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.
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The Office of the Governor, Division of Medicaid (known as DOM) must by law keep
your health information private and give you notice of its legal
duties and privacy
practices for your health information. If you have questions about any part of this
notice or if you want more information about the privacy practices at DOM, please
contact:
Division of Medicaid Privacy Officer
550 High Street, Suite 1000
Jackson, MS 39201
(601) 359-6120
(800) 421-2408 Ext. 6120
Effective Date of This Notice: April 14, 2003
I. How DOM May Use or Disclose Your Health Information
DOM gets health information from you and stores it in files and on a computer. This
is part of your Medicaid record. The Medicaid record belongs to DOM, but the information
in the medical record belongs to you. DOM keeps your health information private.
The law lets DOM use or disclose your health information for the following purposes:
- Treatment. DOM will get or keep information about you regarding your health care
treatment and options. Although DOM does not give the treatment directly to you,
DOM will get some medical history and coded information about your health and treatment.
DOM does use and keep this specific health information to make sure proper payment
of benefits, and many times that the best benefits have been given to you within
Medicaid guidelines. This use or disclosure by DOM does not mean that your health
providers are not responsible to provide the best care. You and your provider must
decide together what care is best for you. Example: DOM will get your medical information
from your provider, who will send billing information to Medicaid for care they
provide to you. DOM will then review the billing and treatment information to make
sure it was correct, based on standards, and DOM will pay your provider for the
services that you are eligible for at pre-set rates.
- Payment. DOM does get information about you and will use and disclose information
about you to health care providers, business associates, and other covered entities
in order to send and get payments for services you get from providers. Example:
Your doctor will send certain health and private information about you to DOM or
a DOM business associate, who will in turn check to be sure you were eligible for
benefits and will send payment directly to the health care provider for the services
you got if you were eligible for such.
- Regular Health Care Operations. DOM does some contracts with business associates
to handle your personally identifiable health information. These business associates
will often prepare reports, data and information for use and disclosure throughout
DOM and to any others allowed by law. Also, DOM will use and disclose your information
as the law allows to conduct an assessment of Medicaid systems and training. Example:
DOM does plan for future Medicaid services by conducting needs assessments. Also,
DOM does conduct medical reviews or administrative proceedings to check quality
control of services available.
- Information provided to you. DOM does let individuals
request an opportunity to see the health information about themselves.
- Notification and communication with family. We may disclose your health information
to tell a family member, your personal representative or another person responsible
for your care about where you are, your general
condition or if you die. If you
are able and can agree or object, DOM will give you a chance to object prior to
making this notification. If you are unable or cannot agree or object, our health
professionals will use their best judgment in telling your family and others.
- Required by law. As required by law, we may use and disclose your health information.
- Public health. As required by law, we may disclose your health information to
public health authorities for purposes related to: preventing or controlling disease,
injury or disability; reporting child
abuse or neglect; reporting domestic violence;
reporting to the Food and Drug Administration problems with products and reactions
to medications; and reporting disease or infection exposure.
- Health oversight activities. We may disclose your health information to health
agencies during the course of audits, investigations, inspections, licensure and
other proceedings.
- Judicial and administrative proceedings. We may disclose your health information
in the course of any administrative or judicial proceeding.
- Law enforcement. We may disclose your health information to a law enforcement
official for purposes such as identifying or locating a suspect, fugitive, material
witness or missing person, complying with a court order or subpoena, and other law
enforcement purposes.
- Deceased person information. We may disclose your health information to coroners,
medical examiners, and funeral directors.
- Organ donation. We may disclose your health information to organizations involved
in procuring, banking or transplanting organs and tissues.
- Research. We may disclose your health information to researchers doing research
that has been approved by a DOM approved Privacy Board.
- Public safety. We may disclose your health information to appropriate persons
in order to prevent or lessen a serious and imminent threat to the health or safety
of a particular person or the general public.
- Specialized government functions. We may disclose your health information for
military, national security, correctional institutions and government benefits purposes.
- Worker's compensation. We may disclose your health information as necessary
to comply with worker's compensation laws.
- Marketing. We may contact you to remind you of appointments or to give you information
about other treatments or health-related benefits and services that may be of interest
to you.
II. When DOM May Not Use or Disclose Your Health Information
Except as described
in this Notice
of Privacy Practices, DOM will not use or disclose your health information
without your written authorization. If you do authorize DOM to use or disclose your
health information for another purpose, you may take back your authorization in
writing at any time.
III. Your Health Information Rights
- You have the right to ask for restrictions on certain uses and disclosures of
your health information. DOM does not have to agree to the restriction that you
ask for.
- You have the right to get your health information through a reasonable alternative
means or at an alternative location. You must present a DOM form which tells your
specific request. There may be charges to get this information. You will be told
in advance.
- You have the right to see and copy your health information. There may be fees
and charges for the time it takes to copy, prepare, supervise, and mail the information
you ask for.
- You have a right to request that DOM change your health information that is not
correct or not complete. DOM does not have to change your health information and
will give you information about DOM not changing the information. You will be told
how you can disagree with the denial.
- You have a right to get a list of disclosures of your health information made
by DOM, except that DOM does not have to include disclosures for: 1 (treatment),
2 (payment), 3 (health care operations), 4 (information provided to you), and 16
(certain government functions) of Section I of this Notice of Privacy Practices.
- You have a right to a paper copy of this Notice of Privacy Practices and can
get this Notice in another format.
IV. Changes to this Notice of Privacy Practices
DOM reserves the right to change
this Notice of Privacy Practices at any time in the future, and to make the new
provisions effective for all information that it keeps, including information that
was created or received prior to the date of such change. Until such change is made,
DOM must by law comply with this Notice. Upon a material change of this Notice,
DOM will send a new Notice with the changes and effective date of change to each
current beneficiary.
V. Complaints
Complaints about this Notice of Privacy Practices or how DOM handles
your health information should be sent to: Division of Medicaid Privacy
Officer 550 High Street Suite 1000
Jackson, MS 39201
If you are not satisfied with the manner in which this office handles a complaint,
you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your complaint to one of the regional Offices for Civil Rights.
A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.
For instructions on how to obtain this information in either Braille or a non-English
speaking format, please contact your local Division of Medicaid Office for details.
DOM /HIPAA NPP - 04.14.03 Revised Jan. 2003
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