This notice is required by a law known as HIPAA. It applies to Transitions LifeCare Hospice (“Transitions LifeCare,” “we,” “us”, “our”). We use and share your Protected Health Information (PHI) to provide you with hospice and related health care services, to obtain payment for your care, and to conduct our business operations.
Purpose of this Notice. In the course of doing business, we receive, produce and maintain personal information about your health. This Notice describes how we protect the confidentiality of your PHI.
What is Protected Health Information? Protected Health Information, or PHI, is information that identifies who you are and relates to your past, present or future physical or mental health condition, the provision of health care to you, or a past, present or future payment for the provision of health care to you. It does not include information about you that is publicly available or that is not individually identifiable. PHI includes medical information which may indicate that you have a communicable or non-communicable disease. PHI also includes medical information which may indicate that you have or have been treated for psychological or psychiatric conditions, or for drug or alcohol abuse.
How We Protect your PHI. Access to your PHI is limited to those employees and contractors who provide services to you, have a need to use the information for billing, administrative or similar purposes, or become involved with an issue regarding your health or a claim on your behalf. We maintain physical, electronic and procedural safeguards to protect your PHI against unauthorized use or disclosure. We make agreements with third parties who work with us; these agreements are called “Business Associate Agreements.” Business Associates have duties to safeguard and use your PHI according to the law and this Notice. We will not sell your PHI without your written authorization or for a legally-permitted exception.
Government Oversight. The U.S. Department of Health and Human Services is called “HHS.” It oversees the privacy activities of all medical providers under HIPAA.
Parental and Custodial Rights. A parent generally may control his/her minor child’s PHI. However, in some cases we are permitted or even required by law to deny a parent’s access to a child’s PHI, such as when the child can legally consent to medical services without the parent’s permission. For unmarried parents, Oklahoma law requires us to give information to either parent, even if the parent does not have custody, unless a court has prohibited the disclosure of such information to the non-custodial parent.
Types of uses and disclosures of PHI we may make without your Authorization. We have the legal right to use and disclose your PHI to provide health care services to you, as well as to bill and collect payments for the health care services provided to you by your provider. Federal law also allows Transitions LifeCare to use and disclose your PHI as necessary in connection with health care operations of Transitions LifeCare. We may receive, create, maintain, revise, use and disclose your PHI for certain purposes; this is called “working with” your PHI:
¨For treatment, we may work with your PHI to or in connection with our staff members and to doctors, nurses, technicians, students, or other personnel involved in taking care of you. These professionals may include outside professionals who are involved in providing health care to you. Different departments or sites may share your PHI in order to coordinate your care, such as prescriptions, nursing, lab testing and x-rays. We may provide PHI to others involved in your continued care, such as authorized family members or nursing service providers. In working with your PHI, we may contact you, to remind you of appointments or of services being provided to you. In addition to individuals who may remind you, we may use automated systems to contact you or your phone or email site that you have provided to us. If we do not contact you personally, we may leave word on your voice, digital or email system.
¨For payment, we may work with your PHI so the treatment and services you receive may be billed and payment collected from you, an insurance company or health plan, a governmental entity or employer, or a third party. We may work with your PHI to determine eligibility or coverage, establish premiums, coordinate payments among various payers , determine “subrogation” rights, address coding, recordkeeping or “level of care” decisions, handle billing and collections, make claims against you or third parties, defend refund requests, justify medical necessity, justify charges, or participate in “Utilization Review” programs such as pre-certification.
¨For Health Care Operations, we may work with your PHI in connection with the handling or resolution of any grievance you may file, in connection with population-based disease management programs, to perform our business functions (such as, for example, peer review, quality assessment or improvement, or practice management support), to maintain our licenses, credentials, certifications and accreditations, to cooperate with education, insurance coverage or underwriting, legal, tax, auditing and similar services, consulting reviews, legal compliance reviews, business planning or management, customer service, administration of grievance processes, purchases, sales or loans, other business functions and cooperation with our business associates. We may combine your PHI with others’ PHI with respect to uses related to Health Care Operations.
We may also use and disclose your PHI without your consent or authorization for the following purposes:
¨ When required by law.
¨ To you or someone authorized by you or by law to receive your PHI.
¨ For public health activities, such as reports about communicable diseases or work-related health issues (these are just examples of other public health activities).
¨ In reports about child abuse, domestic violence, neglect, or certain injuries.
¨ For health oversight activities, such as reports to governmental agencies responsible for licensing physicians or other health care providers.
¨ In connection with court proceedings or proceedings before administrative agencies or to defend us in a legal dispute.
¨ To an employer in connection with an examination done at the employer’s request.
¨ To someone who may have been at risk of being exposed to, contracting or spreading a communicable disease.
¨ For law enforcement purposes, limited to information for identification, victims of crime, suspicion of death as result of criminal conduct, the crime occurs on premises of practice, a crime on our premises, and medical emergency that a crime has occurred.
¨ As required by a subpoena, warrant or similar document in a criminal proceeding.
¨ In reports to coroners, medical examiners, funeral directors, executors and next of kin.
¨ For tissue or organ donation.
¨ For research, with the approval of certain oversight entities; otherwise, use and disclosure of your personal information for research requires your authorization.
¨ To avert a serious threat to the health or safety of a person or public.
¨ For military, veterans, national security intelligence and similar activities, including the protection of the President.
¨ In connection with services provided under worker compensation laws.
¨ For Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, to enable product recalls or to make replacement.
¨ If you are under the custody of a law enforcement agency, it may be necessary for the institution to provide you with health care and/or protect the health and safety of you and/or others.
¨ To governmental entities that oversee our compliance with HIPAA or other laws.
¨ To your family members if they are involved in your care or payment for that care without either your consent or your authorization. However, you must be provided with an opportunity to object to the disclosure.
¨ For “directory purposes,” which includes: your name, address, phone number, etc… (You may object to the release of directory information.)
¨ To notify you of the health plans that include us or our professionals as preferred or network providers
¨ In order to remind you of appointments.
¨ To describe other treatments or services that we offer.
¨ To mention treatment alternatives.
¨ To market services in a face-to-face meeting.
¨ To provide you gifts of a nominal value, such as a calendar or coffee mug.
We may provide information to Business Associates that technically may be considered a “sale” but relates to our services for you. If Transitions LifeCare’s business is sold, PHI may be included in the sale. The HHS may allow other limited types of sales.
We may use or disclose your PHI in connection with certain fundraising solicitations or activities. At this time, we do not intend to make or conduct fundraising solicitations. In the unlikely event that we make fundraising solicitations in the future, each solicitation will provide you a way to opt out of future solicitations.
Our rights to use and disclose your PHI may be exercised directly or through a contractor.
All Other Uses And Disclosures Require Your Prior Written Authorization. The following uses and disclosures will be made by us only with a written permission (an authorization) from you:
¨ Most uses and disclosures of psychotherapy notes;
¨ Use or disclosures for marketing, other than face-to-face communications and promotional gifts of nominal value described above;
¨ Uses or disclosures that constitute a sale of your PHI; and
¨ Any other use or disclosure of your protected health information that is not described in this Notice.
If you provide us with such an authorization, you may cancel (revoke) the authorization in writing at any time, and this revocation will be effective for future uses and disclosures of your PHI. Revoking your written permission will not affect a use or disclosure of your PHI that we or our Business Associates have previously made based on your written authorization.
Your Rights Regarding your PHI
Reviewing and Copying your PHI. You may review and copy your PHI that is in our possession. If you desire to access your PHI, you must notify us in writing. We will respond to your request within 30 days and provide a time and place, within normal business operating hours, for your inspection. If you request a copy of your PHI, a copy may be provided. We reserve the right to charge a reasonable administrative fee for copying to the extent permitted by applicable law. If we have PHI in electronic form, you can request an electronic or paper copy (but you should ask about the fees for the various types of copies).
You may not, however, inspect or copy psychotherapy notes, or information compiled in reasonable anticipation of, or use in, a civil, criminal, or administration proceedings. If you want to review your PHI, you should request a copy of our notice that provides further details of our disclosure policy. That policy also describes your rights to appeal our denial of your review or copying, and our handling of the appeal.
Amending Your PHI. You may ask us to add to or correct your PHI while we possess it. Your request must be made in writing with a reason to support the request. You should submit the request to our Chief Executive Officer. We will respond within 60 days of receiving your written request. If we deny your request, we will explain why. We may deny your request if you ask us to amend information that: is accurate and complete, was not created or is not part of the information maintained by Transitions LifeCare, is not part of the information which you would be permitted to inspect and have copied, or is inconsistent with our policy. If you want to exercise this right, youshould request a copy of our separate policy on the amendment of PHI.
Any agreed-upon correction will be included as an addition to, and not a replacement of, your PHI records.
Restricting the Use of Your PHI. You may ask us to restrict the ways that we use and disclose your PHI for treatment, payment, or healthcare operations. All requests must be made in writing. We will review your request and notify you whether we have accepted or denied your request. We are not required to grant your request for restrictions unless you request us, in writing, not to furnish PHI to an insurer or other payor and you prepay the full amount of the services for which you want us not to disclose the PHI, in cash. If we agree to a requested restriction, we will comply with your request unless the information is needed to provide you emergency treatment. If you want to exercise this right, you should request a copy of our separate policy relating to this issue.
Requesting Confidential Communications. You may ask us to communicate with you about your PHI matters in a certain way or at a certain location. Examples are sending by a sealed envelope rather than a post card or calling you at work. Your request must specify how or where you wish to be contacted. We will not ask you to explain your request. If you want to exercise this right, you should request a copy of our separate policy relating to this issue.
Accountings of Disclosures. You may ask us to provide you a history of certain disclosures of your PHI. You can request this history by writing to us. Your request must state a time period, which may not be longer than six years and may not include dates prior to April 14, 2003. Disclosures made for treatment, payment, or health care operations, need not be made unless those disclosures were made electronically and were recorded after a recent change in the law caused us to maintain records of such disclosures (or we can readily obtain records of previous electronic disclosures); furthermore, these disclosures are limited to a maximum of the last three years of such electronic disclosures. We also are not required to furnish an accounting of disclosures authorized by you or disclosures that we cannot legally describe to you. 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. If you want to exercise this right, you should request a copy of our separate policy relating to this issue.
The Right to be Notified of a Breach of Unsecured Protected Health Information. You have the right to be notified and we have the duty to notify you of a breach of your unsecured PHI. A breach means the acquisition, access, use, or disclosure of your unsecured PHI in a manner not permitted under HIPAA that compromises the security or privacy of your PHI. If this occurs, you will be provided information about the breach and how you can mitigate any harm as a result of the breach.
Copies of this notice. You have may ask for and receive an electronic or paper copy of this notice at any time, at no charge. We will ask you to acknowledge receipt of this notice. You may obtain a copy of this notice at our website: www.TransitionsLC.com.
Right to authorize other disclosures. If you want us to disclose PHI in a way that is not described in this Notice, you can sign a written “Authorization.” If you cannot furnish a written Authorization, you can ask us about our procedures to permit some limited oral Authorizations.
Right to Complain. If you have any question about this Notice, wish to exercise your rights, or file a complaint; please direct your inquiries to:
Transitions LifeCare Hospice
Attention: Privacy Official
1216 N. Lansing, Suite D
Tulsa, OK 74106
If you want to exercise this right, you should request a copy of our separate complaint procedure.
You may notify the following agencies of your complaints. Your complaint must be in writing or filed electronically, and must be received within 180 days after you knew or should have known of the event that causes you to complain. HHS can waive the 180-day time period for good cause shown. Here are the addresses: (1) U.S. Department of Health and Human Services, 200 Independence Avenue, Southwest, Washington, D.C. 20201, phone 1-877-696-6775; and (2) Office of Civil Rights, DHHS, 1301 Young Street, Suite 1169, Dallas, TX 75202, phones (all 214) 767-4956, TDD: 767-8940; Fax: 767-0432.
Transitions LifeCare will not retaliate against you if you make a complaint.
Keeping and Destroying PHI. We keep copies of PHI for different periods of time depending on the type of PHI and the guidelines for keeping PHI. We may destroy your PHI, may convert it to microfilm or electronic form, or may send PHI to an offsite electronic or paper archive maintained by us or a Business Associate, without notifying you or obtaining your consent. We do not guarantee that we will continue to keep your PHI or that your PHI will be complete or accurate.
Electronic PHI. We will adopt reasonable safeguards relating to electronic PHI. We will adopt procedures that call for us to transmit electronic PHI either in a form that does not identify you, or in a form that includes protections against third-party disclosure (such as encryption). These procedures will call for us, to make practicable electronic disclosures of PHI in a “limited data set” that omits some of your identifying information. If a limited data set is impracticable, the procedures will call for us to determine and transmit the minimum necessary PHI.
After HHS publishes new regulations relating to electronic PHI, we will attempt to understand and apply the new regulations instead of the protections described in the previous paragraph.
In some cases, we may have a duty to notify affected patients, the media, and HHS, of possible material disclosures of large amounts of PHI. If we have the duty to notify you, we will notify you according to law.
Our Duties. We are required to maintain the privacy of Protected Health Information to the extent that the law protects such information. We must provide individuals with a notice of our legal duties and privacy practices with respect to Protected Health Information. We must follow the terms of this notice until we amend this notice. If we change our privacy practices, we will modify this notice and may apply our new privacy practices to all Protected Health Information that we have including Protected Health Information received before we changed our practices. We will post an amended notice in our offices, and will provide a copy of the notice to every patient the first time that he or she contacts us after we change our notice. We will also post an amended notice at our website, www.TransitionsLC.com.
Our Rights. We may change our privacy practices in accordance with State and Federal Law at any time. We may make any changes effective for all existing or future PHI that we possess.
If we make material or important changes to our privacy practices, we will promptly revise our Notice. See the previous section. Unless law requires the changes, we will not implement material changes to our privacy practices before we revise our Notice.
We may use and disclose your PHI to the fullest extent authorized by law.
The effective date of this Notice is May 24, 2013.
Your acknowledgments: With your signature on the “Statement of Consent/Election of Benefits” you acknowledge that:
– We have provided you a copy of this form and have explained all of the information contained on this form to your complete satisfaction.
– You understand your rights as a hospice patient regarding your PHI.
– You understand the complaint process.