Notice Of Privacy Practices
(Effective date: November 26, 2018)
This notice describes how medical/health information about you may be used and disclosed at Rocky Mountain Health Care Services PACE Program and how you can get access to this information. Please review it carefully.
We at Rocky Mountain PACE are required by law to maintain the privacy of your health information; to provide you this detailed notice of our legal duties and privacy practices relating to your health information; and to abide by the terms of the notice that are currently in effect.
Use and disclosures for treatment, payment and health care operations:
The following lists various ways in which we may use or disclose your health information for purposes of treatment, payment, and health care operations.
We will use and disclose your health information in providing you with treatment and services and coordinating your care and may disclose information to other providers involved in your care. Your health information may be used by physicians involved in your care and by nurses and home health staff as well as by physical therapists, social workers and case managers, or other persons involved in your care. For example, members of the Interdisciplinary Team will discuss your plan of care and contact any specialists regarding care provided to you.
We may use and disclose your health information for billing and payment purposes. We may disclose your health information to your personal representative, or to an insurance or managed care company, Medicare or Medicaid (Colorado Department of Health Care Policy and Financing). We will also require you to sign a release permitting the disclosure of personal information to Medicare and Medicaid for these purposes as a condition of your enrollment agreement.
For Health Care Operations.
We may use and disclose your health information as necessary for health care operations, such as management, personnel evaluation, education and training, and to monitor quality of care. For example, we will use data about your treatment in order to conduct quality assessment activities.
Specific uses and disclosures of your health information.
The following lists various ways in which we may use or disclose your health information.
Individuals Involved in Your Care or Payment for Your Care.
With your permission, we may disclose health information about you to a family member, close personal friend or other person you identify, including clergy, who is involved in your care.
We may use or disclose your health information as necessary in emergency treatment situations.
As Required by Law.
We may use or disclose your health information when required by law to do so.
Our business associates are individuals and organizations that carry out functions or activities on our behalf that involve protected health information. We may disclose your protected health information to a contractor or business associate who needs the information to perform services for Rocky Mountain PACE. Our business associates are committed to preserving the confidentiality of this information.
Public Health Activities.
We may disclose your health information for public health activities. These activities may include, for example, reporting to a public health authority for preventing or controlling disease, injury or disability; reporting elder abuse or neglect, or reporting deaths.
Reporting Victims of Abuse, Neglect or Domestic Violence.
If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your health information to notify a government authority, if authorized or required by law or if you agree to report.
Health Oversight Activities.
We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure actions or for activities involving government oversight of the health care system. As a condition of enrollment, we will require you to sign a release permitting the disclosure of personal information to Medicare and Medicaid.
To Avert a Serious Threat to Health or Safety.
When necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person, we may use or disclose health information, limiting disclosures to someone able to help lessen or prevent the threatened harm.
Judicial and Administrative Proceedings.
We may disclose your health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.
We may disclose your health information for certain law enforcement purposes, including, for example, to comply with reporting requirements; to comply with a court order, warrant, or similar legal process; or to answer certain requests for information concerning crimes.
We may use or disclose your health information for research purposes if the privacy aspects of the research have been reviewed and approved, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations.
We may release your health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
We may disclose health information about you to a disaster relief organization.
Military, Veterans and other Specific Government Functions.
If you are a member of the armed forces, we may use and disclose your health information as required by military command authorities. We may disclose health information for national security purposes or as needed to protect the President of the United States or certain other officials or to conduct certain special investigations.
We may use or disclose health information if we leave a message to remind you about appointments.
Treatment Alternatives and Health-Related Benefits and Services.
We may use or disclose your health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you.
Uses and disclosures with your authorization.
Except as described in this notice, we will use and disclose your health information only with your written authorization. You may revoke an authorization in writing at any time.
If you revoke an authorization, we will no longer use or disclose your health information for the purposes covered by that authorization, except where we have already relied on the authorization.
Your rights regarding your health information:
Listed below are your rights regarding your health information. Each of these rights is subject to certain requirements, limitations and exceptions. Exercise of these rights may require submitting a written request to Rocky Mountain PACE. At your request, Rocky Mountain PACE will supply you with the appropriate form to complete.
You have the right to:
You have the right to request restrictions on our use of or disclosure of your health information for treatment, payment, or health care operations. This includes the right to submit a written consent limiting the degree of information disclosed and the persons to whom information is disclosed. You also have the right to request restrictions on the health information we disclose about you to a family member, friend, or other person who is involved in your care or the payment for your care. We are not required to agree to your requested restrictions on how we use your health information within Rocky Mountain PACE. We will limit disclosures outside Rocky Mountain PACE (except for disclosures to The Centers for Medicare and Medicaid and the State Administering Agency) in accordance with your written consent. We will grant requests to restrict use of protected health information within Rocky Mountain PACE if they are reasonable and can be accommodated. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.
Access to Personal Health Information.
You have the right to inspect and obtain a copy of your clinical or billing records or other written information that may be used to make decisions about your care, subject to some exceptions. Your request must be made in writing. In most cases we may charge a reasonable fee for our costs in copying and mailing your requested information.
You have the right to request amendment of your health information maintained by Rocky Mountain PACE for as long as the information is kept by or for Rocky Mountain PACE. Your request must be made in writing and must state the reason for the requested amendment.
We may deny your request for amendment if the information (a) was not created by Rocky Mountain PACE, unless the originator of the information is no longer available to act on your request; (b) is not part of the health information maintained by or for Rocky Mountain PACE; (c) is not part of the information to which you have a right of access; or (d) is already accurate and complete, as determined by Rocky Mountain PACE. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial. We will attach your request to your medical record.
Request an Accounting of Disclosures.
You have the right to request an ‘accounting’ of certain disclosures of your health information. This is a listing of disclosures made by Rocky Mountain PACE or by others on our behalf, but does not include disclosures for treatment, payment and health care operations, disclosures made pursuant to your Authorization, and certain other exceptions. To request an accounting of disclosures, you must submit a request in writing, stating a time period that is within six years from the date of your request. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.
Request Confidential Communications.
You have the right to request that we communicate with you concerning your health matters in a certain manner. We will accommodate your reasonable requests. Special rules apply regarding disclosure of psychiatric, substance abuse and HIV-related information. Disclosure of this information will be in compliance with state laws, as noted on the Release of Information form that you signed.
Obtain a Paper Copy.
You have the right to obtain a paper copy of this notice upon request.
Rocky Mountain Health Care Services’ Right to Modify Notice Terms.
We reserve the right to change the terms of this notice and to make the new Notice provisions effective for all the Personal Health Information it maintains. Rocky Mountain PACE will provide participants with a revised notice by mail.
For further information or to file a complaint:
If you have any questions about this Notice of Privacy Practices or would like further information concerning your privacy rights, please contact Kim Lopez of Rocky Mountain PACE. If you believe that your privacy rights have been violated, you may file a complaint in writing with Rocky Mountain PACE or with the Office for Civil Rights in the U.S. Department of Health and Human Services at 1.866.627.7748 / TTY 303.894.7832. We will not retaliate against you if you file a complaint.
To file a complaint with Rocky Mountain PACE, please contact:
Kim Lopez, Quality and Compliance Officer
2502 E. Pikes Peak Ave.
Colorado Springs, CO 80909
Regular Business Hours and After Business Hours 719-314-2327.
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