Uses and disclosures for treatment, payment, and health care operations

Uses and disclosures for treatment, payment, and health care operations. Notwithstanding Sections 30 and 35 of this Act, a covered entity may, without a patient's consent: (1) use or disclose genetic information for its own treatment, payment, or health care operations; (2) disclose genetic information for treatment activities of a health care provider; (3) disclose genetic information to another covered entity or health care provider for the payment activities of the entity that receives the information; (4) disclose genetic information to another covered entity for health care operations activities of the entity that receives the information, if each entity has or had a relationship with the individual who is the subject of the genetic information being requested, the genetic information pertains to such relationship, and the disclosure is for the purpose of (A) conducting quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of any studies resulting from such activities; patient safety activities; population-based activities relating to improving health or reducing health care costs, protocol development, case management, and care coordination, contacting of health care providers and patients with information about treatment alternatives; and related functions that do not include treatment; (B) reviewing the competence or qualifications of health care professionals or health care providers, evaluating practitioner and provider performance, health plan performance, conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities; or (C) health care fraud and abuse detection or compliance; and (5) disclose genetic information to other participants in an organized health care arrangement in which the covered entity is also a participant for any health care operations activities of the organized health care arrangement. (Source: P.A. 98-1046, eff. 1-1-15.)