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Notice of Privacy Practices
Effective 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.
If you have any questions about this notice, contact Missouri
Consolidated Health Care Plan's Privacy Officer at 832 Weathered
Rock Ct., P.O. Box 104355, Jefferson City, MO 65110, or by
calling 800.701.8881 or 573.751.8881.
This notice describes the information privacy practices
followed by employees and staff of Missouri Consolidated
Health Care Plan. For purposes of this notice, the pronouns “we”, “us” and “our” and
the acronym “MCHCP” refer to Missouri Consolidated
Health Care Plan.
This notice applies to the information and records we have
about your health care and the services you receive. We are
required by law to maintain the privacy of your protected
health information. We are also required by law to give you
this notice. It tells you about the ways in which we may
use and disclose health information about you and describes
your rights and our obligations regarding the use and disclosure
of that information.
How We May Use and Disclose
Health Information About You
For Treatment: We may use health information about you to
assist in providing you with medical treatment or services.
For example, we may use and disclose health information with
your providers (pharmacies, physicians, hospitals, etc.)
to assist in your treatment.
For Payment: We may
use and disclose health information about you so that the
treatment and services you receive are paid. For example,
we may use protected health information in order for your
claims to be processed. We may also assist you and your health
plan with prior authorizations and in determining whether
your plan covers the treatment. We may also use and disclose
your personal and limited health information to determine
eligibility for coverage and in order to obtain payment of
your premiums from your employer or sponsoring entity.
For Health Care Operations:
We may use and disclose health information for our health
care operations. For example, we may use your health information
for appeals, grievances, external review programs, disease
management, and case management.
We may also use and disclose personal and limited health
information with your employer as necessary to perform administrative
functions. Employers who receive this type of information
are required by law to have safeguards in place to protect
against inappropriate use or disclosure of your information.
Special Situations
We may use or disclose health information about you without
your permission for the following purposes, subject to all
applicable legal requirements and limitations:
To Avert a Serious Threat
to Health or Safety: We may use and disclose health
information about you when necessary to prevent a serious
threat to your health and safety or the health and safety
of the public or another person.
Required By Law: We
disclose your health information when required to do so by
federal, state, or local law.
Workers' Compensation: We
may release health information about you for workers' compensation
or similar programs. These programs provide benefits for
work related injuries or illness.
Law Enforcement: We
may release health information if asked to do so by a law
enforcement official in response to a court order, subpoena,
warrant, summons or similar process, subject to all applicable
legal requirements.
Information Not Personally
Identifiable: We may use or disclose health information
about you in a way that does not personally identify you
or reveal who you are.
Family and Friends: We
may disclose health information about you to your family
members or friends if we obtain your written agreement to
do so. We may also disclose health information to your family
or friends if we can infer from the circumstances, based
on our professional judgment that you would not object. For
example, we may assume you agree to our disclosure of your
personal health information to your spouse when you bring
your spouse with you to a meeting or have your spouse on
the telephone while such information is discussed.
In situations where you are not capable of giving consent
(due to your incapacity or medical emergency), we may, using
our professional judgment, determine that a disclosure to
your family member or friend is in your best interest. In
that situation, we disclose only health information relevant
to the person's involvement in your care.
Other Uses and Disclosures of Health
Information
We will not use or disclose your health information for
any purpose other than those identified in the previous sections
without your specific, written Authorization. If you give
us Authorization to use or disclose health information about
you, you may revoke that Authorization, in writing, at any
time. If you revoke your Authorization, we no longer use
or disclose information about you for the reasons covered
by your written Authorization, but we cannot take back any
uses or disclosures already made with your permission.
If we have HIV or substance abuse information about you,
we cannot release that information without a special signed,
written authorization from you. In order to disclose these
types of records for purposes of treatment, payment or health
care operations, we need both your signed Consent and a special
written Authorization that complies with the law governing
HIV or substance abuse records.
Your Rights Regarding Health Information
About You
You have the following rights regarding health information
we maintain about you:
Right to Inspect and Copy: You
have the right to inspect and copy your health information,
such as medical and billing records. You must submit a written
request to MCHCP's Privacy Officer in order to inspect and/or
copy your health information. If you request a copy of the
information, we may charge a fee for the costs of copying,
mailing or other associated supplies. We may deny your request
to inspect and/or copy in certain limited circumstances.
If you are denied access to your health information, you
may ask that the denial be reviewed. If such a review is
required by law, we select a licensed health care professional
to review your request and our denial. The person conducting
the review is not the person who denied your request, and
we comply with the outcome of the review.
Right to Amend Incorrect or
Incomplete PHI: If you believe health information
we have about you is incorrect or incomplete, you may ask
us to amend the information. You have the right to request
an amendment as long as the information is kept by this
office.
To request an amendment, complete and submit a Medical
Record Amendment/Correction Form to MCHCP's Privacy
Officer. We may deny your request for an amendment if it
is not in writing or does not include a reason to support
the request. In addition, we may deny your request if you
ask us to amend information that:
- We did not create, unless the person or entity that created
the information is no longer available to make the amendment;
- Is not part of the health information that we keep;
- You would not be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of
Certain Disclosures: You have the right to request
an accounting of disclosures. This is a list of the disclosures
we made of medical information about you for purposes other
than treatment, payment and health care operations. To
obtain this list, you must submit your request in writing
to MCHCP's Privacy Officer. It must state a time period,
which may not be longer than six years and may not include
dates before April 14, 2003. Your request indicates in
what form you want the list (for example, on paper or electronically).
We may charge you for the costs of providing the list.
We notify you of the cost involved and you may choose to
withdraw or modify your request at that time before any
costs are incurred.
Right to Request Restrictions: You
have the right to request a restriction or limitation on
the health information we use or disclose about you for treatment,
payment or health care operations. You also have the right
to request a limit on the health information we disclose
about you to someone who is involved in your care or the
payment for it, like a family member or friend. For example,
you could ask that we not use or disclose information about
a particular health care treatment you received.
We are Not Required to Agree
to Your Request: We are not required to agree to
your request for restrictions. If we do agree, we comply
with your request unless the information is needed to provide
you emergency treatment. If your request restricts us from
using or disclosing information for purposes of treatment,
payment or health care operations, we have the right to
discontinue providing you with health care treatment and
services.
To request restrictions, you may complete and submit the Request
for Restriction on Use/Disclosure of Medical Information to
MCHCP's Privacy Officer.
Right to Request Confidential
Communications: You have the right to request that
we communicate with you about medical matters in a certain
way or at a certain location. For example, you can ask
that we only contact you at work or by mail.
To request confidential communications, you may complete
and submit the Request
for Restriction on Use/Disclosure of Medical Information and/or
Confidential Communication to MCHCP's Privacy Officer. We
will not ask you the reason for your request. We accommodate
all reasonable requests. Your request must specify how or
where you wish to be contacted.
Right to a Paper Copy of This Notice: You have the right
to a paper copy of this notice. You may ask us to give you
a copy of this notice at any time. Even if you have agreed
to receive it electronically, you are still entitled to a
paper copy. To obtain such a copy, contact MCHCP's Privacy
Officer.
Changes to This Notice
We reserve the right to change this notice, and to make
the revised or changed notice effective for medical information
we already have about you, as well as any information we
receive in the future. We distribute any amended notice by
mail unless you agree to receive it electronically. Note
that the amended notice may be part of another mailing from
MCHCP. In addition, we post a summary of the current notice
in our office and on our website (www.mchcp.org)
with its effective date directly under the heading. You are
entitled to a copy of the notice currently in effect.
You may contact the Department of Labor
for assistance or information on your rights under HIPAA
at:
U.S. Department of Labor
Office of Public Affairs
City Center Square
1100 Main, Suite 840
Kansas City, MO 64105
816-426-5481
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