in each calendar year.
177          (ii) Any request for additional copies in addition to the one copy allowed under
178     Subsection (11)(c) is subject to the fee provisions described in Subsection (10).
179          (12) By January 1, 2023, a health care provider and all of the health care provider's
180     contracted third party health related services shall accept a properly executed form described in
181     Title 26, Chapter 70, Standard Health Record Access Form.