PACE, INC.
HIPPA –Notice of Privacy Practices
(Federal Health Insurance and Portability Act)
THIS NOTICE[1] DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USEDAND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW ITCAREFULLY. If you have any questions about this Notice or want additionalinformation, please contact Bruce Johnson, Executive Director (Privacy Contact)at 302-999-9812.
Purpose. We are required by law to maintain theconfidentiality and privacy of your protected health information. “Protectedhealth information” is information about you that may identify you and thatrelates to your past, present or future physical or mental health or conditionand related health care services. This Notice describes how we may use anddisclose your protected health information to carry out treatment, payment orhealth care operations and for other purposes that are permitted or required bylaw.[2] It also describes your rights to access and control you protected healthinformation.
We are required to abide by the terms of this Notice, which iseffective April 14, 2003 . We reserve the right to change the terms of ourNotice at any time as permitted b law. The new Notice will be effective for allprotected health information that we maintain at that time and for informationwe receive in the future. We will post a current copy of the policy and willhave copies of our current policy available each time you are here for healthcare services. We will also provide you with any revised Notice of PrivacyPractices upon a request made by you via phone or in person.
Uses and Disclosures of Protected Health Information forTreatment, Payment and/or Operations.
The following categories describe different ways that we may use and disclosehealth information for treatment, payment and operations. At least one exampleis given for each category. Please be aware that not every possible use ofdisclosure is listed.
Treatment: We may use and disclose your protected healthinformation to provide you with treatment and services and to coordinate yourcare. For example, we may disclose your protected health information to otheragency clinical staff that are involved in your care as well as differentdepartments of the agency in order to coordinate the various services you mightneed, such as prescriptions.[3]
Payment: Your protected health information may be used toobtain approval for and payment for services you receive. For example, we mayconfirm your eligibility with insurance plans, governmental agencies, orMedicaid in order to obtain approval and/or payment of services.
Operations: We may use or disclose your protected healthinformation as necessary for our regular business activities such as healthoversight, accreditation, licensing, and quality assurance. For example, membersof the quality assurance team may use information in your health record toassess the care in your case in an effort to continually improve the quality andeffectiveness of the healthcare services we provide.
As part of operations, we may contact you to provide appointmentreminders.
We may share your protected health information with third party“business associates” that perform various activities for us involvingprotected health information (e.g., auditors, attorneys), but only when we havea written contract with the business associate that fully protects the privacyof your protected health information.
Other Permitted and/or Required Uses and Disclosures
According to Federal Privacy Regulations, we may make thefollowing uses disclosures without obtaining consent or written authorizationfrom you.
Unless you object, under federal law we may disclose healthinformation about you to a member of your family, a relative, a close friend orany other person you identify as involved in your case.[4]
We may use or disclose your protected health information in anemergency situation when use and disclosure of the protected health informationis necessary to prevent serious risk of bodily harm or death.[5]
We may use or disclose your protected health information if andto the extent we are required by federal or state law. You will be notified, ifrequired by law, or any such uses or disclosures.
We may disclose to a court when ordered by the court.
We may disclose to a public health authority that is authorizedby law to receive reports of child abuse or neglect. In addition, if we believethat you have been a victim of abuse, neglect or domestic violence, we maydisclose your protected health information to the governmental entity or agencyauthorized to receive such information. Any disclosure of suspected abuse willbe made consistent with the requirements of applicable state law.
We may disclose to governmental agencies or private entitiesresponsible for overseeing health care activities through audits,investigations, inspections and licensure. Oversight agencies include governmentand/or private agencies that oversee the health care systems, government benefitprograms, government regulatory programs and civil rights laws.
Required Uses and Disclosures: Under federal law, we must makedisclosures when required by the Secretary of the United States Department ofhealth and Human Services to investigate or determine our compliance with therequirements of 45 C.F.R. Part 164.308 et. seq.
We may disclose for public health purposes such as notifyingpublic health authorities regarding specific communicable diseases, but only tothe extent authorized by state law.
We may disclose to federal, state or local agencies engaged indisaster relief to the extent that such information is required to enable themto carry out their responsibilities in specific disaster situations.
Uses and Disclosures of Protected Health Information BasedUpon Your Written Authorization.
Other uses and disclosures of you protected health informationnot covered by this Notice or by laws that apply to us will be made only withyour written authorization. You may revoke this authorization, at any time, inwriting. If you revoke this authorization, we will no longer use or discloseyour protected health information for the reasons covered by the authorization.However, we cannot undo any disclosure we have already made with theauthorization and are required to retain our records of the care that weprovided to you.
Your rights Regarding Your Protected Health Information.
You have the following rights with respect to your protected health information:
You Have the Right to Request Restrictions: You have theright to request a limitation or restriction on the protected health informationwe use or disclose about you for treatment, payment or healthcare operations. Weare not required to agree to restriction that you may request. If we agree tothe requested restriction, we may not use or disclose your protected healthinformation in violation of the restriction unless it is needed to provideemergency treatment. You must make this request in writing to our PrivacyContact at the address listed below.
Right to Request Confidential Communication: You have theright to request to receive confidential communications from us in a certain wayor at an alternative location. For example, you can ask that we only contact youat home or by mail. We will accommodate reasonable requests. We may alsocondition this accommodation by asking you for specification of an alternativeaddress or other method of contact. The request must be made in writing to ourPrivacy Contact at the address listed below specifying how or where you wish tobe contacted.
Right to Inspect and Copy: You have the right to inspectand obtain a copy of protected health information about you that we maintain. Toinspect and/or obtain a copy of protected health information, you must submityour request in writing to our Privacy Contact. If you request a copy of theinformation, we may charge a reasonable fee for the costs of copying, mailing,or other related costs.
We may deny your request to inspect a copy in certain limitedcircumstances. Under federal law, for example, you may not inspect or copy thefollowing records; psychotherapy notes; information compiled in reasonableanticipation of, or use in, a civil, criminal, or administrative action orproceeding. We are also permitted to deny your request to inspectand copy if the protected health information was obtained from someone under apromise of confidentiality. Please contact our Privacy Contact if you havequestions about access to your records.
Right to Amend: If you believe that healthinformation we have about you is incorrect or incomplete, you may request thatwe amend it. Your request must be in writing, submitted to theaddress listed below, and must state the reason you are seeking an amendment. Ifwe deny your request for amendment, you have the right to file a statement ofdisagreement with us which will be made a part of your record. We may prepare arebuttal to your statement and will provide you with a copy of such rebuttal.Please contact our Privacy Contact if you have questions about amending yourrecord.
Right to Receive an Accounting of Disclosure: You havethe right to an accounting of disclosures for purposes other than treatment,payment or healthcare operations as described in this Notice. You have the rightto receive specific information regarding these disclosures that occurred afterApril 14, 2003 . You must submit your request in writing to the addresses listedat the end of this Notice. The right to receive this information is subject tocertain exceptions, restrictions and limitations.
Right to Receive a Copy: You have aright to receive apaper copy of the notice of Privacy Practices upon request.
Complaints
If you believe we have violated your privacy rights, you may complain to usor to the Secretary of Health and Human Services. You may file a complaint withus by notifying our Privacy Contact. We will not retaliate against you forfiling a complaint.
Contacting Privacy Officer
You may contact our Privacy Contact, Bruce Johnson, by phone at 302-999-9812or submit written requests to him at:
PACE, Inc.
Attn: Bruce Johnson
Woodmill Corporate Center
5171 West Woodmill Road, Suite 9
Wilmington , DE 19808
1] This notice is based on the requirements ofthe Federal Health Insurance Portability and Accountability Act (HIPAA), 45C.F.R. Parts 160 and 164.
[2] Please note that in may cases state law governing behavioral healthtreatment is stricter than HIPAA and provides even greater confidentialityprotection for individuals. In those cases, we will follow state law therebyaffording you the highest level of confidentiality.
[3] Although federal law would allow us to share confidential information withthird parties who are also providing health care services to you, in compliancewith applicable state law we will not do so unless you provide written consent.24 Del. Code Ann. § 3913; 16 Del. Code 516.3.
[4] We will follow applicable state law which prohibits this disclosure unlesswe obtain a written consent for release of information.
[5] Other Federal law (42 C.F.R. 2.51; 2/12 (c) (5) significantly limits this inthe case of substance abuse treatment. Disclosure is only permitted to medicalpersonnel to the extent necessary to handle a medical emergency or to lawenforcement officials if the client has committed or threatened to commit acrime on program premises or against program personnel.