§164.524(a) Standard: Access to protected health information. (4) Review of a denial of access. If access is denied on a ground permitted under paragraph (a)(3) of this section, the individual has the right to have the denial reviewed by a licensed health care professional who is designated by the covered entity to act as a reviewing official and who did not participate in the original decision to deny. The covered entity must provide or deny access in accordance with the determination of the reviewing official under paragraph (d)(4) of this section.
§164.524(d) Implementation specifications: Denial of access. If the covered entity denies access, in whole or in part, to protected health information, the covered entity must comply with the following requirements: (4) Review of denial requested. If the individual has requested a review of a denial under paragraph (a)(4) of this section, the covered entity must designate a licensed health care professional, who was not directly involved in the denial, to review the decision to deny access. The covered entity must promptly refer a request for review to such designated reviewing official. The designated reviewing official must determine, within a reasonable period of time, whether or not to deny the access requested based on the standards in paragraph (a)(3) of this section. The covered entity must promptly provide written notice to the individual of the determination of the designated reviewing official and take other action as required by this section to carry out the designated reviewing official’s determination.
Do policies and procedures address request for and fulfillment of review of instances of access denial? Inquire of management.
Review policies and procedures to determine whether they comply with the established performance criterion. For example, does the entity have a process for an individual to request and receive a review of a denial of access by a licensed health care professional who did not participate in the original decision to deny the individual’s request for access as set forth in §164.524(d)(4)? Does it provide prompt referral of denial for review by licensed health care professional not directly involved in the original denial, determination within a reasonable period of time, and prompt written notice to individual?
Review documentation obtained for item 66 for consistency with these requirements