Notice of Privacy Practices
Effective April 1, 2012
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, please contact the Rubicon Management, Inc. Privacy Officer at email@example.com.
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgment of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment, and health care operations when necessary.
WHO WILL FOLLOW THIS NOTICE
This notice describes the Rubicon Management, Inc. (RMI) practices regarding your protected health information.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
“Protected health information” is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future physical or mental health or condition and related health care services. RMI is required by law to do the following:
- Make sure that your protected health information is kept private.
- Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information.
- Follow the terms of the notice currently in effect.
- Communicate any changes in the notice to you.
We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. You may obtain a Notice of Privacy Practices by accessing this web site or calling the RMI Privacy Officer and requesting a copy be mailed to you.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive.
Required Uses and Disclosures
By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to an ICF Provider or a Local Management Entity (MCO) operating 1915(b)(c) waivers in the State of North Carolina. We may disclose your protected health information from time-to-time to a physician, or health care provider who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions.
In emergencies, we will use and disclose your protected health information to provide the treatment you require.
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities the MCO might undertake before it approves or pays for the health care services recommended for you such as managing utilization of ICF/MR services.
Health Care Operations
We may use or disclose, as needed, your protected health information to support the daily activities related to health care. These activities include, but are not limited to, quality assessment activities, investigations, oversight or staff performance reviews, and conducting or arranging for other health care related activities.
We may use or disclose your protected health information, as necessary, to contact you to remind you of an appointment.
We will share your protected health information with third-party “business associates” who perform various activities (for example, billing) for the MCO. The business associates will also be required to protect your health information.
We may use or disclose your protected health information, as necessary, to provide you with other health-related benefits and services that might interest you. For example, your name and address may be used to contact you about an available bed at a Provider that we think might best fit you.
Required by Law
We may use or disclose your protected health information if law or regulation requires the use or disclosure.
We may disclose your protected health information to a public health authority who is permitted by law to collect or receive the information. The disclosure may be necessary to do the following:
- Prevent or control disease, injury, or disability.
- Report births and deaths.
- Report child abuse or neglect.
- Report reactions to medications or problems with products.
- Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to do the following:
- Report adverse events, product defects, or problems and biologic product deviations.
- Track products.
- Enable product recalls.
- Make repairs or replacements.
- Conduct post-marketing surveillance as required.
We may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative, and in certain conditions in response to a subpoena, discovery request, or other lawful process.
We may disclose protected health information for law enforcement purposes, including the following:
- Responses to legal proceedings
- Information requests for identification and location
- Circumstances pertaining to victims of a crime
- Deaths suspected from criminal conduct
- Crimes occurring at the RMI site
Under applicable Federal and state laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Some state laws concerning minors permit or require disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the state where the treatment is provided and will make disclosures following such laws.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION
In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required.
Individuals Involved in Your Health Care
Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. We may also give information to someone who helps pay for your care. Additionally we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You may exercise the following rights by submitting a signed copy of the HIPAA Patient Release Authorization Form to the RMI Privacy Officer.
Right to Inspect and Copy
You may inspect and obtain a copy of your protected health information that is contained in a "designated record set" for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that RMI uses for making decisions about you.
It is the Policy of Rubicon Management, Inc. that our Designated Record Set, for the purposes of fulfilling HIPAA Patient Rights includes the following types or categories of data and items:
- Medical Record Numbers internally generated by providers
- Last Name
- First name
- Date of Birth
- Social Security Number
- County of Medicaid eligibility
- LME payer – the resident's assigned MCO
- LME ID Number – uniquely generated by the resident's MCO
- Medicaid Number
- Patient Liability amounts
- Medicaid rates
- Medical Diagnosis Code
- Date of admittance
- Inpatient census
- Date of discharge
- Therapeutic leave census
- Date of Re-admittance
It is the Policy of Rubicon Management, Inc. that our Designated Record Set, for purposes of fulfilling HIPAA Patient Rights excludes the following types or categories of data and items:
- Psychotherapy notes
- Health information that is not used to make decisions about individuals or information that the person served does not have a right of access based on state or federal law.
- Quality Improvement records/Utilization Review
- Risk Management records
- Research documentation (Note: When protected health information is created or obtained by a covered health care provider/researcher for a clinical trial, the Privacy Rule permits the patient’s access rights in these cases to be suspended while the clinical trial is in progress, provided the research participant agreed to this denial of access when consenting to participate in the clinical trial.)
- Information compiled in reasonable anticipation of, or for use in civil, criminal, or administrative action or proceeding (e.g., Incident Reports – used to identify problems and implement corrective action)
Right to Request Restrictions
You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. Your request must be made in writing to the RMI Privacy Officer.
Right to Request Confidential Communications
You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.
Right to Request Amendment
If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.
Right to an Accounting of Disclosures
You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. You also have the right to be given the names of anyone, other than employees of the agency, who received information about you from RMI.
Right to Obtain a Copy of this Notice
You may obtain a paper copy of this notice from RMI or view it electronically at the RMI web site or at www.rubiconnc.org.
FEDERAL PRIVACY LAWS
This RMI Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply including the Freedom of Information Act, the Privacy Act and the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. These laws have not been superseded and have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information.
If you believe these privacy rights have been violated, you may file a written complaint with the RMI Privacy Officer or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint.
You may contact the RMI Privacy Officer for further information about the complaint process, or for further explanation of this document. The RMI Privacy Officer may be contacted at
Rubicon Management, Inc.
Attention: Stuart Mull
209 13th Avenue Place NW, Suite 102
Hickory, NC 28601
This notice is effective in its entirety as of April 1, 2012.