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Notice of Privacy Practices

Effective Sept. 1, 2013

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 Missouri Consolidated Health Care Plan's Privacy Officer at 832 Weathered Rock Court, PO Box 104355, Jefferson City, MO 65110, or by calling 573-751-8881 or toll-free 800-701-8881.

This notice describes the privacy practices followed by work force members 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 and to notify you if there has been a breach of your protected health information. We are also required by law to give you this notice. It will tell 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

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 protected health information with your providers (pharmacies, physicians, hospitals, etc.) to assist in your treatment.

For Payment:  We may use and disclose protected health information about you so that the treatment and services you receive will be paid. For example, we may use or disclose protected health information in order for your claims to be processed, coordinate your benefits, review health care services provided to you and evaluate medical necessity or appropriateness of care or charges. We may also use or disclose your protected health information to determine whether a treatment is a covered benefit under the health plan. We may use and disclose your protected health information to determine eligibility for coverage, in order to obtain pre-tax payment of your premiums from your employer or sponsoring entity, and for determining wellness premium incentives. We may use and disclose your protected health information for underwriting purposes, but, if we do, we are prohibited from using your genetic information for such purposes.

For Health Care Operations:  We may use and disclose protected health information for our health care operations. For example, we may use and disclose your protected health information to address or resolve complaints or appeals regarding your medical benefits. We may use or disclose protected health information with our wellness or disease management programs in which you participate. We may use your protected health information to conduct audits, for purposes of rate-making, as well as for purposes of risk management. We may also disclose your protected health information to our attorneys, accountants and other consultants who assist us in performing our functions. We may disclose your protected health information to health care providers or entities for certain health care operations activities, such as quality assessment and improvement activities, case management and care coordination. In this case, we will only disclose your protected health information to these entities if they have or have had a relationship with you and your protected health information pertains to that relationship, such as with other health plans or insurance carriers in order to coordinate benefits, if you or your family members have coverage through another health plan.

Disclosures to Employer:   We may also use and disclose protected 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.

Disclosures to Family Members or Others:   We may disclose health information about you to your family members or friends if we obtain your written authorization to do so. Also, unless you object, we may disclose relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. 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. We may also disclose claim and payment information of family members to the subscriber in a family plan.

If you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, we will disclose protected health information (as we determine) in your best interest. After the emergency, we will give you the opportunity to object to future disclosures to family and friends.

Disclosures to Business Associates:   We contract with individuals and entities (business associates) to perform various functions on our behalf or provide certain types of services. To perform these functions or provide these services, our business associates will receive, create, maintain, use or disclose protected health information. We require the business associates to agree in writing to contract terms to safeguard your information, consistent with federal and state law. For example, we may disclose your protected health information to a business associate to administer claims or provide service support, utilization management, subrogation or pharmacy benefit management.

 Special Situations

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 will disclose your health information when required to do so by federal, state or local law.
  • Public Health Activities:  We may disclose your information to a public health authority that is authorized by law to collect or receive such information for the purpose of preventing disease or injury.
  • For Research:  Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.
  • To a Health Oversight Agency:  We may disclose your health information to a health oversight agency for oversight activities authorized by law.
  • Judicial and Administrative Proceedings:  We may disclose your health information in the course of any judicial or administrative proceedings in response to an order of a court or administrative tribunal. We may disclose your health information in the course of any judicial or administrative proceeding in response to a subpoena, discovery request, or other lawful process if we receive satisfactory assurance that you have been given notice of the request or that there is a qualified protective order for the information.
  • 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.
  • For Military, National Security or Incarceration/Law Enforcement Custody:  If you are involved with the military, national security or intelligence activities, or you are in the custody of law enforcement officials or an inmate in a correctional institution, we may release your health information to the proper authorities so they may carry out their duties under law.
  • 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.

 Other Uses and Disclosures of Health Information

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 will 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 will have to have both your signed consent and a special written authorization that complies with the law governing HIV or substance abuse records.

If you have psychotherapy notes, we will not use or disclose that information without authorization unless the use or disclosure is used to defend MCHCP in a legal action or other proceeding brought by you.

MCHCP will not use or disclose your protected health information for marketing purposes without an authorization, except if the marketing communication is in the form of a face-to-face communication made by MCHCP to you or in the form of a promotional gift of nominal value provided by MCHCP. MCHCP will not sell your protected health information without your authorization.

 Your Rights Regarding Health Information About You

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 enrollment, eligibility 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 will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will 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 Member 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:

    1. We did not create, unless the person or entity that created the information is no longer available to make the amendment;
    2. Is not part of the health information that we keep;
    3. You would not be permitted to inspect and copy; or
    4. 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 go back more than six years from the date of the request. Your request should indicate 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 will 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, such as 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 will 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 Health Care Information and/or Confidential Communication 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 Health Care Information and/or Confidential Communication to MCHCP's Privacy Officer. We will not ask you the reason for your request. We will 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

Changes to This Notice

MCHCP is required to abide by the terms of the notice currently in effect. 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 will post the revised notice to our website prior to the effective date of the change, and we will distribute any amended notice or information about the change and how to obtain a revised notice in the next annual communication to members, either by mail or electronically if you have agreed to receive communication in that manner. Please note that the amended notice may be part of another mailing from MCHCP. In addition, we will post a summary of the current notice in our office and on this website with its effective date directly under the heading. You are entitled to a copy of the notice currently in effect.

 Complaints

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the federal office of the Secretary of the Department of Health and Human Services - Office of Civil Rights. To file a complaint with our office, contact MCHCP’s Privacy Officer at 573-751-8881 or toll-free 800-701-8881. You will not be penalized or retaliated against for filing a complaint.

You may contact the Department of Health and Human Services on your rights under HIPAA at:

Kansas City Office for Civil Rights
U.S. Department of Health and Human Services
601 E. 12th St., Room 353
Kansas City, MO 64106

Customer Response Center: 800-368-1019
Fax: 202-619-3818
TDD: 800-537-7697
Email: ocrmail@hhs.gov

www.hhs.gov

 Discrimination is Against the Law

Discrimination is Against the Law

MCHCP complies with applicable Federal civil rights laws and
does not discriminate on the basis of race, color, national origin,
age, disability, or sex. MCHCP does not exclude people or treat
them differently because of race, color, national origin, age,
disability, or sex.

MCHCP:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, contact Shelley Farris.

If you believe that MCHCP has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Shelley Farris
Director of Benefit Administration
832 Weathered Rock Court, PO Box 104355
Jefferson City, MO 65110
Phone/Fax: 573-526-3427
Compliance@mchcp.org

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Shelley Farris (Director of Benefit Administration) is available to help you.

You can also file a civil rights complaint with the U.S. Department
of Health and Human Services, Office for Civil Rights,
electronically through the Office for Civil Rights Complaint Portal,
available at ocrportal, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F
HHH Building Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at
hhs.gov/ocr/office/file/index.html.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1‑800‑487‑0771 (TTY: 1‑800‑735‑2966).

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ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1‑800‑487‑0771 (ATS : 1‑800‑735‑2966).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1‑800‑487‑0771 (TTY: 1‑800‑735‑2966).

Wann du Deitsch schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1‑800‑487‑0771 (TTY: 1‑800‑735‑2966).

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ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1‑800‑487‑0771 (መስማት ለተሳናቸው: 1‑800‑735‑2966).

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1‑800‑487‑0771 (TTY: 1‑800‑735‑2966).

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