Notice of Privacy Practices
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.
A. Our Commitment to your Privacy.
B. Ways in which your Health Information may be used and
disclosed.
C. Uses and disclosures NHP is permitted
or required by law to make without your authorization.
D. Your Rights regarding your Protected Health Information.
E. Further Information.
F. Right to File a Complaint.
SUMMARY
- NHP uses and discloses your Protected Health Information for routine purposes, i.e., payment and health care operations. You sign a consent for these uses and disclosures when you enroll as a member of NHP. However, NHP will not disclose sensitive medical information, i.e., information about HIV status, drug and alcohol rehabilitation, treatment of sexually transmitted diseases, and mental illness, without your specific authorization.
- NHP will obtain your specific authorization before disclosing your Protected Health Information for non-routine purposes, unless there is a public policy reason to do so.
- You have rights under federal law with respect to your Protected Health Information. These rights include: the right to request a restriction on uses and disclosures of your Protected Health Information; the right to confidential communications; the right to access your Protected Health Information; the right to amend your Protected Health Information; the right to an accounting of disclosures made by NHP; and the right to a paper copy of NHP’s Privacy Notice.
- Employees of NHP receive education and training to guarantee that your written, oral, and electronic PHI is kept confidential. PHI transmitted electronically is encrypted and any documents containing your PHI are stored in a secure area with access limited to designated individuals. NHP uses, discloses and requests only the minimum amount of information necessary.
- NHP does not disclose PHI to your employer for employment-related purposes without your authorization, but may disclose PHI for plan administration purposes.
A. OUR COMMITMENT TO YOUR PRIVACY
Neighborhood Health Partnership (NHP) is committed to protecting your confidentiality and understands the importance of safeguarding your personal health information. NHP is required by federal law to keep health information that identifies you, or that could be used to identify you, known as “Protected Health Information,” private. NHP is also required to provide you with a Notice of NHP’s legal duties and privacy practices with respect to Protected Health Information that we collect and maintain.
This Notice describes how we protect the confidentiality of the Protected Health Information we receive. It provides an explanation of the uses and disclosures NHP makes of your Protected Health Information. It also explains your rights under federal law with respect to your Protected Health Information. NHP is required by federal law to abide by this Notice. NHP reserves the right to change its privacy practices as outlined in this Notice and make the new provisions effective for all Protected Health Information NHP maintains at that time. Should NHP make such a change, NHP will mail a revised Notice to you.
B. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS
When you enroll as a member of NHP, you provide general consent for routine uses and disclosures of most types of Protected Health Information, known as General Protected Health Information. You do not provide general consent for disclosures of Special Protected Health Information, which includes sensitive medical information, i.e., information about HIV status, drug and alcohol rehabilitation, treatment of sexually transmitted diseases, and mental illness. NHP requires a written authorization to disclose Special Protected Health Information.
NHP is permitted under federal law to use and disclose General Protected Health Information without your specific permission for three types of purposes: treatment, payment and health care operations.
1. Disclosures for Treatment. Although NHP is permitted under federal law to make disclosures for treatment purposes, as a health maintenance organization, NHP does not perform any treatment functions. Therefore, none of NHP’s uses and disclosures of your Protected Health Information are for NHP’s treatment purposes. While NHP does not disclose medical records or clinical information to health care providers, it does disclose other types of Protected Health Information to health care providers, such as authorizations to provide care. Health care providers are permitted by federal law to use and disclose your Protected Health Information for treatment, payment and health care operations purposes without your specific authorization.
2. Disclosures for Payment. Your Protected Health Information can be used and disclosed by NHP for payment purposes. For example, your Protected Health Information will be used to determine NHP’s responsibility for the provision of benefits. Your Protected Health Information may also be disclosed for the purpose of conducting utilization review activities, such as providing precertification and preauthorization of a service.
Other purposes for which NHP may use and disclose your Protected Health Information for payment include, but are not limited to, the following:
- Concurrent and Retrospective review of services.
- Claims management.
- Adjudication or Subrogation of claims.
- Reviewing health care services, with respect to medical necessity, coverage, appropriateness of care, or justification of charges.
- Coordination of benefits.
- Claims audits.
- Determination of coverage, including a pre-existing condition investigation.
- Billing and collection activities.
C. OTHER USES AND DISCLOSURES NHP IS PERMITTED OR REQUIRED BY LAW TO MAKE WITHOUT YOUR AUTHORIZATION
NHP is permitted or required to make certain uses and disclosures of your Protected Health Information without your specific written authorization. 1. Compliance with Federal Privacy Law. NHP is required to disclose your Protected Health Information to the Secretary of the United States Department of Health and Human Services when required to investigate or determine NHP's compliance with federal privacy law. 2. Parental Request. NHP is permitted to disclose Protected Health Information about a child under the age of 18 to a parent or guardian. However, Protected Health Information may not be disclosed to a child's parent or guardian without the child's written authorization when such information relates to alcohol or drug treatment, or sexually transmitted diseases. 3. Release of Information to Family/Friend. NHP is permitted to disclose your Protected Health Information to a family member, other relative, or close personal friend if it is relevant to that person's involvement in your care or the payment related to your care. 4. Plan Sponsors. NHP is permitted to disclose your Protected Health Information to your employer or other plan sponsor of your group health plan for plan administration purposes, such as quality assurance, claims processing, auditing and monitoring. NHP is not permitted to disclose Protected Health Information to your employer for employment-related purposes without your specific authorization. In most cases, NHP either does not provide any Protected Health Information to your employer or plan sponsor, or only provides Summary Health Information (e.g., summary of claims history, claims expenses or types of claims experienced). 5. Health-Related Benefits and Services. NHP is permitted to use and disclose your Protected Health Information to contact you to provide information about health-related benefits and services that may be of interest to you. 6. Appointment Reminders. NHP is permitted to use and disclose your Protected Health Information to contact you and remind you of visits and/or deliveries of equipment. 7. Health Oversight Activities. NHP is permitted to disclose your Protected Health Information to a health oversight agency for oversight activities authorized by law. These agencies may include the Florida Agency for Health Care Administration, the Florida Department of Insurance, or the federal Centers for Medicare and Medicaid Services. These activities may include audits; civil, administrative or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities. These activities are necessary for the government to monitor the health care system, your government benefit program, if any, and compliance with laws. 8. Law Enforcement. NHP is permitted to release Protected Health Information if asked to do so by a law enforcement official: n In response to a court order, subpoena, warrant, summons, administrative request, or similar legal process. n To identify or locate a suspect, fugitive, material witness or missing person. n Regarding criminal conduct at NHP's offices. 9. Lawsuits and Similar Proceedings. NHP is permitted to disclose your Protected Health Information: n In the course of judicial and administrative proceedings, including where NHP is not a party. n In response to an order of a court or administrative tribunal. n In response to a subpoena, discovery request, or other lawful process that is not accompanied by a court order, provided that NHP receives satisfactory assurances from the party seeking the information that they have made efforts to notify you or obtain a protective order. 10. Workers' Compensation. NHP is permitted to disclose your Protected Health Information to the extent necessary to comply with Florida law relating to workers' compensation. 11. Public Health. NHP is permitted to disclose your Protected Health Information to a government agency if it believes that you have been the victim of neglect, abuse or domestic violence. However, NHP would only disclose this information if you agree or NHP is required or authorized by law to make such disclosure. 12. Serious Threat to Health or Safety. NHP is permitted to use and disclose your Protected Health Information when necessary to reduce or prevent a serious threat to your health and safety, the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to prevent or lessen the threat. 13. Research. NHP is permitted to use and disclose your Protected Health Information for research when the research has been approved by an Institutional Review Board or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your Protected Health Information. 14. Military. If you are a member of the military, NHP is permitted to use and disclose your Protected Health Information for activities deemed necessary by appropriate military command authorities. 15. National Security. NHP is permitted to disclose your Protected Health Information for national security and intelligence activities. 16. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, NHP is permitted to disclose your Protected Health Information to the correctional institution or law enforcement official. Disclosures for these purposes would be made if necessary for your health care or the safety of the correctional institution. 17. Other Uses and Disclosures Require Your Written Authorization. Other uses and disclosures not listed in this Privacy Notice require your specific written authorization. If you provide such an authorization for NHP to use or disclose your Protected Health Information, you have the right to revoke it, in writing, except to the extent that NHP has already taken action in reliance on your authorization.
D. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding the Protected Health Information that we maintain about you. 1. Requesting Restrictions. You have the right to request that NHP restrict the uses and disclosures of your Protected Health Information for treatment; payment; health care operations; or to a family member, other relative, or close personal friend. NHP does not have to agree to such a restriction. If NHP agrees to such a restriction, NHP may not use your Protected Health Information in violation of the restriction, except if you need emergency treatment and your Protected Health Information is needed from NHP. NHP may terminate its agreement to a restriction if you agree to such a termination or if NHP informs you that it is terminating the restriction, provided, however, that the termination of the restriction is only effective for Protected Health Information NHP receives after NHP informs you of the termination. 2. Confidential Communications. You have the right to request communications of your Protected Health Information by alternative means or at alternative locations, if you communicate to NHP that the disclosure of the Protected Health Information could endanger you. The request must be in writing. NHP must accommodate such requests if they are reasonable, provided that, if applicable, you provide information as to how payment will be handled or an alternative address or other way to contact you. 3. Inspection and Copies. You have the right to inspect and copy your Protected Health Information that is maintained in a designated record set. NHP is required to provide access within 30 days after receipt, in writing, of your request to access your Protected Health Information (60 days if the information is stored off-site). NHP is required to provide the information at a convenient time or place, or mail the information to you. NHP may charge a reasonable fee to cover duplicating costs, including associated labor costs and postage. You do not have the right to access psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding or Protected Health Information that is not maintained in a designated record set. NHP may deny your request for access if a health care professional finds that it will endanger you or another person. 4. Amendment. You have the right to request, in writing, an amendment to your Protected Health Information. NHP may deny your request if the Protected Health Information was not created by NHP, if the Protected Health Information is contained in psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding; or if NHP determines that your Protected Health Information is accurate and complete. NHP must act on your request for an amendment within 60 days (with up to a 30-day extension, if needed). If NHP denies the amendment, it is required to send a written explanation to you and afford you the right to submit a written statement of disagreement. 5. Accounting of Disclosures. You have the right to obtain an accounting of non-routine disclosures of your Protected Health Information in the six years prior to your request. NHP is required to provide the accounting within 60 days (with one 30-day extension) and to provide one accounting, free of charge, in any 12-month period (for more frequent requests, a reasonable fee may be charged). The following disclosures are not required to be included in the accounting: disclosures before April 14, 2003; disclosures for treatment, payment, and health care operations (i.e., routine disclosures); disclosures to you; disclosures you authorized; disclosures for law enforcement; incidental disclosures which occur as by-products of routine disclosures; and disclosures to correctional institutions. 6. Paper Copy. 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. To obtain a paper copy of this Notice contact Customer Service at 305-715-2500 or 1-800-354-0222. 7. Right to Provide an Authorization for Other Uses and Disclosures. You or your personal representative have the right to request NHP to disclose your Protected Health Information pursuant to a specific written authorization signed by you or your personal representative. NHP will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide NHP regarding the use and disclosure of your Protected Health Information may be revoked, in writing, at any time, except to the extent that action has already been taken.
E. FURTHER INFORMATION
If you have questions about this Notice or would like additional information, you may call Member Services at 305-715-2500 (in Miami-Dade County), 1-800-354-0222, or (TTY) 305-715-2322 for the hearing impaired, Monday through Friday between 8am and 6pm.
F. RIGHT TO FILE A COMPLAINT
If you believe your privacy rights have been violated by NHP, you can file a complaint with NHP by writing to Grievance Administrator, P.O. Box 025680, Miami, FL 33126-1216. You also have the right to file a complaint with the Secretary of the United States Department of Health and Human Services. You will not be subject to any retaliation for filing a complaint.
EFFECTIVE DATE
The Effective Date of This Notice Is April 2003.
HM-3053-0 2/03
