§164.508(b)(4) Prohibition on conditioning of authorizations. A covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization, except:
(i) A covered health care provider may condition the provision of research-related treatment on provision of an authorization for the use or disclosure of protected health information for such research under this section;
(ii) A health plan may condition enrollment in the health plan or eligibility for benefits on provision of an authorization requested by the health plan prior to an individual’s enrollment in the health plan, if:
(A) The authorization sought is for the health plan’s eligibility or enrollment determinations relating to the individual or for its underwriting or risk rating determinations; and
(B) The authorization is not for a use or disclosure of psychotherapy notes under paragraph (a)(2) of this section; and
(iii) A covered entity may condition the provision of health care that is solely for the purpose of creating protected health information for disclosure to a third party on provision of an authorization for the disclosure of the protected health information to such third party.
Does the covered entity condition treatment, payment, enrollment, or eligibility on receipt of an authorization? If so, does one of the limited exceptions apply?
Obtain and review policies and procedures related to seeking authorizations from individuals.
Obtain and review a sample of conditioned authorizations to assess whether the exceptions listed in the established performance criterion have been applied consistent with its requirements.