SARATOGA COUNTY MAPLEWOOD MANOR 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.

At SCMM, we believe in keeping your protected health information (PHI) safe.  PHI includes information that we have created or received about your past, present, or future health or medical condition that could be used to identify you.  It also includes information about medical treatment that you have received and about payment for health care you have received.  SCMM keeps protected health information in strict confidence.  As part of providing services, we may receive information from applications, forms, prior medical records, and other information provided to us.  This information can be given to us in writing, in person, by telephone, electronically, or by other means.  This information may include your name, address, social security and insurance information as well as medical information.  We do not share, sell, or rent any protected health information about our current or former residents.  We do not use any protected health information for fundraising or marketing purposes.  However, in the event protected health information is to be used for other uses and disclosures not described in the notice, authorization for use of the health protected information shall be obtained prior to use.

SCMM restricts access to information to those SCMM employees who need to know that information to provide services.  We also maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to guard your information.

This Notice of Privacy Practice explains how SCMM uses information about you and when we share that information with others.  The law requires SCMM to maintain the privacy of your health information and to give you this notice of our legal duties and privacy practices about how we treat your health information.  SCMM must follow the terms of this notice.  This notice takes effect on April 14, 2003, and will remain in effect unless SCMM replaces it.  If you have questions about any part of this notice or if you want more information about the privacy practices at SCMM, please contact SCMM Compliance Coordinator at (518) 885-5381 ext. 2202.

SCMM has the right to change this Notice of Privacy Practices as well as SCMM’s privacy policies and procedures as business needs and changes in federal and state law require.  If we make a significant change to the privacy practices in this notice, we will provide a revised Notice of Privacy Practices to all residents within 60 days and update our Web site.  Except as required by law, SCMM will not put into practice a significant change to any part of this notice before the effective date of the new notice.  The descriptions provided in this notice are examples and are not meant to be a complete list of all uses and disclosures.

Uses and Disclosures for Treatment, Payment, & Health Care Operations

SCMM uses and discloses protected health information in a number of different ways in connection with your care, treatment, payment for your care, and our health care operations.  The following are only a few examples of the types and uses and disclosures of your protected health information that we are allowed to make without your authorization.

TREATMENT

In order to care for you, we must develop a healthcare record at SCMM.  We will disclose health and billing information about you to health care providers who come into SCMM or to whom you are scheduled to see in their offices.  This also includes hospital visits and admissions.  For example, if you go to visit a cardiologist, we will furnish your medical record and billing information to him.

PAYMENT

We will disclose your protected health information in order to submit your claims for payment.  We may also disclose your protected health information for utilization review and management; medical necessity review; and answering complaints and appeals.  For example, we will furnish treatment records to Medicare, Medicaid, or a health insurance company to obtain payment.

HEALTH CARE OPERATIONS

We will disclose your protected heath information in order to conduct facility operations including but not limited to quality improvement measures, business associate interactions, for the facility directory and for notification to family members.

HEALTH-RELATED BENEFITS AND SERVICES

We may use your information to facilitate your discharge from SCMM to another setting including home or to outside day treatment programs.

Uses and Disclosures of PHI Without an Authorization

SCMM discloses your PHI without your written authorization as required by law and by government agencies.  For example, we disclose your PHI as required by law to respond to a court order or subpoena.  We are also allowed to disclose your PHI to a government agency authorized to oversee nursing homes such as for audits or to keep our license; and for public health requirements.

In the unfortunate event of your death, we may disclose your PHI to a coroner or medical examiner.  This may be necessary to determine cause of death.  We may also release this information to funeral directors as necessary to carry out their duties.

Uses and Disclosures of PHI With an Authorization

For any uses or disclosures that are not for treatment, health care operations, payment, and as required by law, SCMM will obtain your signed authorization and will use the information as stated in the authorization.  All requests for non-routine disclosures are looked at on a case-by-case basis to limit the release of information to the minimum amount necessary to meet the purpose for which the request was made.  You may cancel an authorization at any time, except to the extent that SCMM or another company or individual has already relied on the authorization.

Your written authorization is required for any use or disclosure of psychotherapy notes, except: for use by the originator of the psychotherapy notes for treatment or health oversight activities; for use or disclosure to defend us in a legal action or other proceeding brought by you; to the extent required to investigate or determine our compliance with the applicable law; to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law; for health oversight activities with respect to oversight of the originator of the psychotherapy notes; for disclosure to a coroner or medical examiner for the purpose of identifying a deceased person, determining cause of death, or other duties authorized by law; or if disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public and is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Your Health Information Rights

You have the following rights that deal with your medical information.  You can contact the Compliance Coordinator at (518) 885-5381 ext. 2202 to obtain the appropriate form needed to use any of these rights.

RIGHT TO INSPECT AND COPY PHI

You have the right to look at and get a copy of your protected health information in your medical record.  Medical records are the property of SCMM.  If you would like to review your records, you must make your request orally or in writing to the Compliance Coordinator.  You will be provided with an opportunity to inspect the records within 24 hours.  If you would like copies of your records, we will respond to you within two working days after your request and we may charge you a fee of up to $.75 per page for the cost of copying and postage.  In certain circumstances, we may deny your request.  If we do, we will tell you in writing the reason we are denying your request.

RESTRICTION RIGHT

SCMM does not share your information for any purpose other than for treatment, care, administration, or billing, or for other purposes permitted or required by law without prior authorization from you.   You have the right to ask for restrictions on uses and releases of your information.  However, SCMM is not required to agree to restriction requests.  You can contact the Compliance Coordinator at (518) 885-5381 ext. 2202 to ask for a restriction request.

RIGHT TO AMEND PHI

You have the right to ask us to correct your PHI or add missing information if you think there is a mistake in your PHI.  You must submit your request in writing to the Compliance Coordinator and give us a reason for your request.  We will respond to you within 60 days of getting your written request.  If we approve your request we will make the change to your PHI.  We will tell you that we have made the change.  We will also tell others who need to know about the change to your PHI.

We may deny your request if your PHI is:  correct and accurate; not made by us; not allowed to be disclosed; or not part of our record.  Our written denial will also explain your rights to file a written statement of disagreement.  You have the right to ask that your written request, our written denial, and your statement of disagreement be attached to your PHI.

RIGHT TO HAVE SOMEONE ACT ON YOUR BEHALF

You have the right to name a personal representative who may act on your behalf to control the privacy of your health information.

HEALTH PLAN RESTRICTIONS

In the event you are paying out of pocket in full for health care items or services, you have the right to restrict certain disclosures of protected health information to your health insurance plan.

RIGHT TO CONFIDENTIAL COMMUNICATIONS

You have the right to ask that we send PHI to you at an address of your choice or to communicate with you in a certain way.  All requests for alternative communications must be made in writing to the Compliance Coordinator.  We will respond to you in writing within 30 days of receiving your written request.

RIGHT TO AN ACCOUNTING OF DISCLOSURES

You have the right to get a list of situations in which we have given out your PHI.  The list will not include:  disclosures we made so that you could receive treatment; disclosures we made so that we could receive payment for the care we provide to you; disclosures we made in order to operate our business; disclosures made directly to you or to people you choose; disclosures made to law enforcement agencies or other authorized governmental personnel; disclosures we made before April 14, 2003; or disclosures we made in accordance with your authorization.

We will respond within 60 days of getting your written request.  The list we give you can only include disclosures made after April 14, 2003, the date this notice becomes effective.  Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003.

The list will include: the date of the disclosure; the person to whom PHI was disclosed (including that person’s address, if known); a description of the information disclosed; and the reason for the disclosure.  If you ask, we will give you one list of disclosures every 12 months for free.  However, if you ask for another list within 12 months of getting your free list, we will send you one of you agree to pay the reasonable fee we will charge for the additional list.  We will tell you in advance of the fee and give you a chance to cancel or change your request.

RIGHT TO OUR NOTICE OF PRIVACY PRACTICES

You have the right to receive a paper copy of this Notice of Privacy Practices at any time.  You can call the Compliance Coordinator at (518) 8850-5381 ext. 2202 or you can get a copy of this notice from our page on the county Web site at www.co.saratoga.ny.us/phmaplew.html.

INFORMATION BREACH NOTIFICATION

We will notify you in writing if we discover a breach of your unsecured PHI, unless we determine, based on a risk assessment, that notification is not required by applicable law.  You will be notified without unreasonable delay and no later than 60 days after discovery of the breach.  Such notification will include information about what happened and what has been done or can be done to mitigate any harm to you as a result of such breach.

FILING A PRIVACY COMPLAINT

If you think that your privacy rights have been violated, you may send a written complaint to the Compliance Coordinator at Saratoga County Maplewood Manor, 149 Ballston Avenue, Ballston Spa, New York 12020.  You will not be penalized for filing a complaint about our privacy practices.  You may also make a complaint to the Office for Civil Rights, U.S. Department of Health and Human Services.

HIPAA — Notice of Privacy Practices

Effective April 14, 2003; February 2005, October 2013

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