Protection and Advocacy Agency Access Authority

 
The Disability Law Center (DLC) is the federally mandated Protection  and Advocacy (P&A) agency for Massachusetts.  The P&A system is a
national network of disability rights agencies investigating abuse  and neglect and providing legal representation and other advocacy  services to people with disabilities.  To aid P&A systems in  fulfilling their mandate, Congress gave them extensive access  authority.[1]

  
I. General

  
As the P&A for Massachusetts, DLC may:

  •  Investigate incidents of abuse and neglect[2]
  •  Provide information, referrals and training about the rights of  people with disabilities and about DLC’s services[3]
  •  Monitor  compliance with respect to the rights and safety of  individuals with disabilities[4]  and
  •  Pursue administrative, legal and other appropriate remedies to
    ensure the protection of the rights of individuals with
    disabilities.[5]



II. Access to Facilities, Service Providers and Schools


A.  Facilities Defined

The term facilities  includes, but is not limited to, hospitals, nursing homes, community  living arrangements (group homes, board and care homes, individual  residences and apartments), juvenile detention centers, homeless  shelters, and jails and prisons (including both general areas and  special mental health or forensic units).[6]

 

B. Service Providers

Service providers are  intentionally undefined by statutes due to the rapidly changing  nature of who provides services, the variation in delivery of  supports and range of settings for delivery.[7]

    

C. Schools Defined

A school constitutes a  service provider or facility when it provides special education  services to individuals with disabilities, regardless of whether it  provides residential services to those individuals and regardless of  whether all of its students have disabilities.[8]

 

D. What Triggers Access

1. Monitoring

a. Definition

DLC is responsible for “monitoring compliance with respect to the rights and safety of  individuals with… disabilities[.]”[9]
DLC’s monitoring authority may include “[i]nspecting, viewing and  photographing all areas of the facility which are used by residents
or are accessible to residents.”[10]

 DLC’s monitoring responsibility is separate and distinct from DLC’s  responsibility to investigate allegations of abuse or neglect.[11] 

b. Scope of Authority 

DLC must have “reasonable  unaccompanied” access to service providers for monitoring.[12]  This includes, at minimum, having access during normal work and  visiting hours.[13]   Although DLC must be able to monitor all facilities, DLC will  attempt to do so in a manner which does not interfere with existing  facility programs.[14]

 

2. Providing Information and Training

a. Definition

DLC is responsible for  providing information and training on any issue applicable to  persons with disabilities, including individual rights and the P&A  system.[15] 

b. Scope of Authority

DLC must have “reasonable  unaccompanied” access to service providers for routine  circumstances.[16]  This includes areas which are used by individuals with disabilities  and are accessible to individuals with disabilities at reasonable  times and, at minimum, includes access during normal work andvisiting hours.[17]

 Although DLC must be able to provide information, it will attempt to  do so in a manner which does not interfere with existing facility  programs.[18]

 

3. Investigation of Abuse and Neglect

a. Definition

DLC must “have reasonable  unaccompanied access to individuals with… disabilities at all times  necessary”[19]  to investigate allegations of abuse and neglect.  

 Abuse includes:  

verbal, nonverbal, mental  and emotional harassment; rape or sexual assault; striking; the use  of excessive force when placing such an individual in bodily  restraints; the use of bodily or chemical restraints which is not in  compliance with Federal and State laws and regulations; any other  practice which is likely to cause immediate physical or  psychological hart or result in long term harm is such practices  continue; or an act that DLC determines, in its discretion, is a  violation of an individual’s legal rights that amounts to abuse,  such as if an individual is subject to significant financial  exploitation.[20] 

 

Neglect includes failure  to:

 establish or carry out an  appropriate individual program plan or treatment plan (including a  discharge plan); provide adequate nutrition, clothing, or health  care to an individual with developmental disabilities; provide a  safe environment which also includes failure to maintain adequate  numbers of trained staff; or take appropriate steps to prevent  self-abuse, harassment, or assault by a peer.[21]

 In addition to the strict  definitions of abuse and neglect, DLC recognizes that its mandate  involves protecting the human rights of people with disabilities.  These human rights include, but are not limited to, independence,  self-determination and integration.[22]
These values serve as a backdrop for all investigations of abuse and  neglect.
 

DLC may investigate an  allegation of abuse or neglect if a report is made or “if there is
probable cause to believe that [an incident] occurred.”[23]  DLC determines probable cause, and this determination is not subject
to review.[24]   DLC may rely on the experience and training of its personnel to
decide whether there is “reasonable ground for belief” that a  disabled individual has been abused or neglected or that the health
or safety of the individual is in serious and immediate jeopardy.[25]

 In addition, DLC may rely  on information that it discovers via monitoring or other available
sources such as newspaper articles.[26] 

 

b. Scope of Authority

DLC must have access to  individuals with disabilities at all times necessary to conduct a  full investigation of an incident of abuse or neglect when (1) the  incident is reported or a complaint is made through the P&A system;  (2) the P&A system determines there is probable cause to believe an  incident has or may have occurred; or (3) the P&A system determines  that there may be imminent danger of serious abuse or neglect of an  individual with a disability.[27] 


DLC’s access to public and private service providers, programs in  the state, and to all areas of the service provider’s premises that
are used by individuals with disabilities or are accessible to them  will be provided without advance notice and made available
immediately upon request.[28

This authority includes the ability to interview any individual with  a disability, employee, or other persons who DLC might be reasonably
believe to have knowledge of the incident under investigation.  

[29]
DLC is  not required to provide the name or other identifying information  regarding the people with whom it plans to meet or justify or  explain its interactions with such persons.[30]

 DLC may conduct an investigation “independently or in cooperation  with other agencies authorized to conduct similar investigations.”[31]



III. Access to Information and Records


A. Records Defined

DLC has access to a wide  range of records.  Records may be “written or in another medium,  draft or final, [and] includ[e] handwritten notes, electronic files,  photographs or video or audio tape records.”[32]

They include:

§ Records made or received by staff, including “intake, assessment,
evaluation, education, training and other services”[33]

§ Medical records[34]

§ Financial records[35]

§ Monitoring or other like reports made or received by  the service provider[36]

§ Reports prepared by a Federal, State or local governmental agency,  or a private organization charged with investigating incidents of
abuse or neglect, injury or death
[37]

§ Reports made by regulatory agencies, such as those performing a  certification, licensure or professional accreditation function[38]

§ Discharge planning records[39]

and

§ “[P]rofessional, performance, building or other safety standards,  and demographic and statistical information relating to service
provider.”[40]

 

B. When Records May Be Obtained by DLC?

DLC may access  confidential records of a person with a disability if:

§ The person is a DLC client, either  acting in his or her own  capacity, or through a legal representative,[41]

§ DLC received a complaint related to an individual who is unable to  consent to access him or herself but does not have a legal
representative,[42]
or

§ DLC received a complaint related to the treatment, abuse or neglect  of an individual who is unable to consent to access him or herself
but has an unresponsive legal representative.[43]


DLC may obtain these records if it an allegation is made or it

has probable cause to  believe either an individual with a disability

was subject to abuse or  neglect or the health or safety of the

individual is in serious  and immediate jeopardy.[44]   DLC staff   making the probable cause determination may base the decision 
on reasonable inferences drawn from their experience or training 
regarding similar  incidents, conditions or problems that are usually  associated with abuse or  neglect.[45]


In the case of death, DLC  does not require probable cause to believe the death resulted from  abuse or neglect or consent from another party in order to gain  access to records.[46]


C. Timing of Records Access    

In most situations, a  facility must provide the DLC with a person with a developmental  disability’s records within three business days of a written
request.[47

In an emergency situation, where DLC has reason to believe that a  person with a developmental disability either “is in serious and  immediate jeopardy” or has died, a facility must allow DLC to have  immediate access to the individual’s records no later than 24 hours  after receiving a written request.[48]



IV. Confidentiality


A. General

DLC must keep all records  confidential.[49]


However, this does not prohibit DLC from initiating legal action or  pursuing administrative or other remedies.[50]

 There are some instances  in which DLC may share information from records.  First, DLC may  share information with the individual who is the subject of the  records, provided the supervising mental health professional has not  determined that such disclosure would be detrimental to the  individual’s health.[51]

 Second, DLC may make a public report about an investigation,  provided it does so in a way that maintains confidentiality.[52]

Third, DLC may provide information to investigative or enforcement  agencies, provided that it does so in a way that maintains
confidentiality.[53]

 DLC must keep confidential  the identity of individuals who report incidents of abuse or neglect  or who furnish information that forms the basis for a determination  that probable cause exists.[54]

 

B. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) 

The regulations pertaining  to HIPAA provide that “[a] covered entity may use or disclose  protected health information to the extent that such use or  disclo sure is required by law and the use or disclosure complies  with and is limited to the relevant requirements of such law.”[55]

 Disclosures of information to P & A agencies pursuant to the access  authority established by P & A laws are “required by law” within the
meaning of the regulations.  The term “required by law” specifically  includes statutes or regulations that require disclosure.[56]
Post-HIPAA authority has expressly confirmed that HIPAA-covered  entities must disclose information to P & A agencies where required
to do so by law.[57 Courts have also interpreted other federal privacy statutes to be  secondary to P&A access authority.[58]

  
V. Denial of Access


A service provider must promptly provide a written statement  explaining its reasons for denying or delaying DLC access within one
business day after the expiration of its deadline.[59

If the facility believes that DLC lacks authorization, the written  statement must include the name, address and telephone number of the
individual whose treatment is under investigation and his or her  legal representative.[60]

  
[
1] This authority was first codified through the passage of the  Protection & Advocacy for People with Developmental Disabilities (PADD)
Act. 42 U.S.C. § 15043(a)(2)(B).  Over time, Congress extended the
protections of the PADD Act, incorporating them by 0reference into
legislation protecting persons with other forms of disabilities.
This includes both the
Protection &
Advocacy for Individual Rights (PAIR) Act,
29 U.S.C. §
794e(f)(1),
and the Protection & Advocacy for Individuals with Traumatic Brain
Injury (PATBI) Act.
42 U.S.C. § 300d-53 (eff. April
28, 2008).  Similarly, Congress expanded the P & A system through
passage of the
Protection &
Advocacy for Individuals with Mental Illness (PAIMI) Act

42 C.F.R. § 51.42(c)(2) and the Protection & Advocacy for Beneficiaries of Social
Security (PABSS). The Ticket to Work and Work Incentives Improvement
Act of 1999, as amended, 42 U.S.C. § 1320b-21
governs
funding of P&A systems.



[
2] 42 U.S.C. § 15043(a)(2)(B) (PADD); 42 U.S.C. § 10801(b)(2)(B) (PAIMI).


[
3] 42 U.S.C. § 15043(a)(2)(A)(ii) (PADD); 42 U.S.C. § 10801(b)(2)(A)
(protection and advocacy as PAIMI duty); 29 U.S.C. § 794e(f)(1)
(PAIR authority, generally the same as PADD and PAIMI authority).



[
4] 45 C.F.R. § 1326.27(c)(2)(ii) (PADD); 42 C.F.R. § 51.42(c)(2) (PAIMI).


[
5] 42 U.S.C. § 15043(a)(2)(A)(i) (PADD); 42 U.S.C. § 10801(b)(2)(B); 42
U.S.C. § 10807(a) (PAIMI); 29 U.S.C. § 794e(f)(3) (PAIR).  Under
certain circumstances, P&As also have associational standing to
bring claims on behalf of constituents.  See e.g., Dunn v.
Dunn
, ____F. Supp. 3d ___, (M.D. Ala. 2016), 2016 WL 6949585
(Nov. 25, 2016).

  [6] 42 U.S.C. § 10802(3) (PAIMI
definition); 42 C.F.R. § 51.2 (PAIMI: “Facility includes any public
or private residential setting that provides overnight care
accompanied by treatment services.”).


[7]
See generally 45 C.F.R. § 1326.27 (PADD).


[8]
Disability Rights New York v. N.
Colonie Bd. Of Educ.
,
No. 1:14-CV-0744, 2016 WL 1122055, at *5 (N.D.N.Y Mar. 21, 2016)
(qualification as a service provider or facility under the P&A
statutes does not require all student at a school to have a
disability); Michigan Prot. & Advocacy Serv., Inc v. Flint Cmty.
Sch.
, 146 F. Supp. 3d 897, 907 (E.D. Mich. 2015) (“Although
‘service provider’ is also an undefined term in the regulations,
taking its ordinary meaning, the district certainly “provides
services” to students with mental or emotional illnesses,
developmental disabilities, and other relevant conditions.”);
Disability Law Ctr. of Alaska, Inc. v. Anchorage Sch. Dist
., 581
F.3d 936, 939 (9th Cir. 2009) (PAIMI and DD Act granted a P&A access
to a school’s intensive special needs education class);
Connecticut Office of Prot. & Advocacy for Persons with Disabilities
v. Hartford Bd. Of Educ.
, 464 F.3d 229, 240 (2d Cir. 2006) (a
school district is subject to the DD Act’s disclosure provisions,
even if it does not provide residential services to students);
Disability Rights Wis., Inc. v. Wis. Dep’t of Pub. Instruction
,
463 F.3d 719, 726 (7th Cir. 2006) (a school with a special education
program “easily” met the DD Act’s definition of a facility providing
care and treatment).


[9]
45 C.F.R. § 1326.27(c)(2)(ii) (PADD);
42 C.F.R. § 51.42(c)(2) (PAIMI).  Courts have consistently affirmed
P&As’ ability to conduct monitoring activities.  See, e.g.,
Alabama Disabilities Advocacy Program v. SafetyNet Youthcare,
Inc.
, 65 F. Supp. 3d 1312 (S.D. Ala. 2015), judgment entered,
No. CIV A. 13-0519-CG-B, 2014 WL 714644 (S.D. Ala. Dec. 15, 2014),
and on reconsideration in part, No. CVI.A. 13-0519-CG-B 2015
WL 566946 (S.D. Ala. Feb. 11, 2015) (residential treatment
facilities that provide treatment for individuals with behavioral
and mental health needs are subject to PAMII and must give its P&A
reasonable access to its “moderate” treatment program);
Pennsylvania Prot. and Advocacy, Inc. v. Royer-Graves Sch. for the
Blind
, 1999 WL 179797, *4 (E.D. Pa. March 25, 1999) (monitoring
not limited to recipients of advocacy services); Michigan Prot.
and Advocacy Serv., Inc. v. Miller
, 849 F. Supp. 1202, 1208-1209
(1994) (when a facility falls under PADD or PAIMI, P&A has access
authority).



[
10] 42 C.F.R. § 51.42(c)(3) (PAIMI).


[
11]  Compare
45 C.F.R. § 1326.27(c)(2)(ii) (PADD) and 42 C.F.R. § 51.42(c)(2)
(PAIMI) with 42 U.S.C. § 15043(a)(2)(B) (PADD) and 42 U.S.C.
§ 10801(b)(1)(B) (PAIMI).



[
12] 45 C.F.R. § 1326.27(c) (PADD); 42 C.F.R. § 51.42(c) (PAIMI).


[14]
 See, e.g.,
42 C.F.R. § 51.42(c) (PAIMI).



[15]
45 C.F.R. § 13.26.27(c)(2)(i) (PADD:“. . . P&As shall be permitted
to post, in an area which individuals with developmental
disabilities receive services, a poster which states the protection
and advocacy services available from the P&A system, including the
name, address and telephone number of the P&A system.”); 42 C.F.R. §
51.42(c)(1) (PAIMI).



[
16] 45 C.F.R. § 13.26.27(c) (PADD).


[
17] 45 C.F.R. § 13.26.27(c) (PADD); 42 C.F.R. § 51.42(c) (PAIMI).


[
18] See, e.g.,
42 C.F.R. § 51.42(c) (PAIMI).



[
19] 45 C.F.R. § 1326.27(b) (PADD); 42 C.F.R. § 51.42(b) (PAIMI).


[
20] 45 C.F.R. § 1326.19 (PADD); 42 C.F.R.
§ 51.2 (PAIMI);  see also 45 C.F.R. § 1326.19 (PADD: “Abuse
means any act or failure to act which was performed, or which was
failed to be performed, knowingly, recklessly, or intentionally, and
which caused, or may have caused, injury or death to an individual
with developmental disabilities . . . ”).



[21]
45 C.F.R. § 1326.19 (PADD); 42 C.F.R.
§ 51.2 (PAIMI);  see also 45 C.F.R. § 1326.19 (PADD: “Neglect
means a negligent act or omission by an individual responsible for
providing services, supports or other assistance which caused or may
have caused injury or death to an individual with a developmental
disability(ies) or which placed an individual with a developmental
disability(ies) at risk of injury or death . . . ”).



[
22]  See, e.g.,
42 U.S.C. § 15001(a)(1) (PADD: “disability is a natural part of the
human experience that does not diminish the right of individuals
with developmental disabilities to live independently, or exert
control and choice over their own lives, and to fully participate in
and contribute to their communities through full integration and
inclusion in the economic, political, social, cultural, and
educational mainstream of United States society . . . ”); 42 U.S.C.
§ 15009(a)(2) (PADD: least restrictive environment).

 
[
23] 42 U.S.C. § 10801(b)(2)(B)
(PAIMI); 42 U.S.C. § 15043(a)(2)(B) (PADD); 42 C.F.R. § 51.42(b)(3)
(PAIMI: when “[t]he P&A system determines that there is or may be
imminent danger of serious abuse or neglect of an individual with
mental illness.”); 45 C.F.R. § 1326.10.



[
24]  See Office of Prot. and Advocacy for Persons with Disabilities v.
Armstrong
,
266 F. Supp. 2d 303, 321-22 (D. Conn. 2003) (finding P&A
independence in making the probable cause determination); Arizona
Ctr. for Disability Law v. Allen
, 197 F.R.D. 689, 693 (D. Ariz.
2000) (“[A] P&A is the final arbiter of probable cause for the
purpose of triggering its authority to access all records for an
individual that might have been subject to abuse or neglect” because
if the state or provider could second guess this determination it
would undermine the purpose of the P&A system); but see
Disability Law Ctr. v. Discovery Acad.,
2010 WL 55989, *4-7 (D.
Utah 2010) (requiring a factual basis for probable cause
determination; distinguishing Allen).




[
25] 45 C.F.R. § 1326.19 (PADD); 42 C.F.R.
§ 51.2 (PAIMI).


[
26] 45 C.F.R. § 1326.25(a)(2)(iii) (PADD:
probable cause “can be the result of monitoring or other activities
including media reports and newspaper articles”); Alabama
Disabilities Advocacy Program v. J.S. Tawater Dev. Ctr.
, 97 F.3d
492, 498-99 (11th Cir. 1996) (holding that an anonymous telephone
call providing sufficient evidence can be probable cause);
Georgia Advocacy Office v. Borison
, 520 S.E.2d 701, 703-04 (Ga.
Ct. App. 1999).



[
27] 45 C.F.R. § 1326.27(b) (PADD); 42
C.F.R. § 51.42(b) (PAIMI).


[
28]45 C.F.R. § 1326.27(b)(2) (PADD); Dunn v. Dunn, No. 2:14CV601-MHT,
2016 WL 324990 (M.D. Ala. Jan 27, 2016) (“[PAIMI] authorizes access,
by protection and advocacy systems, to a health care provider’s
quality-assurance records, which would otherwise be protected by
state-law privileges.”)



[
29] 45 C.F.R. § 1326.27(b)(1) (PADD); 42
C.F.R. § 51.42(b) (PAIMI).



[30]
45 C.F.R. § 1326.27(b)(2) (PADD).


[31]
45 C.F.R. § 1326.19 (PADD); 42 C.F.R.
§ 51.2 (PAIMI).




[
32] 45 C.F.R. § 1326.25(b) (PADD); 42
C.F.R. § 51.41(c) (PAIMI)


[
33]42 C.F.R. § 51.41(c) (PAIMI).  See also 45 C.F.R. §
1326.25(b)(1) (PADD: “This includes records stored or maintained at
sites other than that of the service provider, as well as records
that were not prepared by the service provider, but received by the
service provider from other service providers.”); 42 U.S.C. §
10543(c) (PADD); 42 U.S.C. § 10806(b)(3)(A) (PAIMI); In the
Matter of Disability Rights Idaho Request for Ada Cty. Coroner
Records, Sonnenberg v. Disability Rights Idaho
, No.
14-CV-00369-EJL, 2016 WL 878484 (D. Idaho Mar. 7, 2016) (“[R]ecords
that the coroner compiled in investigation of patient’s death fell
within definition of “records” under PAIMI.”).




[
34] 45 C.F.R. § 1326.25 (b)(1) (PADD); 42
C.F.R. § 51.41(c)(1) (PAIMI).



[
35] Id.

[
36] Id.

[
37] 42 U.S.C. § 10543(b)(2) (PADD); 45
C.F.R. § 1326.25 (b)(2) (PADD: “The organizations whose reports are
subject to this requirement include, but are not limited to,
agencies in the foster care systems, developmental disabilities
systems, prison and jail systems, public and private educational
systems, emergency shelters, criminal and civil law enforcement
agencies such as police departments, agencies overseeing juvenile
justice facilities, juvenile detention facilities, all pre- and
post-adjudication juvenile facilities, State and Federal licensing
and certification agencies, and private accreditation organizations
such as the Joint Commission on the Accreditation of Health Care
Organizations or by medical care evaluation or peer review
committees, regardless of whether they are protected by federal or
state law.”); 42 U.S.C. § 10806(b)(3)(A) (PAIMI); 42 C.F.R. §
51.41(c)(2) (PAIMI). See also, Indiana Prot. and Advocacy
Servs. v. Indiana Family and Social Servs. Admin.
, 603 F.3d 365,
382-83 (7th Cir. 2010) (PAIMI allows access to peer review records);
Ctr. for Legal Advocacy v. Hammons, 323 F.3d 1262, 1270 (10th
Cir. 2003) (P&A “should have access to peer review and quality
assurance records”); Pennsylvania Prot. and Advocacy, Inc. v.
Houstoun
, 228 F.3d 423, 426 (3d Cir. 2000).  State agencies
investigating abuse and neglect must upon request, furnish to the
P&A unredacted reports, including all information used and reviewed
in preparing such reports. Disability Rights New York v. Wise,
117 F. Supp. 3d 54, 61 (N.D. N.Y. 2016).




[
38] 42 C.F.R. § 51.41(c)(4) (PAIMI).

[
39] 42 U.S.C. § 10543(c)(3) (PADD); 45
C.F.R. § 1326.25 (b)(2)(iii) (PADD); 42 U.S.C. § 10806(b)(3)(A) (PAIMI);
42 C.F.R. § 51.41(c)(3) (PAIMI).




[
40] 45 C.F.R. § 1326.25 (b)(4) (PADD); 42
C.F.R. § 51.41(c)(5) (PAIMI).


[41]
42 U.S.C. § 10543(a)(2)(I)(i) (PADD);
U.S.C. § 10805(a)(4)(A) (PAIMI); see also 45 C.F.R. § 1326.19
(PADD: “The terms ‘legal guardian,’ ‘conservator,’ and ‘legal
representative’ all mean a parent of a minor, unless the State has
appointed another legal guardian under applicable State law, or an
individual appointed and regularly reviewed by a State court or
agency empowered under State law to appoint and review such
officers, and having authority to make all decisions developmental
disabilities [sic].  It does not include persons acting only
as a representative payee, persons acting only to handle financial
payments, executors and administrators of estates, attorneys or
other persons acting on behalf of an individual with developmental
disabilities only in individual legal matters, or officials or their
designees responsible for the provision of services, supports and
other assistance to an individual with developmental
disabilities.”); 42 C.F.R. § 51.2 (PAIMI).




[
42] 42 U.S.C. § 10543(a)(2)(I)(ii)
(PDD); 42 U.S.C. § 10805(a)(4)(B) (PAIMI).


[43]
42 U.S.C. § 10543(a)(2)(I)(iii) (PADD); 42 U.S.C. § 10805(a)(4)(C) (PAIMI);
Disability Law Center, Inc. v. Riel, 150 F. Supp. 2d 294, 299
(D. Mass. 2001) (where there is a complaint or probable cause, P&As
have the authority to access records needed to pursue legal,
administrative, or other remedies for individuals with disability
and to investigate incidents of abuse and neglect).


[44]
42 U.S.C. § 10801(b)(2)(B) (PAIMI); 42 U.S.C. § 15043(a)(2)(B) (PADD);
42 C.F.R. § 51.42(b)(3) (PAIMI); 45 C.F.R. § 1326.10 (PADD).

 
[45]
  42 C.F.R. § 51.42(b)(3) (PAIMI); 45 C.F.R. § 1326.10 (PADD).



[46]
42 U.S.C. § 15043(a)(2)(J)(i)(II) (PADD); 45 C.F.R. § 1326.25(a)(5)
(PADD).



[
47] 42 U.S.C. § 10543(a)(2)(J)(i) (PADD).


[
48] 42 U.S.C. § 10543(a)(2)(J)(ii) (PADD).

[
49] 45 C.F.R. § 1326.28(a) and (b) (PADD);

 42 U.S.C. § 10806(a) (PAIMI); 42 C.F.R. § 51.45(a) (PAIMI).


[
50] 42 U.S.C. § 15043(a)(2)(A)(i) (PADD);
42 U.S.C. § 10801(b)(2)(B) (PAIMI).


[51]
42 C.F.R. § 51.46(a) (PAIMI).


[52]
42 C.F.R. § 51.45(b)(1) (PAIMI).


[53]
42 C.F.R. § 51.45(b)(2) (PAIMI).



[54]
45 C.F.R. §
1326.28(b)(1)(iii) (PADD); 42 C.F.R. § 51.45 (a)(1)(iii) (PAIMI).




[55]
45 C.F.R. § 164.512(a)(1).

 
[56]
45 C.F.R. § 164.103.

 
[57]
  Prot. & Advocacy
System Inc. v. Freudenthal
,
412 F. Supp. 2d 1211, 1212 (D. Wyo. 2006) (“The
Court holds that neither HIPAA nor the Medicaid Act bars the
Plaintiff from accessing records at [a hospital] as long as the
disclosure is required by a P & A act and P & A complies with all
requirements set forth in the P & A act.”
).



[
58] E.g., Michigan Prot. and Advocacy
Service, Inc
, 849 F. Supp. at 1208 (P&A access authority
controls over competing privacy rights of youth in DSS schools and
centers, under Family Education Rights Privacy Act (FERPA), 20 U.S.C.
§ 1232g(b)).

 
[
59] 45 C.F.R. § 1326.26 (PADD); 42 C.F.R.
§ 51.43 (PAIMI).



[
60] Id. (“All of the above information
shall be provided whether or not the P&A has probable cause to
suspect abuse or neglect or has received a complaint.”)
 

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