Elder Service Plan of the North Shore National PACE Association Member Lynn, MA
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Elder Service Plan of the North Shore National PACE Association Member Lynn, MA |
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Privacy Policy Effective Date: Health Insurance Portability & Accountability Act (of 1996) THIS NOTICE DESCRIBES HOW
MEDICAL/HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY
ESPNS is required by law
to maintain the privacy of your health information; to provide you this detailed Notice of
our legal duties and privacy practices relating to your health information; and to abide
by the terms of the Notice currently in effect.
This Notice applies to our use and disclosure of your health information for
purposes of enrollment, eligibility and payment by ESPNS as well as our use and disclosure
of your health information for purposes of providing you with treatment under the PACE
program.
I. USES
AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
The following lists various ways in
which we may use or disclose your health information for purposes of treatment, payment
and health care operations.
For Treatment. ESPNS
will use and disclose your health information in providing you with treatment, services
and coordinating care and may disclose information to other providers involved in your
care. Your health information may be used by
doctors involved in your care and by nurses, home health aides as well as by physical
therapists, social workers, personal care attendants or other persons involved in your
care. For example, multidisciplinary team members will discuss your plan of care and
contact any specialists regarding care provided to you.
For Payment. ESPNS
may use and disclose your health information for billing and payment purposes. ESPNS may disclose your health information to your
personal representative, or to an insurance or managed care company, Medicare, Medicaid or
the state agency charged with administering PACE programs.
For example, we may disclose health information to Medicare or the state
administering agency in order to determine your continued eligibility for services. ESPNS will also require you to sign a release
permitting the disclosure of personal information to Medicare, Medicaid, and the state
administering agency for these purposes as a condition of your enrollment agreement. For Health Care Operations. ESPNS may use and disclose your health information
as necessary for health care operations, such as management, personnel evaluation,
education, training and to monitor quality of care. ESPNS
may use data about your treatment in order to conduct quality assessment activities. ESPNS may disclose your health information to
another entity you have or had a relationship with if that entity requests information for
health care operations or health care fraud and abuse detection or compliance activities.
II.
SPECIFIC USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
The following lists various ways in
which ESPNS may use or disclose health information. Individuals Involved in Your Care or Payment for
Your Care. Unless you object, ESPNS
may disclose health information about you to a family member, close personal friend or
other person you identify, including clergy, who is involved in your care.
Emergencies. ESPNS
may use or disclose your health information as necessary in emergency treatment
situations.
As Required By Law. ESPNS
may use or disclose your health information when required by law to do so.
Business Associates.
ESPNS
business associates are individuals and organizations that carry out functions or
activities on our behalf that involve protected health information. ESPNS may disclose your
protected health information to a contractor or business associate who needs the
information to perform services for the PACE Program.
Our business associates are committed to preserving the confidentiality of
this information.
Public Health Activities. ESPNS
may disclose health information for public health activities. These activities may include
reporting to a public health authority for preventing or controlling disease, injury or
disability; reporting elderly abuse or neglect or reporting deaths. Reporting Victims of Abuse, Neglect or Domestic
Violence. If ESPNS believes you have
been a victim of abuse, neglect or domestic violence, we may use and disclose your health
information to notify a government authority, if authorized by law or if you agree to the
report. Health Oversight Activities. ESPNS may disclose your health information to a
health oversight agency for activities
authorized by law, such as audits, investigations, inspections and licensure actions or
for activities involving government oversight of the health care system. As a condition of enrollment, ESPNS will require
you to sign a release permitting the disclosure of personal information to Medicare,
Medicaid, and the state administering agency
for these purposes. To Avert a Serious Threat to Health or Safety. When necessary to prevent a serious threat to your
health or safety or the health or safety of the public ESPNS may use or disclose health
information, limiting disclosures to someone able to help lessen or prevent the threatened
harm.
Judicial and Administrative
Proceedings. ESPNS may disclose your health information in
response to a court or administrative order. We
also may disclose information in response to a subpoena, discovery request, or other
lawful process; efforts must be made to contact you about the request or to obtain an
order or agreement protecting the information.
Law Enforcement. ESPNS
may disclose your health information for certain law enforcement purposes, including to
comply with reporting requirements; to comply with a court order, warrant, or similar
legal process; or to answer certain requests for information concerning crimes.
Research.
ESPNS may use or disclose your health information for research purposes if
the privacy aspects of the research have been reviewed and approved, if the researcher is
collecting information in preparing a research proposal, if the research occurs after your
death, or if you authorize the use or disclosure.
Coroners, Medical Examiners, Funeral
Directors, Organ Procurement Organizations.
ESPNS may release your health information to a coroner, medical examiner,
funeral director or, if you are an organ donor, to an organization involved in the
donation of organs and tissue.
Disaster Relief. ESPNS
may disclose health information about you to a disaster relief organization.
Military, Veterans and other Specific Government
Functions. If you are a member of the
armed forces, ESPNS may use and disclose your health information as required by military
command authorities. We may disclose health
information for national security purposes or as needed to protect the President of the
Fundraising Activities. ESPNS
may use certain limited information to contact you in an effort to raise funds its
operations.
Appointment Reminders. ESPNS
may use or disclose health information to remind you about appointments.
Treatment Alternatives and
Health-Related Benefits and Services.
ESPNS may use or disclose your health information to inform you about
treatment alternatives and health-related benefits and services that may be of interest to
you.
III. USES
AND DISCLOSURES WITH YOUR AUTHORIZATION
Except as described in this Notice,
ESPNS will use and disclose your health information only with your written Authorization. You may revoke an Authorization in writing at any
time. If you revoke an Authorization, we will no longer use or disclose your health
information for the purposes covered by that Authorization, except where we have already
relied on the Authorization.
IV. YOUR
RIGHTS REGARDING YOUR HEALTH INFORMATION
Listed below are your rights regarding
your health information. Each of these rights
is subject to certain requirements, limitations and exceptions. Exercise of these rights
may require submitting a written request to ESPNS. At
your request, we will supply you with the appropriate form to complete. You have the right to:
Request Restrictions. Request
restrictions on our use or disclosure of your health information for treatment, payment,
or health care operations. This includes the
right to submit a written consent limiting the degree of information disclosed and the
persons to whom information is disclosed. You
also have the right to request restrictions on the health information we disclose about
you to a family member, friend or other person who is involved in your care or the payment
for your care.
ESPNS is not required to agree to your
requested restriction on how to use health information within the program. We will limit disclosures outside the program
(except for disclosures to CMS and the State Administering Agency) in accordance with your
written consent. We will grant requests to
restrict use of protected health information within the program if they are reasonable and
can be accommodated. If we do agree to accept
your requested restriction, we will comply with your request except as needed to provide
you emergency treatment. Access to Personal Health Information. You have the right to inspect and obtain a copy of
your clinical or billing records or other written information that may be used to make
decisions about your care, subject to some exceptions.
Your request must be made in writing. In
most cases we may charge a reasonable fee for costs in copying and mailing your requested
information.
Request Amendment. You
have the right to request amendment of your health information maintained by the program
for as long as the information is kept by or for the program. Your request must be made in writing and must state
the reason for the requested amendment.
ESPNS may deny your request for
amendment if the information (a) was not created by the program, unless the originator of
the information is no longer available to act on your request; (b) is not part of the
health information maintained by or for the program; (c) is not part of the information to
which you have a right of access; or (d) is already accurate and complete, as determined
by the program.
If we deny your request for amendment,
we will give you a written denial including the reasons for the denial and the right to
submit a written statement disagreeing with the denial. Request an Accounting of Disclosures. You have the right to request an
“accounting” of certain disclosures of your health information. This is a listing of disclosures made by ESPNS or
by others on our behalf, but does not include disclosures for treatment, payment and
health care operations, disclosures made pursuant to your Authorization, and certain other
exceptions.
To request an accounting of
disclosures, you must submit a request in writing, stating a time period beginning after Request a Paper Copy of This Notice. You have the right to obtain a paper copy of this
Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. [In
addition, you may obtain a copy of this Notice at our website, www.pacenorthshore.org.] Request Confidential Communications. You have the right to request that we communicate
with you concerning your health matters in a certain manner.
We will accommodate your reasonable requests.
V.
SPECIAL
RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION VI. FOR
FURTHER INFORMATION OR TO FILE A COMPLAINT
If you have any questions about this
Notice or would like further information concerning your privacy rights, please contact
Robert Durante or Brenda Raney at (781)
715-6608.
If you believe that your privacy
rights have been violated, you may file a complaint in writing with the PACE Program or
with the Office of Civil Rights in the U.S. Department of Health and Human Services. ESPNS
will not retaliate against you if you file a complaint. To file a complaint with the
program, contact
Robert Durante, Privacy Official,
at (781) 715-6608.
VII. CHANGES
TO THIS NOTICE
ESPNS reserves the right to change
this Notice and to make the revised or new Notice provisions effective for all health
information already received and maintained by the program as well as for all health
information we receive in the future. We will provide a copy of the revised Notice upon
request.
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