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Health Insurance Portability and Accountability Act (HIPAA) for the Group Health Plans Effective Date: April 14, 2003 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. General Information About this Notice This Notice relates to the use and disclosure of your medical information by the following group health plans ("Plans") maintained by The Methodist Hospitals, Inc.
Please note that depending on the circumstances, the term "Plans" as used in this Notice may mean multiple Plans or a single Plan. The Plans continue their commitment to maintaining the confidentiality of your medical information for purposes of your Plan coverage. This Notice describes the Plans’ legal duties and privacy practices with respect to that information. This Notice also describes your rights and the Plans’ obligations regarding the use and disclosure of your medical information. This Notice applies to:
The Plans are required by law to:
Plans’ Use and Disclosure of Your Medical Information The Plans are required by law to maintain the privacy of your protected health information ("PHI"). PHI is the information that is created or received by or on behalf of the Plans and includes.
This information may be maintained or transmitted either electronically or in any other form or medium. If the Plans need to amend this Notice due to changes in their operation, then this Notice will be amended, and an updated privacy Notice will be made available to you. The Plans need to use your PHI in certain ways that are described below in more detail. Use or disclosure for payment. The Plans may use and disclose your PHI so that the Plan can make proper payment for the services provided to you. For example, the Plans may use your PHI to determine your benefit eligibility or coverage level, to pay a health care provider for your medical treatment, or to reimburse you for your direct payment to a health care provider. Use or disclosure for health care operations: The Plans may use and disclose your PHI to the extent necessary to administer and maintain the Plans. For example, the Plans may use your PHI in the process of negotiating contracts with third party carriers, such as HMOs and provider networks, or for internal audits. Disclosure to The Methodist Hospitals, Inc.: With respect to your Plan coverage, the Plans may use and disclose your PHI to The Methodist Hospitals, Inc. as permitted or required by the Plan documents or as required by law. Certain Methodist Hospitals, Inc. employees who perform administrative functions for the Plans may use or disclose your PHI for Plan administration purposes. Any PHI disclosure to The Methodist Hospitals, Inc. by the Plans for other than payment or health care operations will require written authorization. At no time will PHI be disclosed to The Methodist Hospitals, Inc. for employment-related actions or decisions. Disclosures to Family or Close Friends: Under certain circumstances, the Plan may release your PHI to either a family member or someone who is involved in your health care or payment for your care. Your Written Authorization The following are examples of when the Plans may disclose your PHI without your authorization: Required by Law: The Plans may use or disclose your PHI to the extent that such disclosure is required by law and the use of disclosure complies with and is limited to the relevant requirements of such law. Required for Public Health: The Plans may use or disclose your PHI for public health reasons. These reasons may include the following:
Victims of Abuse, Neglect or Domestic Violence: As permitted or required by law, the Plans may disclose your PHI to an appropriate government authority if the Plans reasonably believe you are the victim of abuse, neglect or domestic violence. Health Oversight Activities: As required by law, the Plans may disclose your PHI to health oversight agencies. Such disclosure will occur during audits, investigations, inspections, licensure, and other government monitoring and activities related to health care provisions or public benefits or services. Judicial Proceedings, Lawsuits and Disputes: The Plans may disclose your PHI in response to an order of a court or administrative tribunal, provided that the Plans disclose only the PHI expressly authorized by such order. If you are involved in a lawsuit or a dispute, the Plans may disclose your PHI when responding to a subpoena, discovery request, or other lawful process where there is no court order or administrative tribunal. Under these circumstances, the Plans will require satisfactory assurance for the party seeking your PHI that such party has made reasonable effort either to ensure that you have been given notice of the request or to secure a qualified protective order. Law Enforcement: In response to a court order, subpoena, warrant, summons or other legal request, or upon a law enforcement official’s request, the Plans may release your PHI to a law enforcement official. The Plans may also release medical information about you to authorized government officials for purposes of public and national security. Coroners, Medical Examiners and Funeral Directors: Upon your death, the Plans may release your PHI to a coroner or a medical examiner for purposes of identifying you or to determine cause of death, and to funeral directors as necessary to carry out their duties. National Security and Intelligence Activities: The Plans may release medical information about you to authorized federal officials for intelligence, counterintelligence, and any other national security activities authorized by law. Military and Veterans: If you are or were a member of the armed forces, the Plans may release your PHI as required by military command authorities. The Plans may also release PHI about foreign military personnel to the appropriate authority. Workers’ Compensation: The Plans may release your PHI to comply with workers’ compensation or similar programs. Your Rights You have the following rights regarding your PHI maintained by the Plans: Right to request restriction: You have the right to request a restriction or limitation on the Plans’ use or disclosure of your PHI for payment or health care operations purposes as set forth above. You also have the right to request a limit on the PHI the Plans disclose about you to someone who is involved in your care or the payment of your care. (For example, you may ask the Plans to limit your PHI provided to a large case manager who is assigned to you.) The Plans are not required to agree to your request. If the Plans do agree, the Plans will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions on the use and disclosure of your PHI, you must complete and submit a written request on the "Request for Restrictions or Limitations Form" to the Privacy Official. Your written request must specify: (1) the information you want to limit; (2) whether you want the Plans to limit the use, disclosure, or both; and (3) to whom you want the restrictions to apply. Right to receive confidential communications: You have the right to request the Plans to communicate with you about your PHI in a certain manner or at a certain location. For example, you may request that the Plans contact you only at home and not at work. To request a specific manner to receive confidential communications, you must complete and submit a written request on the "Request for Confidential Communications Form" to the Privacy Official. The Plans will accommodate all reasonable requests if you clearly state that you are requesting the confidential communication because you feel that disclosure could endanger your life. You must make sure your request specifies how or where you wish to be contacted. Right to inspect and copy your PHI: You have the right to inspect and copy your PHI that is contained in records maintained, used, collected or disseminated by the Plans. Usually, this includes the medical and billing records maintained by the Plans but does not include psychotherapy notes, if any, to which the Plans have access. To inspect and copy your PHI maintained by the Plans, you must submit a written request to the Privacy Official. The Plans may charge you fees for the costs of copying, mailing or other supplies directly associated with your request. If the Plans deny your request, you will have an opportunity to have the denial reviewed if the denial was based on a licensed health care professional’s opinion that:
If this occurs, a licensed health care professional chosen by the Plans will review the request and denial. The person conducting the review will not be the person who denied your request. The Plans will comply with the outcome of the review. Right to amend your PHI: You have the right to request an amendment to your PHI if you believe the PHI the Plans have about you is incorrect or incomplete. You have this right as long as your PHI is maintained by the Plans. To request an amendment, you must submit a written request to the Privacy Official. You must provide the Plans with a reason that supports your request. The Plans may deny your request for an amendment in any of the following circumstances:
Right to receive an accounting of disclosure of PHI: You have the right to request a list of the disclosures of the PHI the Plans have made about you, subject to certain exceptions. In order to receive an accounting of disclosures, you must submit a written request to the Privacy Official. Your request must include (1) the time period for the accounting which may not be longer than six (6) years and may not include dates prior to April 14, 2003; and (2) the form (i.e., electronic, paper) in which you would like the accounting. Your first request with a 12-month period will be free. The Plans may charge you for costs associated with providing you additional lists. The Plans will notify you of the costs involved, and you may choose to withdraw or modify your request before you incur any costs. Right to receive a paper copy of this Notice: You have the right to receive a paper copy of this Notice. In order to receive a paper copy, you must submit a written request to the Privacy Official. You may receive a paper copy of this Notice, even if you previously agreed to receive this Notice electronically. Filing a Complaint Against the Plans If you believe your rights have been violated, you may file a complaint with the Plans. The complaint should contain a brief description on how you believe your rights have been violated. You should attach any documents or evidence that supports your believe, along with the Plans’ Privacy Notice provided to you, or the date of such Notice. The Plans take complaints very seriously. You will not be retaliated against for filing such a complaint. Please contact the Privacy Official for additional information. Please send all complaints to: The Methodist Hospitals, Inc. You may also file complaints with the United States Department of Health and Human Services at: United States Department of Health and Human Services The Plans reserve the right to change their privacy practices as described in this Notice. These changes may affect the use and disclosure of your PHI already maintained by the Plans, as well as any of your PHI that the Plans may receive or create in the future. The Plans will provide a copy of the current Notice to individuals currently covered under the Plans and to new Plan enrollees at the time of enrollment. A copy of the current Notice is also available during normal business hours upon request to the Privacy Official, and at www.methodisthospitals.org. Additionally, the Plans will provide you with the revised Notice within sixty (60) days of a material revision of this Notice. Nothing contained in this Notice shall be construed as a contract of employment between The Methodist Hospitals, Inc. and any employee, nor as a right of any employee to be continued in the employment at The Methodist Hospitals, Inc., nor as a limitation of the right of The Methodist Hospitals, Inc. to discharge any of its employees, with or without cause. No Change to Plans If you have any questions regarding this Notice, please contact: The Methodist Hospitals, Inc.
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