Skip to main content

Connecting Your Healthcare

New Options For Managing Your Child's Digital Medical Records

Imagine:

  • You go to a new healthcare provider because your child doesn't feel well and that provider can pull up your child's health history from the past five years.
  • The provider uses that information to diagnose your child and quickly find the right specialist by checking an up-to-date provider directory.
  • You have a question about a claim, so you go to your computer and see if it's paid, denied, or still being processed.

Starting in 2021, a new federal rule will make it easier for Children's Medical Services Health Plan members* to do all of this and more.

The Interoperability and Patient Access rule (CMS-9115-F) puts patients first by giving you control and easy access to your child's health information when you need it most. Complete access to your child's health information allows you to manage your child's health better and know what healthcare resources are available to you.

The new rule makes it so you can easily find information** on:

  • claims (paid and denied)
  • past test results
  • your cost of care
  • healthcare providers
  • provider appointments
  • health status
  • specific parts of your clinical information
  • pharmacy directory data***

What Types of Medical Information Can I See?

Patient Demographics

  • first name
  • last name
  • previous name
  • middle name
  • suffix
  • birth sex
  • date of birth
  • race
  • ethnicity
  • preferred language

Allergies and Intolerances

  • substances (medications)
  • substances (drug class)
  • reaction

New Demographics

  • current address
  • previous address
  • phone number
  • phone number type
  • email address

Clinical Notes

  • consultation note
  • discharge summary note
  • history and physical
  • imaging narrative
  • laboratory report narrative
  • pathology report narrative
  • procedure note
  • progress note

Vital Signs ****

  • body height
  • body weight
  • BMI percentile (2-20 years)
  • blood pressure
  • heart rate
  • respiratory rate
  • body temperature

Immunizations

Procedures

Medications

Laboratory Tests and Results

Assessment and Treatment Plan

Care Team Members

* Applies to Medicare Advantage, Medicaid and CHIP Managed Care, and federally funded ACA exchange plans.

** Data will be available for dates of service on or after Jan. 1, 2016.

*** For Medicare Advantage Prescription Drug (MAPD) plans.

**** Vital Signs maintained by the health plan will be available.

Why Is This So Important?

Having your child's medical information in one place helps you and your providers understand your child's health better so you can make better decisions and improve your child's health outcomes. This often reduces healthcare costs. This information will follow you to any provider or health plan in the future.

Keeping Your Child's Protected Health Information (PHI) Safe Is Important To Us.

At CMS Health Plan, your child's privacy and the security of your child's PHI is a top concern. The new rule allows you to look up your child's information using an app from a third-party application developer (a company with no connection to CMS Health Plan. We promise to give you information on what to consider when selecting an app, the ways your child's data can be used by the third party, and the importance of understanding the security and privacy practices of the app. We will give you information on federal agencies you can contact if you feel your child's rights to patient privacy have not been protected.

The CARIN alliance is a bipartisan, multi-sector collaborative working to advance consumer-directed exchange of health information. Learn more about third-party application privacy standards on the on the CARIN Alliance website. The CARIN Code of Conduct is a set of industry-leading best practices these applications have voluntarily adopted to protect and secure your health information. We will require third-party application developers to prove they will follow certain privacy standards by attesting to the CARIN Code of Conduct. Visit My Health Applicationfor a list of apps that have attested to the CARIN Code of Conduct.

What Should I Do Now?

Find a trusted app. Visit My Health Application for a list of apps that have attested to the CARIN Code of Conduct ensuring they meet the strictest privacy and security guidelines.

Download the app. Smartphone apps are available through the Google Play Store (Android) and the App Store (iOS), and web apps are available for computers.

Create your account. Follow the instructions in the app of your choice to sign up and link your child's health information.

Use the information to manage your child's healthcare. Now you have the information you need to make the best healthcare decisions for your child.

Question About How To Find The Right Third-Party App?

Check out the Frequently Asked Questions or Contact Us.

Questions about the new Interoperability and Patient Access Rule and how it affects your child?

Call CMS Health Plan at 1-866-799-5321 or visit Wellcare.com/Florida.

For more information on CMS Policies and Technology for Interoperability and Burden Reduction, visit the Centers for Medicare and Medicaid website.

How many years back will my child's information go?

Any health information maintained by CMS Health Plan with a date of service January 1, 2016 or later will be made available.

What happens to my child's health information if they go to a different health plan or provider?

You will have access to your child's health information, no matter what health plan or provider they go to.

Can I find out if my child is up to date on their immunizations?

Yes, you can use an app to see what shots your child has had with a date of service January 1, 2016 or later.

Do I have to use an app from CMS Health Plan?

No, the app you use will not be affiliated with CMS Health Plan. You may also visit My Health Application for a list of apps that have attested to the CARIN Code of Conduct ensuring they meet the strictest privacy and security guidelines. Follow the instructions on the app to connect it with your child's health record.

Will all of the apps keep my child's health information private?

There may be some apps that don't follow all the privacy provisions. We will let you know which apps have agreed to follow our guidelines for your privacy. If you have already selected an app prior to us receiving a response from the app provider on their privacy policies, you will have a chance to select another app within a certain timeframe. We recommend that you request a Notice of Privacy Practices from the app. If the app does not provide you with a Notice of Privacy Practices, we recommend that you choose another app. You may also visit My Health Application for a list of trusted apps.

When will I have access to my child's healthcare information through the app?

Starting July 1, 2021, you will be able to access your CMS Health Plan information through the apps.

I'm not comfortable using an app to get my child's healthcare info. Do I have to?

No, you do not have to use an app to access your child's healthcare info. You can contact your child's provider or health plan for needed information.

What health data will the app collect?

The app will collect your child's health data including, but not limited to, your child's claims, medications, diagnoses, procedures, and doctor visits. When you enroll your child in the app, you are giving your permission for the app to collect this information.

Will the app collect non-health data from my device, such as my location?

Apps do have the ability to collect non-health data such as location. Some apps let you have the option to provide that information. We recommend that you ask your app provider.

What impact would sharing my child's data with this app have on others, such as my family members?

Requesting your child's health data via an app could potentially include the health data of family members who are associated with your child's health account.

How do I correct mistakes in my child's health data?

To correct mistakes in your child's health data, you will need to contact your child's provider or health insurance company. The health app only makes data available from healthcare sources. The app does not create this data. If the app is showing incorrect information that was not sent to the app then the app must correct this problem.

What are my rights under the Health Insurance Portability and Accountability Act (HIPAA)?

We recommend that you ask the app provider for their notice of privacy and security practices.

Most apps will not be covered by HIPAA. Most apps will instead fall under the jurisdiction of the Federal Trade Commission (FTC) and the protections provided by the FTC Act. The FTC Act, among other things, protects against deceptive acts (e.g., if an app shares personal data without permission, despite having a privacy policy that says it will not do so).

The FTC provides information about mobile app privacy and security for consumers on the FTC consumer information website.

For apps that are subject to HIPAA, you can find more information about patient rights under HIPAA and who is obligated to follow HIPAA.

You can also see the HIPAA FAQs for Individuals

What are my rights when it comes to my child's data collected on this app?

We recommend that you request a Notice of Privacy Practices from the app provider to understand your rights.

What should I do if my child's data has been shared or stolen or an app has used my child's data inappropriately?

We recommend that you request a Notice of Privacy Practices from the app provider to understand how they respond to a privacy and security incident. You have the right to file a complaint with enforcement agencies including the Office for Civil Rights (OCR) and the Federal Trade Commission (FTC).

Most apps will not be considered covered entities under HIPAA. Most apps will instead fall under the jurisdiction of the Federal Trade Commission (FTC) and the protections provided by the FTC Act. The FTC Act, among other things, protects against deceptive acts (e.g., if an app shares personal data without permission, despite having a privacy policy that says it will not do so).

Learn more about filing a complaint with OCR under HIPAA.

Individuals can file a complaint with OCR using the OCR complaint portal.

Individuals can file a complaint with the FTC using the FTC complaint assistant.

How will the app use my child's data?

Although the purpose of the app is for you to be able to see your child's data in one place, we recommend that you request a Notice of Privacy Practices to understand how the app will use your child's data.

Can the app share my child's data with third parties?

We recommend that you request a Notice of Privacy Practices from the app provider to understand if the app will share your child's data with third parties.

If I no longer want to use this app, or if I no longer want this app to have access to my child's health information, how do I stop the app's access to my child's data? Do I have to do more than just delete the app from my device?

We recommend that you request a Notice of Privacy Practices from the app provider to understand what happens to your child's data after you stop using the app.

What is the app's policy for deleting my child's data once I stop using it?

We recommend that you request a Notice of Privacy Practices from the app provider to understand what happens to your child's data after you stop using the app.

What is the process I have to go through to stop sharing my child's data?

The best way to stop sharing data is through the Third Party Application or by contacting the Third Party Application support. If you are unable to successfully stop sharing data through the Third Party Application or using the Third Party Application Support then you may call CMS Health Plan member services for assistance.

Will this app sell my child's data for any reason, such as advertising or research?

We recommend that you request a Notice of Privacy Practices from the app provider to understand if the app will share your child's data with third parties for advertising and research.

How does this app deal with collecting and responding to user complaints?

App providers may respond to user complaints in different ways. We recommend that you ask this question to your app provider.

Will my child's data be stored in a de-identified or anonymized form?

We recommend that you request a Notice of Privacy Practices from the app provider to understand how the app stores your child's data.

What security measures does this app use to protect my child's data? Will they inform me if an incident occurs?

We recommend that you request a Notice of Privacy Practices and additional information on security practices from the app provider to understand how they handle a security incident.

How can I limit this app's use and release of my child's data?

We recommend that you request a Notice of Privacy Practices from the app provider to understand how you can limit the use and release of your child's data.

Contact Us icon

Need help? We're here for you.

Contact Us
Last Updated On: 6/25/2021
WellCare will be performing maintenance on Saturday, October 16, 2021 at 6pm EST until Sunday, October 17, 2021 at 6am EST. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us. ×