Question

Mrs. Harlan is the wife of an active duty service member who is enrolled in TRICARE Standard. She has battled postpartum depression since the birth of her second child, two months earlier, and has decided to seek the services of a mental health professional. What procedure must she follow for these services to be covered by TRICARE Standard? If the doctor shares Mrs. Harlan's medical records with Mr. Harlan, does this violate HIPAA? Explain

Answer 1

1.You'll first need to ensure that your spouse is enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). To do that you'll need to present documents including; your marriage license, your spouse's birth certificate, Social Security card and photo ID. You can do this by making an appointment at your local DOD or military ID card office. The enrollment in DEERS is part of the military ID card issuance process. Dependent IDs can be used as proof of TRICARE enrollment. It is recommend that you enroll your spouse in DEERS and get them a military ID as soon as possible after receiving your marriage license to ensure they have access to TRICARE and other military benefits.

You need to get a referral and prior authorization for all mental health care.

2.Yes. The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient’s care or payment for health care. If the patient is present, or is otherwise available prior to the disclosure, and has the capacity to make health care decisions, the covered entity may discuss this information with the family and these other persons if the patient agrees or, when given the opportunity, does not object. The covered entity may also share relevant information with the family and these other persons if it can reasonably infer, based on professional judgment, that the patient does not object.