Bill 3B - Right to Dignified Care Act - Public leadership Institute

MODEL BILLS

Privacy Protections

Right to Dignified Care Act

Issue Overview

Unregulated Pregnancy Clinics (UPCs) often present themselves as free medical clinics to mislead clients seeking abortion. Their primary goal is to prevent clients, through persuasion, misinformation, or delay, from having an abortion.¹⁵⁹ While these organizations have the right to oppose abortion, most use misleading tactics, including ads, signs, and websites presenting their facilities as conventional medical clinics, even, at times, as abortion providers.^160,161 Inside, they often resemble medical offices, with waiting rooms and exam rooms outfitted with medical equipment, and staff in lab coats and scrubs. Clients must often fill out intake forms that ask for private health information.¹⁶²

UPC intake forms are often invasive. Even though they are not medical providers, many UPCs ask for prescription drug lists, past or current illnesses, and medical conditions unrelated to their services. Some ask inappropriate questions like the name or age of the person who impregnated the client, whether the client is living with someone they aren’t married to, when they first had sex, or whether they have multiple partners or same-sex partners. Collecting such information is unnecessary and unethical, given that most UPCs only provide over-the-counter pregnancy tests, STD/STI tests without treatment, lay counseling, and material resources like diapers and wipes. Further, even though they don’t bill insurance, UPCs often ask for clients’ government identification documents, insurance information, income, employer, or eligibility for public assistance.¹⁶³

Because the vast majority of UPCs are not medical clinics, they can and do violate clients’ privacy. Traditional medical clinics must follow the privacy, confidentiality, and records security requirements of the Health Insurance Portability and Accountability Act (HIPAA). UPCs are not subject to HIPAA and, therefore, are not required to protect clients’ private health information.¹⁶⁴

Many UPCs maintain client records in online databases accessible by third parties outside the UPC.¹⁶⁵ A digital system called eKYROS feeds personal client information into a central database linked with the national UPC umbrella groups Heartbeat International and Care Net.¹⁶⁶ Other central databases used by UPCs include Next Level¹⁶⁷ and CoolFocus.¹⁶⁸

The national UPC umbrella organizations collect these records to amass “digital dossiers” on clients that could be used in pregnancy-related prosecutions. As a brief by the Alliance reports: “the CPC industry is now functioning as surveillance infrastructure for the anti-abortion movement, amassing data that could be used in pregnancy- and abortionrelated prosecutions….”¹⁶⁹ The global anti-abortion group Heartbeat International, for example, stores “digital dossiers” on clients, stating “Big data is revolutionizing all sorts of industries. Why shouldn’t it do the same for a critical ministry like ours?”¹⁷⁰

Our state must regulate UPCs. The American Medical Association “urges the development of effective oversight for entities offering pregnancy-related health services and counseling.”171 The American College of Obstetricians and Gynecologists says that policymakers should hold UPCs “accountable for deceptive practices by, for example, enforcing and strengthening consumer protection laws against false and misleading advertising, investigating the pervasiveness and impact of deceptive practices on patients, and partnering across the public and private sectors to ensure transparency.”¹⁷² They are right.

Right to Dignified Care Act

Summary

Summary: The Right to Dignified Care Act prohibits [what your state calls an Unregulated Pregnancy Clinic] from asking improper and intrusive questions as a condition of receiving products or services.

[NOTE: This bill applies to states which fund UPCs. The same problem is addressed for other states through the Professional Responsibility in Health Care Act.]

SECTION 1. SHORT TITLE

This Act shall be called the “Right to Dignified Care Act.”

SECTION 2. FINDINGS

The legislature finds that:

Unregulated Pregnancy Clinics (UPCs) [or whatever name your state uses], also known as “crisis pregnancy centers,” are facilities that represent themselves as offering unbiased reproductive health care information and services but are primarily intended to prevent clients from seeking or accessing abortions.
UPCs commonly ask clients to fill out a form, designed to look like a medical intake form, prior to receiving any products or services. As one UPC explains on its website, “We will give you an intake form similar to what you might fill out at a doctor’s office.”^¹⁷³
But a UPC is not a traditional doctor’s office. For that reason, it is improper and unreasonably intrusive for UPCs to ask certain questions on an intake form.
UPCs primarily seek out or advertise to attract clients who are young and unfamiliar with health care standards, have lower incomes, and are in vulnerable situations, so these clients may be unaware that some questions are only reasonable if asked by a licensed medical provider and others are unreasonable for a medical intake form under any circumstances.
UPCs are not required to follow the privacy, confidentiality and records security requirements of the Health Insurance Portability and Accountability Act (HIPAA).
Nevertheless, many UPCs give clients a sense of security by falsely claiming that they are subject to HIPAA or “HIPAA compliant.”^¹⁷⁴
There is a strong need for legislation. Every one of the topics listed in Section (3)(B) is actually asked on intake forms at some UPCs.

SECTION 3. RESTRICTIONS ON HEALTH CARE INTAKE FORMS

After section XXX, the following new section XXX shall be inserted:

(A) PROHIBITED INTAKE QUESTIONS

A [what your state calls an Unregulated Pregnancy Clinic] shall not make it a condition of service, or make it reasonably appear to be a condition of service, that a client must disclose any of the following information:
(a) A list of the prescription drugs the client takes;
(b) A list of the client’s current or past illnesses;
(c) A list of the client’s medical conditions that are not directly relevant to a determination of pregnancy;
(d) The name or age of the potential baby’s father;
(e) Whether the client is living with a man to whom they are not married;
(f) The client’s age when she first became sexually active;
(g) Whether the client is currently sexually active with one or more than one partner;
(h) Whether the client engages in same-sex relationships; or
(i) For a site that does not bill insurance or is an official Medicaid or WIC enrollment site, the client’s income, employer, or eligibility for public assistance.
The [Attorney General/Department of Health] may promulgate regulations to clarify which intake questions are overly intrusive and whether a facility is making answers to overly intrusive questions a condition of service, or it reasonably appears to make them a condition of service.

(b) ENFORCEMENT

A [whatever your state calls an Unregulated Pregnancy Clinic] shall not qualify for a state grant under any program if the grantee violates this subsection.
Any grantee that fails to comply with the requirements of this subsection shall be prohibited from applying for any state funding for a six-month period beginning the day after the last instance of noncompliance.
The Attorney General may commence an action in any court of competent jurisdiction for injunctive relief to compel compliance with the provisions of this section, and for civil penalties for violations.
Prior to commencing an action in court, the Attorney General shall give written notice to the grantee to cure such violations not later than 10 business days after receipt of the written notice.

SECTION 4. EFFECTIVE DATE

This law shall become effective on July 1, 20XX.