Effective Date: April 14, 2003
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.
We understand that information we collect about you and your health is personal. Keeping your health information private is one of our most important responsibilities. We are committed to protecting your health information and following all laws regarding the use of your health information. The law says:
1. we must keep your health care information from others who do not need to know it.
2. you may ask that we not share certain health care information. (In some instances, we may not be able to agree with your request.)
Your private health information may be used by health care providers such as doctors, nurses, and therapists who take care of you. They may need your private health information in order to determine your plan of care. This may cover health care services you had before now, or services you may have later on.
We may share health information about you in order to help you get services you may need.
Your health care provider sends a bill (also called a "claim") to an insurance company or to a government program such as Ohio Medicaid to get paid. The bill has all of the information about what services you had. We receive all billings designated for payment by Medicaid. We review health care information and bills to make sure that you get quality care and that all laws providing and paying for your health care are being followed.
You may see your health information, unless it is the private notes taken by a mental health provider or it is part of a legal case. Most of the time you can receive a copy if you ask. You may be charged a small amount for the copying costs.
If you think some of the information is wrong, you may ask in writing that it be changed or new information be added if you provide a reason for the need to change the information. You may ask that the changes or new information be sent to others who have received your health information from us. You may ask in writing that you receive your information by alternative means or in alternative locations if you specify that the disclosure of all or part of it could endanger you. You may ask for a list of any places where health information may have been sent, unless it was sent for treatment, for payment, for checking to make sure you receive quality care, or to make sure the laws are being followed. Your requests may be sent to:
Your local Developmental Center
Attention: HIPAA Privacy Officer
You may be asked to sign a separate form, called an authorization form, allowing your health care information to go somewhere else if:
1. your health care provider needs to send it to other places;
2. you want us to send it to another health care provider; or,
3. you want it sent to another person for you.
The authorization form tells us what, where and to whom the information must be sent. Your authorization is good until the date you put on the form or the passing of an identifiable event you indicate as the end of your authorization. You can cancel at any time or limit the amount of information sent at any time by letting us know in writing.
Note: If you are less than 18 years old, your parents or guardians will receive your private health information, unless by law you are able to consent for your own health care treatment. If you are, then your private health information will not be shared with parents or guardians unless you sign an authorization form. You may also ask to have your health information sent to a different person that is helping you with your health care.
When private health information is released without authorization, it is normally used to support Treatment or Payment of medical situations or it may be released for the use of Medicaid or Department Operations. The release of health information for this purpose is not tracked or accountable to you, the recipient of services (HIPAA rule 164.506). Any other release made without your authorization is tracked and accountable.
We always report::
1. contagious diseases, birth defects and cancer;
2. reactions and problems with medicine;
3. to the police when they are investigating a crime, when child or elder abuse may be happening, or when the court orders us to do so;
4. to the government to review how the Ohio Medicaid program is working;
5. to a provider or to an insurance company who needs to know if you have Ohio Medicaid;
6. work related injuries to Workers' Compensation;
7. birth, death, and immunization information;
8. to the Federal Government when they are investigating something important to protect our country, the President and/or other government workers.
To find out if your health information has been released without your authorization for purposes other than Treatment, Payment or Operations, you may submit a request for a "Request for Accounting for Disclosures" form. Simply fill out the form, attach a copy of your most recent Medicaid card, or a copy of your most recent medical card, and send both to:
Your local Developmental Center
Attention: HIPAA Privacy Officer
This notice is yours. We are required by law to provide you with it to let you know what we must do with your personal health information under the law and under our privacy policies. We are required to follow the terms of this notice though we reserve the right to change our privacy practices and the terms of this notice at any time. You can get a new notice from:
Your local Developmental Center
Attention: HIPAA Privacy Officer
You can also obtain additional copies of this notice by calling (614) 728-0129.
If you have other medical insurance, you may receive other privacy notices. The policies and procedures contained in this notice are only for Ohio Medicaid and our other programs.
If you have any questions about this notice, or you think that we have not protected your private health information and you wish to complain about it, please contact either of the following:
Ohio Department of Mental Retardation and Developmental Disabilities
30 East Broad Street, 12th floor
Columbus, Ohio 43215-3434
Attention: HIPAA Compliance Officer
OR
Telephone number
Phone: (866) 313-6733
You can also complain to the Federal Government by writing to the:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201-0004
Or by calling the Office for Civil Rights at: (800) 368-1019
Absolutely nothing. Your Ohio Medicaid and other Department benefits will NOT be affected if your file a complaint. It is against the law for us to take any retaliatory or other negative action against you if you file a complaint.