HIPAA Joint Notification 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.
An Organized Health Care Arrangement (OHCA) is a clinically integrated care setting, in which patients receive health care from more than one health care provider. An OHCA can be formed between covered entities that present themselves to the public as part of a joint arrangement. An OHCA allows legally separate covered entities to use and disclose protected health information for the joint operation of the arrangement.
This Notice of Privacy Practices applies to the following entities, which are members of an organized health care arrangement referred throughout this notice as the “OHCA members”.
Cole Speech & Language Center, LP dba Cole Pediatric Therapy
Cole Home Healthcare of Houston Inc. dba Cole Home Health
Cole Consolidated Rehab, LLC dba Cole Pediatric Therapy
Champions Billing and Bookeeping, Inc. dba Cole Health
Northeast Rehab Center Inc. dba Cole Rehabilitation
This Notice describes how the OHCA members may use and disclose your protected health information. This Notice also sets out the OHCA members’ legal obligations concerning your protected health information and describes your rights to control and access your health information. The OHCA is required by law-Health Insurance Portability and Accountability Act of 1996(HIPAA), Health Information Technology for Economic and Clinical Health Act 2009 (HITECH), and the Identity Theft Act 2003 (Red Flag Rule) – to maintain the confidentiality of the medical and financial information that identifies you and to provide you with this notice of our legal duties and privacy practices. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. The OHCA reserves the right to change the terms of this Notice. Each entity of the OHCA will post the revised notice and will make it available upon request. The OHCA members all agreed to abide by the terms of this Notice.
Questions and Further Information. If you have any questions or want additional information about the Notice or the policies and procedures described in the Notice, please contact OHCA Privacy Officer using the Contact Information provided at the end of this Notice.
OHCA MEMBER’S RESPONSIBILITIES
OHCA members are required by law to maintain the privacy of your protected health information. The OHCA is obligated to provide you with a copy of this Notice setting forth OHCA members’ legal duties and its privacy practices with respect to your protected health information. OHCA members must abide by the terms of this Notice.
USE AND DISCLOSURE OF HEALTH INFORMATION
The OHCA may use and disclose your health information for treatment, payment, and healthcare operations. Texas law allows us to disclose information for these purposes only if we believe the person receiving it will not use or disclose it for another purpose and will take appropriate steps to protect it.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND
PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
TO PROVIDE TREATMENT The OHCA will use and disclose protected health information to provide, coordinate or manage your care. This includes communication and consultation between healthcare providers-doctors, nurses, technicians and other members of your medical team. For example, your doctor may disclose your information to a specialist who is treating you.
TO OBTAIN PAYMENT The OHCA will use or disclose your protected health information to fulfill its responsibilities for coverage and providing benefits. For example, OHCA members may disclose your protected health information when a provider requests information regarding your eligibility for benefits under OHCA members, or it may use your information to determine if a treatment that your received was medically necessary.
TO CONDUCT HEALTHCARE OPERATIONS The OHCA may use and disclose health information for its own operations in order to facilitate the function of the OHCA and as necessary to provide quality care to all of the OHCA’s patients. Healthcare operation includes such activities as:
· Quality assessment and improvement activities
· Activities designed to improve health or reduce healthcare costs
· Protocol development, case management and care coordination
· Contacting healthcare providers and patients with information about treatment alternatives and other related functions that do not include treatment
· Professional review and performance evaluation
· Training programs including those in which students, trainees or practitioners in healthcare learn under supervision
· Training on non-healthcare professionals
· Accreditation, certification, licensing or credentialing activities
· Review and auditing, including compliance reviews, medical review, legal services and compliance programs
· Business planning and development including cost management and planning related analysis and formulary development
· Business management and general administrative activities of the OHCA
· Fundraising for the benefit of the OHCA
For example the OHCA may use your health information to evaluate its staff performance, combine your health information with other OHCA patients in evaluating how to more effectively serve all OHCA patients, disclose your health information to OHCA staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you, or contact you as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
FOR BUSINESS ASSOCIATES OHCA members contract with service providers—called business associates—to perform various functions on its behalf. For example, OHCA members may contract with a service provider to perform the administrative functions necessary to pay your medical claims. To perform these functions or to provide the services, business associates will receive, create, maintain, use, or disclose protected health information, but only after OHCA members and the business associate agree in writing to contract terms requiring the business associate to appropriately safeguard your information.
OTHER COVERED ENTITIES OHCA members may use or disclose your protected health information to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with certain health care operation. For example, OHCA members may disclose your protected health information to a health care provider when needed by the provider to render treatment to you, and OHCA members may disclose protected health information to another covered entity to conduct health care operation in the areas of quality assurance and improvement activities, accreditation, certification, licensing or credentialing. This also means that OHCA members may disclose or share your protected health information with other health care programs or insurance carriers(such as Medicare, etc.) in order to coordinate benefits, if you or your family members have other health insurance or coverage.
FOR FUNDRAISING ACTIVITIES The OHCA may use information about you including your name, address, phone number and the dates you received care in order to contact you to raise money for the OHCA . The OHCA may also release this information to a related OHCA foundation. If you do not want the OHCA to contact you, notify the Privacy Officer and indicate that you do not wish to be contacted.
FOR APPOINTMENT REMINDERS The OHCA may use and disclose your health information to contact you as a reminder that you have an appointment.
FOR TREATMENT ALTERNATIVES The OHCA may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
WHEN LEGALLY REQUIRED The OHCA will disclose your protected health information when it is required to do so by any Federal, State or local law.
WHEN THERE ARE RISKS TO PUBLIC HEALTH The OHCA may disclose your health information for public activities and purposes in order to
· Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
· Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
· Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
· Notify an employer about an individual who is a member of the workforce as legally required.
TO REPORT ABUSE, NEGLECT OR DOMESTIC VIOLENCE The OHCA is allowed to notify government authorities if the OHCA believes a patient is the victim of abuse, neglect or domestic violence. The OHCA will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
TO CONDUCT HEALTH OVERSIGHT ACTIVITIES The OHCA may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The OHCA, however, may not disclose your protected health information if you are the subject of an investigation that is not directly related to your receipt of healthcare or public benefits.
IN CONNECTION WITH JUDICIAL AND ADMINISTRATIVE PROCEEDINGS The OHCA may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when the OHCA makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
FOR LAW ENFORCEMENT PURPOSES As permitted or required by State law, the OHCA may disclose your health information to a law enforcement official for certain purposes as follows:
· As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
· For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
· Under certain limited circumstances, when you are the victim of a crime.
· To a law enforcement official if the OHCA has a suspicion that your death was the result of criminal conduct including criminal conduct at the OHCA.
· In an emergency in order to report a crime.
TO CORONERS AND MEDICAL EXAMINERS The OHCA may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
TO FUNERAL DIRECTORS The OHCA may disclose your health information to funeral directors consistent with applicable law in if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, the OHCA may disclose your health information prior to and in reasonable anticipation of your death.
FOR ORGAN, EYE OR TISSUE DONATION The OHCA may use of disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
FOR RESEARCH PURPOSES The OHCA may, under very select circumstances, use your health information for research. Before the OHCA discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. (If the OHCA intends to routinely conduct research it is important to carefully review the authorization requirements for research exceptions and revise the Notice provisions as needed.)
IN THE EVENT OF A SERIOUS THREAT TO HEALTH OR SAFETY The OHCA may, consistent with applicable law and ethical standards of conduct, disclose your health information if the OHCA, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
FOR SPECIFIED GOVERNMENT FUNCTIONS In certain circumstances, the Federal regulations authorize the OHCA to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.
FOR WORKER’S COMPENSATION The OHCA may release your health information for worker’s compensation or similar programs.
INDIVIDUALS INVOLVED IN CARE, NOTIFICATION The OHCA may disclose relevant protected health information to a family member or friend involved with your care, or handling your bills. If family or friends are present while care is being provided, OHCA members will assume your companions may hear the discussion, unless you state otherwise. The OHCA may also share limited protected health information to notify a family member or legal representative of your location, condition or death.
DISCLOSURES TO THE SECRETARY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OHCA members are required to disclose your protected health information to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining OHCA members’ compliance with HIPAA Privacy Rule.
DISCLOSURES TO YOU OHCA members are required to disclose to you or your personal representative most of your protected health information when you request access to this information. OHCA members will disclose your protected health information to an individual who has been designated by you as your personal representative and who has qualified for such designation in accordance with relevant law. Prior to such a disclosure, however, OHCA members must be given written documentation that supports and establishes the basis for the personal representation, OHCA members may elect not to treat the person as your personal representative if it has a reasonable belief that you have been, or may be, subjected to domestic violence, abuse, or neglect by such person; treating such person as your personal representative could endanger you; or OHCA members determines, in the exercise of its professional judgment, that it is not in your best interest to treat the person as your personal representative.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION You have the following rights regarding your health information that the OHCA maintains:
· Right to request restrictions You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on the OHCA’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, the OHCA is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Officer.
· Right to receive confidential communications You have the right to request that the OHCA communicate with you in a certain way. For example, you may ask that the OHCA only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact the Privacy Officer. The OHCA will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
· Right to inspect and copy your health information You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Privacy Officer. If you request a copy of your health information, the OHCA may charge a reasonable fee for copying and assembling costs associated with your request.
· Right to amend health care information You or your representative have the right to request that the OHCA amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by the OHCA. A request for an amendment of records must be made in writing to the Privacy Officer. The OHCA may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by the OHCA, if the records you are requesting are not part of the OHCA’s records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in the opinion of the OHCA, the records containing your health information are accurate and complete.
· Right to an accounting Your or your representative have the right to request an accounting of disclosures of your health information made by the OHCA for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Privacy Officer. The request should specify the time period for the accounting starting on or after December 17, 2012. Accounting requests may not be made for periods of time in excess of six (6) years. The OHCA would provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
· Right to a paper copy of this notice You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact the Privacy Officer.
· Right to notification of certain breaches of protected healthcare information The OHCA will take reasonable precautions to detect breaches in the security of your medical and financial information. You have the right to be notified of certain breaches and the OHCA will employ an action plan that will attempt to mitigate harmful outcomes resulting from those breaches.
DUTIES OF THE OHCA
The OHCA is required by law to maintain the privacy of your health information and to provide to you and your representatives this Notice of its duties and privacy practices. The OHCA is required to abide by the terms of this Notice of its duties and privacy practices. The OHCA is required to abide by the terms of this notice as may be amended from time to time. The OHCA reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If the OHCA changes its Notice, the OHCA will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to the OHCA and to the Secretary of DADS if you or representative believes that your privacy rights have been violated. Any complaints to the OHCA should be made in writing to the Privacy Officer. The OHCA encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
The OHCA has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact:
Corporate Compliance Officer
Cole Health OHCA
16835 Deer Creek Dr., Suite 220
Spring, Texas 77379
OR you may contact:
U.S. Department of Health and Human Services
Office of Civil Rights
1301 Young Street, Suite 1169
Dallas, TX 75202
Phone: 214-767-4056 Fax: 214-767-0432
TDD 214-767-8940 firstname.lastname@example.org
This Notice is effective December 17, 2012