Notice of Privacy Practices
Magnolia Health Plan, Inc.
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.
Effective: JANUARY 1, 2011
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Covered Entities Duties:
Magnolia is a Covered Entity as defined and regulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Magnolia is required by law to protect the privacy of your protected health information (PHI). We must give you this notice. It includes our legal duties and privacy practices related to your PHI. We must follow the terms of the current notice. We must let you know if there is a breach of your unsecured PHI.
This notice describes how we may use and disclose your PHI. It describes your rights to access, change and manage your PHI. It also says how to exercise your rights. All other uses and disclosures of your PHI not described in this notice will be made only with your written approval.
Magnolia reserves the right to change this notice. We reserve the right to make the revised or changed notice effective for your PHI we already have. We can also make it effective for any of your PHI we get in the future. Magnolia will promptly update and get you this notice whenever there is a material change to the following stated in the notice:
o The Uses and Disclosures
o Your rights
o Our legal duties
o Other privacy practices stated in the notice
Updated notices will be on our website and in our member handbook. We will also mail you or email you a copy on request.
Uses and Disclosures of Your PHI:
The following is a list of how we may use or disclose your PHI without your permission or authorization:
· Treatment. We may use or disclose your PHI to a physician or other healthcare provider providing treatment to you, to coordinate your treatment among providers, or to assist us in making prior authorization decisions related to your benefits.
· Payment. We may use and disclose your PHI to make benefit payments for the health care services you received. We may disclose your PHI for another health plan, ,to a health care provider, or other entity subject to the federal Privacy rules for payment purposes.. Payment activities may include:
o Processing claims
o Determining eligibility or coverage for claims
o Issuing premium billings
o Reviewing services for medical necessity
o Performing utilization review of claims
· HealthCare Operations. We may use and disclose your PHI to perform our healthcare operations. These activities may include:
o Providing customer services
o Responding to complaints and appeals
o Providing care management and care coordination
o Conducting medical review of claims and other quality assessment improvement activities
In our healthcare operations, we may disclose PHI to business associates. We will have written agreements to protect the privacy of your PHI with these associates. We may disclose your PHI to another entity that is subject to the federal Privacy Rules. The entity must also have a relationship with you for its healthcare operations. This includes the following:
o Quality assessment and improvement activities
o Reviewing the competence or qualifications of healthcare professionals
o Care management and care coordination
o Detecting or preventing healthcare fraud and abuse.
· Appointment Reminders/Treatment Alternatives. We may use and disclose your PHI to remind you of an appointment for treatment and medical care with us.. We may also use your PHI to provide you with information regarding treatment alternatives or other health-related benefits and services.. For example, information on how to stop smoking or lose weight.
· As Required by Law. If federal, state, and/or local law requires a use or disclosure of your PHI, we may use or disclose your PHI information. We do this when the use or disclosure complies with such law. The use or disclosure is limited to the requirements of such law. If two or more laws or regulations governing the same use or disclosure conflict, we will comply with the more restrictive laws or regulations.
· Public Health Activities. We may disclose your PHI to a public health authority for the purpose of preventing or control disease, injury, or disability. We may disclose your PHI to the Food and Drug Administration (FDA to ensure the quality, safety or effectiveness products or services under the control of the FDA.
· Victims of Abuse and Neglect. We may disclose your PHI to a local, state, or federal government authority. This includes social services or a protective services agency authorized by law to have these reports. We will do this if we have a reasonable belief of abuse, neglect or domestic violence.
· Judicial and Administrative Proceedings. We may disclose your PHI in judicial and administrative proceedings. We may also disclose it in response to the following:
o An order of a court
o Administrative tribunal
o Discovery request
o Similar legal request
· Law Enforcement. We may disclose your relevant PHI to law enforcement when required to do so. For example, in response to a:
o Court order
o Court-ordered warrant
o Summons issued by a judicial officer
o Grand jury subpoena
We may also disclose your relevant PHI to identify or locate a suspect, fugitive, material witness, or missing person.
· Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to a coroner or medical examiner. This may be needed, for example, to determine a cause of death. We may also disclose your PHI to funeral directors, as necessary, to carry out their duties.
· Organ, Eye and Tissue Donation. We may disclose your PHI to organ procurement organizations. We may also disclose your PHI to those who work in procurement, banking or transplantation of:
o Cadaveric organs
· Threats to Health and Safety. We may use or disclose your PHI if we believe, in good faith, that it is needed to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.
· Specialized Government Functions. If you are a member of U.S. Armed Forces, we may disclose your PHI as required by military command authorities. We may also disclose your PHI:
o To authorized federal officials for national security
o To intelligence activities
o The Department of State for medical suitability determinations
o For protective services of the President or other authorized persons
· Workers’ Compensation. We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs, established by law. These are programs that provide benefits for work-related injuries or illness without regard to fault.
· Emergency Situations. We may disclose your PHI in an emergency situation, or if you are incapacitated or not present. This includes to a family member, close personal friend, authorized disaster relief agency, or any other person previously identified by you. We will use professional judgment and experience to determine if the disclosure is in your best interest. If the disclosure is in your best interest, we will only disclose the PHI that is directly relevant to the person's involvement in your care.
· Inmates - If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official. Your PHI will be released only if it is, necessary for the institution to provide you with health care; to protect your health or safety; or the health or safety of others; or for the safety and security of the correctional institution.
· Research. Under certain circumstances, , we may disclose your PHI to researchers when their clinical research study has been approved. They must have safeguards in place to ensure the privacy and protection of your PHI.
Uses and Disclosures of Your PHI That Require Your Written Authorization
We are required to obtain your written authorization to use or disclose your PHI, with limited exceptions, for the following reasons:
· Sale of PHI. We will request your written approval before we make any disclosure that is deemed a sale of your PHI. A sale of your PHI means we are getting paid for disclosing the PHI in this manner.
· Marketing. We will request your written approval to use or disclose your PHI for marketing purposes with limited exceptions. For examples, when we have face-to-face marketing communications with you orwhen we give promotional gifts of nominal value.
· Psychotherapy Notes. We will request your written approval to use or disclose any of your psychotherapy notes that we may have on file with limited exception. For example, for certain treatment, payment or healthcare operation functions.
All other uses and disclosures of your PHI not described in this Notice will be made only with your written approval. You may take back your approval at any time. The request to take back approval must be in writing. Your request to take back approval will go into effect as soon as you request it. There are two cases it won’t take effect as soon as you request it. The first case is when we have already taken actions based on past approval. The second case is before we received your written request to stop.
The following are your rights concerning your PHI. If you would like to use any of the following rights, please contact us using the information at the end of this notice.
· Right to Revoke an Approval Authorization - You may withdraw your authorization at any time. The withdrawal of your authorization must be in writing. The withdrawal will be effective immediately, except when we have already taken actions based on your authorized approval and before we received your written withdrawal.
· Right to Request Restrictions. You have the right to request restrictions on the use and disclosure of your PHI for treatment, payment or healthcare operations.. We are not required to agree to this request. We will not comply if the information is needed to provide you with emergency treatment. However, we will restrict the use or disclosure of PHI for payment or healthcare operations to a health plan when you have paid for the service or item out of pocket in full.
· Right to Request Confidential Communications. You have the right to ask that we communicate with you about your PHI by other ways or locations if you believe it is needed for your safety. We must agree to your request if it is reasonable and you believe it is needed for your safety. or location where you PHI should be delivered.
· Right to Access and Receive a Copy of your PHI. You have the right, with limited exceptions, to look at or get copies of your PHI contained in a designated record set. You must make a request in writing to obtain access to your PHI. If we deny your request, we will give you a written explanation. We will tell you if the reasons for the denial can be reviewed and how to ask for a review or if the denial cannot be reviewed.
· Right to Amend Your PHI. You have the right to request that we amend your PHI if you believe it contains incorrect information Your request must be in writing. If we deny your request, we will provide you a written explanation. You may respond with a statement that you disagree. If we accept your request to change the information, we will make reasonable efforts to inform others of the change. This includes people you name. We will also make the effort to include the changes in any future disclosures of that information.
· Right to Receive an Accounting of Disclosures. You have the right to get a list of times within the last 6 year period in which we or our business associates disclosed your PHI. This does not apply to disclosure for purposes of treatment, payment, healthcare operations, or disclosures you authorized and certain other activities.
· Right to File a Complaint. If you feel your privacy rights have been violated or that we have violated our own privacy practices, you can file a complaint with us. You can do this in writing or by phone by using the contact information at the end of this notice.
You can also file a complaint to the Secretary of the U.S. Department of Health and Human Services (HHS) Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201 or calling 1-800-368-1019, (TTY: 1-866-788-4989) or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
· WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.
· Right to Receive a Copy of this Notice. You may request for a copy of our Notice at any time by usingthe contact information listed at the end of the notice. If you receive this Notice on our web site or by electronic mail (e-mail), you can also request a paper copy of the Notice.
If you have any questions about this Notice, our privacy practices related to your PHI or how to exercise your rights you can contact us in writing. You can also contact us by phone. Use the contact information listed below. [CDB1]
Attn: Privacy Official
111 East Capital Street, Suite 500
Jackson, Mississippi 39201
FAX (404) 562-7881
TDD (404) 331-2867
WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.