THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Notice, please contact: the East Arkansas Area Agency on Aging (“EAAAA”) privacy officer at (870) 972-5980 or toll free at (800) 467-3278.
This Notice of Privacy Practice describes how we may use and disclose your Protected Health Information to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required by law to give you this Notice about our privacy practices, our legal duties, and your rights concerning your Protected Health Information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all Protected Health Information that we maintain, including Protected Health Information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and send the new Notice to our customers at the time of the change.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the beginning of this Notice.
I.Uses and Disclosures of Protected Health Information.
We will use and disclose your Protected Health Information to provide, coordinate or manage your health care and any related services. This includes a coordination or management of your treatment plan with your health care providers. For example, we would disclose your Protected Health Information to a home health agency that provided personal care to you. In addition, we may disclose your Protected Health Information from time to time with your physician or other specialist who becomes involved in your care by providing assistance with your health care diagnosis or treatment plan.
Your Protected Health Information will be used, as needed, to obtain payment for health care services. This may include certain activities that Medicaid, Medicare or another health insurance plan may undertake before it approves or pays for your health care services such as making a determination of your eligibility or reviewing services provided to you as appropriate and necessary, and undertaking utilization review activities.
3. Health Care Operations.
We may use or disclose, as needed, your Protected Health Information in order to support business activities including, but not limited to, quality assurance reviews, care manager trainings, peer reviews, Medicaid or Medicare or other health insurance plan audit reviews, and independent financial audits.
For example, we may disclose your Protected Health Information with third party “business associates” that perform various activities like billing or claim submission services for EAAAA. Whenever an arrangement between our office and a business associate involves the use or disclosure of your Protected Health Information, we will have a written contract with the business associate that will protect the privacy of your Protected Health Information.
We may disclose your Protected Health Information, as necessary, to contact you to check on your health status, to arrange for your next home visit by your care manager or to remind you of your next appointment for a home visit. We may also call you by name in our waiting room if you visit EAAAA to see your care manager.
We may also send you information about services we feel may be beneficial to you, notify you about our fund-raising efforts or send you our newsletters. You may contact our privacy officer to request that these materials not be sent to you.
We may use or disclose your Protected Health Information that directly relates to the provision of your health care in your home to an individual or agency from our pool of services providers. Only the Protected Health Information that is relevant for the provider to deliver comprehensive health care service(s) will be disclosed.
We may release Protected Health Information to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your conditions and that you are involved with our program. In addition, we may disclose Protected Health Information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
4. Uses and Disclosures of Protected Health Information Based Upon Written Authorization.
Certain uses and disclosures of particular types of Protected Health Information require a written authorization from you before such use or disclosure may occur. In most circumstances, EAAAA must obtain a written authorization from you for any use or disclosure of psychotherapy notes related to you. EAAAA may use or disclose psychotherapy notes without a written authorization to the extent required by law when the use or disclosure is limited to the relevant requirements of such law. EAAAA may use psychotherapy notes without authorization to treat you or to train its employees to treat you. EAAAA may disclose psychotherapy notes when we reasonably believe disclosure is necessary to prevent an injury to someone else. EAAAA may disclose psychotherapy notes without an authorization to comply with an investigation by the Secretary of the Department of Health and Human Services.
In addition, EAAAA must obtain written authorization from you for any use or disclosure of your protected health information from marketing, except if the communication is in the form of (1) a face-to-face communication made by EAAAA to you; (2) a promotional gift of nominal value provided by EAAAA; or (3) if the marketing involves direct or indirect remuneration to EAAAA from a third party, the authorization must state that such remuneration is involved.
Finally, EAAAA must obtain an authorization from you for any disclosure of Protected Health Information which is a sale of such information, and such authorization must state that the disclosure will result in remuneration to EAAAA.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke any written authorization at any time in writing, except to the extent that your care manager has taken an action already in progress in reliance on the use or disclosure indicated in the previously signed authorization.
5. Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object.
You have the opportunity to agree or object to the use or disclosure of all or part of your Protected Health Information. If you are not present or able to agree or object to the use or disclosure of the Protected Health Information, then your care manager may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the Protected Health Information that is relevant to your health care will be disclosed.
II. Your Rights Regarding Protected Health Information About You.
You have the following rights regarding Protected Health Information we maintain about you:
1. Right to Inspect and Copy.
You have the right to inspect and copy Protected Health Information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal, or administrative proceeding. To inspect and copy Protected Health Information that may be used to make decisions about you, you must submit your request in writing to EAAAA. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may in most circumstances request that the denial be reviewed. Another supervisor or director chosen by the agency will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
2. Right to Amend.
If you feel that protected information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for EAAAA. To request an amendment, your request must be made in writing and submitted to EAAAA. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may deny your request if you ask us to amend information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment or that is not part of the Protected Health Information kept by or for EAAAA, or is not part of the information which you would be permitted to inspect and copy, or that is accurate and complete.
3. Right of Accounting and Disclosures.
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of Protected Health Information about you. To request this list of accounting of disclosures, you must submit this request in writing to EAAAA. Your request must state a time period which may not be longer than 72 months and may not include dates for which this agreement is effective. Your request should indicate in what form you want the list (for example, on paper, electronically, by mail). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
4. Right to Request Restrictions.
You have the right to request a restriction or limitation on the Protected Health Information we use or disclose about you for treatment, payment or health care operations as set forth in Section I above. You also have the right to request a limit on the Protected Health Information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. For example, you may not want your spouse to know anything about your services unless it is an emergency. We are not required to agree to your request, except that EAAAA must agree to the request for restriction if (1) the disclosure is for the purpose of carrying out payment or health care operation and is not otherwise required by law; and (2) the Protected Health Information pertains solely to a health care item or service for which you, or any person other than the health plan on behalf of you, has paid EAAAA in full.
If we do agree with your request for restriction or limitation, we will comply with your request unless the information is needed to provide emergency treatment. To request restrictions, you must make your request in writing to EAAAA. In your request, you must tell us (1) what information you want to limit; (2) whether you want us to limit our use, disclosure, or both; and (3) to whom you want the limits to apply (for example, in the hypothetical set for above, your spouse).
5. Right to Request Confidential Communication.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to EAAAA. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
6. Right to a Paper Copy of this Notice.
You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. To obtain a paper copy of this Notice, call EAAAA at (870) 972-5980 or (800) 467-3278.
7. Right to File a Complaint.
You have the right to file a formal complaint if you believe your privacy rights have been violated. You may file a complaint with EAAAA or with the Secretary of the Department of Health and Human Services. To file a complaint with EAAAA, please contact the privacy officer at (870) 972-5980 or (800) 467-3278. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Amend.
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for Protected Health Information we already have about you as well as information we receive in the future. We will post a copy of the current Notice in our office and on our website. The Notice will contain the effective date on the bottom right hand corner of the actual Notice, and on the main page on the website.
September 1, 2013