Effective Date: December 27, 2012
This notice describes how your Protected Health Information may be used and disclosed, and your rights related to this notice. Your admitting clinician will review this notice with you. You will also receive the “Privacy Act Statement- Health Care Records”, Home Health Agency Outcome and Assessment Information Set (OASIS) Notice About Privacy, and Your (the patient) Rights and Responsibilities. If you have any questions related to this notice or any of CMSSHHC’s Privacy Policies, please contact:
Compliance Officer: Cindy Mitsch RN, Administrator 219-472-0233
Assistant Compliance Officer: Kelly Pear, Alternate Administrator 219-472-0233
CM Sunshine Home Healthcare, Inc. ( CMSSHHC ) is required by law to maintain the privacy of your Protected Health Information ( PHI ) and to provide you with this notice which describes CMSSHHC’s legal duties and privacy practices concerning your PHI. Simply stated, when CMSSHHC uses or discloses your PHI, we are obligated to disclose only the minimum amount of information necessary to achieve the purpose of the use or the disclosure. This “minimum necessary rule” does not apply if the disclosure is to a provider regarding your treatment, to you, or due to a legal requirement. CMSSHHC is required to abide by the Privacy Practices set forth in this notice.
Protected Health Information (PHI) is defined as “individually identifiable health information transmitted by electronic media, maintained in any medium that is defined as electronic media, or transmitted or maintained in any other form or medium. This includes all health information whether electronic, paper, or oral.”
This notice is available to anyone who asks for it, and must be provided to you or your authorized representative prior to the provision of care. We are required to ask for your written acknowledgment of receipt of this notice. NOTE: You initial your acknowledgement on the Admission Service Agreement .
CMSSHHC reserves the right to amend/revise this notice at any time. CMSSHHC is required to provide you with the latest notice. A copy of this notice is posted in our office.
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES .
We use and disclose medical information about patients every day. This section of our notice explains how we may use and disclose information about you in order to provide your health care, obtain payment for that health care, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose medical information about you.
1 . Treatment .
We may use and disclose medical information about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment.
2. Payment .
We may use and disclose medical information about you to obtain payment for health care services that you received from CMSSHHC. This includes disclosing medical information about you to State and/or Federal
Agencies or Insurance Companies to arrange for payments. In some cases, we may need to disclose medical information about you prior to the provision of care for the purpose of pre-certification for services to be provided and to be able to notify you if there are any related costs that you may incur as a result of receiving care/services from CMSSHHC.
3. Health Care Operations .
We may use and disclose medical information about you in performing a variety of business activities that we refer to as “health care operations”. These activities allow us to improve the quality of care we provide and reduce health care costs. The following are examples of situations in which we may use or disclose
medical information about you regarding “health care operations”:
4. Persons Involved in Your Care .
We may disclose medical information about you to a relative, close personal friend or any other person that you identify if that person is involved in your care and the information is relevant to your care. We may disclose medical information about you to a relative, close personal friend or any other person that you identify or possibly a disaster relief organization (such as Red Cross) if we need to notify someone of your location or condition.
You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree and abide by your request and not disclose medical information
except in certain limited circumstances (such as emergencies).
5. Required by Law .
We will use and disclose medical information about you whenever we are required by law to do so. There are many State and Federal laws that require us to use and disclose medical information. For example, State law requires us to report gunshot wounds and certain other injuries to the Local Police, and to report known or suspected abuse to Local Law Enforcement, Adult or Child Protective Services, and other required Agencies if indicated. We will comply with all local, state and federal laws.
6. National Priority Uses and Disclosures .
When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as “national priorities”. Simply stated, the government has determined that under certain circumstances (described below), it is so important to disclose medical information that it is acceptable to do so without the individual’s permission. We will only disclose medical information about you in the following circumstances when we are permitted or required to do so by law:
Other than the reasons listed above in numbers 1-6, we will not use or disclose medical information about you without the written “authorization” of you or your authorized representative. In some instances, we may wish to use or disclose medical information about you. In other instances, you may ask us to disclose medical
information about you. We would first contact you and ask for your authorization in writing. You may at any time after signing written authorization in writing- revoke (or cancel) your authorization in writing (except for very limited circumstances related to obtaining insurance coverage). You may write us a letter revoking your authorization, or call our Compliance Officer to request that a statement of revocation of authorization be mailed to you for signature. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action.
YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU.
1 . Right to a Copy of This Notice . You have a right to a paper copy of this notice at any time. You will also receive a copy prior to the provision of care from CMSSHHC. If the notice is amended, you will receive the new/latest copy at the earliest opportunity. If you would like a copy, please call our office at 219-472-0233.
2. Right of Access to Inspect and Copy. You have the right to see and/or review and receive a copy of medical information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of medical information about you, you must request it in writing, or you may call our Compliance Officer and request that a form be mailed to you. You can then return the form in person or mail it to us. If there is a fee associated, you will be informed in advance. If we deny your request (very limited circumstances),
we will inform you in writing, stating the specific reason(s) for the denial.
3. Right to Have Medical Information Amended. You have the right to have us correct or supplement medical information we about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with the request in writing and explain why you would like us to amend the information. Or you may call our Compliance Officer and request that a form be mailed to you. You can then return the form in person or mail it to us. If we deny your request, we will inform you in writing, stating the specific reason(s) for the denial. You will have the opportunity to send us a statement in writing explaining why you disagree with our decision to deny your amendment and we will share your statement whenever we the information in the future.
4. Right to Accounting Disclosures We have Made. In some limited instances , you have the right to receive an accounting (detailed listing) of disclosures that we have made regarding your health information in the previous six (6) years. You must request this in writing, or call our Compliance Officer to mail you a form. The form can be returned in person or mailed. If you request an accounting disclosure more frequently than every twelve (12) months, you may be charged a fee to cover the costs of preparing the report. In addition,CMSSHHC will not include in the accounting disclosures made to you, or for purposes of treatment, payment, healthcare operations, national security, law enforcement/corrections, and certain health oversight activities.
5. Right to Request Restrictions on Uses and Disclosures. You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and health care operations. We are not required to agree to your request. If we do agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In
addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.
6. Right to Request an Alternate Method of Contact. You have the right to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to a different address rather than your home address. We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternate method of contact, you must request this in writing, or call our Compliance Officer to mail you a form. The form can be returned in person or mailed.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with CM Sunshine Home Healthcare, Inc.’s Compliance Officer at 219-472-0233 8:00-4:30p.m., or with the Federal Government at 888-419-3456, Monday through Friday, 8:00-5:00p.m.
We will NOT take any negative action against you or change our treatment of you in any way
if you file a complaint.
To file a written complaint with the Federal Government, you may send your complaint to:
The Office of Civil Rights
U.S Department of Health and Human Services
200 Independence Avenue S.W.
Washington, DC 20201
CORPORATE COMPLIANCE PROGRAM
CM Sunshine Home Healthcare, Inc. had adopted a code of ethics and business conduct that summarizes the virtues and principles that guide our actions in providing the highest quality of care. We are committed to providing care and service that meets or exceeds local, state, federal and ACHC guidelines. You have the right and responsibility to express concerns, dissatisfactions, or make complaints about services you receive or do not receive without fear of reprisal or discrimination. We encourage you to discuss all concerns and/or complaints with us. The following are examples of issues that should be immediately brought to our attention:
CM Sunshine Home Healthcare, Inc. has a formal grievance procedure that ensures that your concerns shall be reviewed and an investigation started within twenty-four (24) hours. Every attempt will be made to resolve the concern as soon as possible. You will be kept informed of the status of the investigation and will receive a written report when resolution is determined. You also have the right to contact the Indiana State Department of Health HOTLINE number: 1-800-227-6334 (or) 1-800-246-8909, twenty-four (24) hours daily, seven days per week.