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A Medicare and Joint Commission
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 The Joint Commission

Doctor's Choice Privacy Policy PRIVACY POLICY & CORPORATE COMPLIANCE


Notice of Privacy Practices

This Notice is effective on April 14, 2003

WE ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOU1 YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to protect the privacy of medical information about you and that identifies you. This medical information may be information about health care we provide to you or payment for health care provided to you. It may also be information about your past, present or future medical condition. We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical information in the manner that which we have described in this Notice. We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all medical information that we maintain. If we make changes to the Notice, we will:

  • Have copies of the new Notice available upon request.

The rest of this Notice will:

  • Discuss how we may use and disclose medical information about you.
  • Explain your rights with respect to medical information about you.
  • Describe how and where you may file a privacy-related compliant.

If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact our Agency at (941) 925-5900.


Privacy Act Statement - Health Care Records

THIS STATEMENT GIVES YOU ADVICE REQUIRED BY LAW (THE PRIVACY ACT OF 1974)

THIS STATEMENT IS NOT A CONSENT FORM. IT WILL NOT BE USED TO RELEASE OR TO USE YOUR HEALTH CARE INFORMATION

I. Authority for collection of your information, including your Social Security Number, and whether or not you are required to provide information for this assessment Sections 1102(a), 1154,1861(0), 1861(z), 1863,1865,1866,1871,1891(b) of the Social Security Act.

Medicare and Medicaid participating home health agencies must do a complete assessment that accurately reflects your current health and includes information that can be used to show your progress toward your health goals. The home health agency must use the "Outcome and Assessment lnformation Set" (OASIS) when evaluating your health. To do this, the agency must get information from every patient. This information is used by the Center for Medicare and Medicaid Services to be sure that the home health agency meets quality standards and gives appropriate health care to its patients. You have the right to refuse to provide information for the assessment to the home health agency. If yours is included in an assessment, it is protected under the federal Privacy Act of 1974 and the "Home Health Agency Outcome and Assessment lnformation Set" (HHA OASIS) System of Records.

II. Principal purposes for which your information is intended t o be used.

The information collected will be entered into the Home Health Agency Outcome and Assessment lnformation Set (HHA OASIS) System No. 09-70-9002. Your health care information in the HHA OASIS System of Records will be used for the following purposes:

  • Support litigation involving the Center for Medicare and Medicaid Services;
  • Support regulatory, reimbursement, and policy functions preformed within the Center for Medicare and Medicaid Services or by contractor or consultant;
  • Study the effectiveness and quality of care provided by those home health agencies;
  • Provide for development, validation, and refinement of a Medicare prospective payment system;
  • Enable regulators to provide home health agencies with data for their internal quality improvement activities;
  • Support research, evaluation, or epidemiological projects related to the prevention of disease or disability or the restoration or . maintenance of health, and for health care payment related projects;
  • and Support constituent requests made to a Congressional representative.

III. Routine Uses

These "routine uses" specify the circumstances when the Center for Medicare and Medicaid Services may release your information from the HHA OASIS System of Records without your consent. Each prospective recipient must agree in writing to ensure the continuing confidentiality and security of your information. Disclosures of the information may be to:

  • The federal Department of Justice for litigation involving the Center for Medicare and Medicaid Services;
  • Contractors or consultants working for the Center for Medicare and Medicaid Services to assist in the performance of a service related t this system of records and who need to access these records to perform the activity;
  • An agency of a State government for purposes of determining, evaluating, and/or assessing cost, effectiveness, and/or quality of health care services provided in the State; for developing and operating Medicaid reimbursement systems; or for the administration of Federal/State home health agency programs within the State;
  • Another Federal or State agency to contribute to the accuracy of the Center for Medicare and Medicaid Services' health insurance operations (payment, treatment, and coverage) and/or to support State agencies in the evaluations and monitoring of care provided by HHAs;
  • Peer Review Organizations, to perform Title XI or Title XVlll functions relating to assessing and improving home health agency quality of care;
  • An individual or organization for a research evaluation, or epidemiological project related to the prevention of disease or disability, the restoration or maintenance of health, or payment related projects;
  • A congressional office in response to a constituent inquiry made at the written request of the constituent about whom the record is maintained.

IV.  Effect on you, if you do not provide information

The home health agency needs the information contained in the Outcome and Assessment Information Set in order to give you quality care. It is important that the information be correct. Incorrect information also could make it hard to be sure that the agency is giving you quality services. I you choose not to provide information, there is no federal requirement for the home health agency to refuse you service.

NOTE: This statement may be included in the admission packet for all new home health agency admissions. Home health agencies may request yc or your representative to sign this statement to document that this statement was given to you. YOUR SIGNATURE IS NOT required. If you or your representative signs the statement, the signature merely indicates that you received this statement. You or your representative must be supplied with a copy of this statement.

Contact Information

If you want to ask the Center for Medicare and Medicaid Services to see, review, copy, or correct your personal health information which that Federal agency maintains in its HHA OASIS System of Records; Call 1-800-MEDICARE (1-800-633-4227), toll-free, for assistance in contacting the HHA OASIS System Manager. TTY for the hearing and speech impaired: 1-877-486-2048.


WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES

We use and disclose medical information about patients everyday. This section of our Notice explains in some detail how we may use and disclose medical information about you in order to provide health care, obtain payment for that health care, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose medical information about you.

1. Treatment

We may use and disclose medical information about you to provide health care treatment to you. In other words, we may use and disclose medic information about you to provide, coordinate or manage your health care and related services. This may include communicating with other heall care providers regarding your treatment and coordinating and managing your health care with others.

2. Payment

We may use and disclose medical information about you to obtain payment for health care services that you received. This means that, within th health department, we may use medical information about you to arrange for payment (such as preparing bills and managing accounts). We also may disclose medical information about you to others (such as insurers, collection agencies, and consumer reporting agencies). In some in instances, we may disclose medical information about you to an insurance plan before you receive certain health care services because, for example, we may want to know whether the insurance plan will pay for a particular service.

3. Health Care Operations

We may use and disclose medical information about you in performing a variety of business activities that we call "health care operations". These "health care operations" activities allow us to, for example, improve the quality of care we provide and reduce health care costs. For example, we may use or disclose medical information about you in performing the following activities:

  • Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
  • Providing training programs for students, trainees, health care providers or non-health care professionals to help them practice or improve their skills.
  • Cooperating with outside organizations that evaluate, certify or license health care providers, staff or facilities in a particular field or specialty.
  • Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients.
  • Improving health care and lowering costs for groups of people who have similar health problems and helping manage and coordinate the care for these groups of people.
  • Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and private organizations.
  • Planning for our organization's future operations.
  • Resolving grievances within our organization.
  • Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes.
  • Working with others (such as lawyers, accountants, and other providers) who assist us to comply with this Notice and other applicable laws.

4. Persons Involved in Your Care

We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care and the information is relevant to your care.

We may also use or disclose medical information about you to a relative, another person involved in your care or possibly a disaster relief organization (such as Red Cross) if we need to notify someone about your location or condition.

You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree to your request and not disclose information except in certain limited circumstances (such as emergencies).

5. Required by Law

We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require us to use and disclose medical information. For example, state law requires us to report gunshot wounds and other injuries to the police and to report known or suspected abuse or neglect to the department of Social Services. We will comply with those state laws and with all other applicable laws.

6. National Priority Uses and Disclosures

When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as "national priorities". In other words, the government has determined that under certain circumstances (described below), it is so important to disclose medical information that it is acceptable to disclose medical information without the individual's permission. We will only disclose medical information about you in the following circumstances when we are permitted to do so by law. Below are brief descriptions of the "national priority" activities recognized by law.

  • Threat to health or safety: we may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety.
  • Public health activities: We may use or disclose medical information about you for public health activities. Public health activities require the use of medical information for various activities, including, but not limited to, activities related to investigating diseases, reporting child abuse and neglect, monitoring drugs or devices regulated by the Food and Drug Administration, and monitoring work-related illnesses or injuries. For example, if you have been exposed to a communicable disease (such as a sexually transmitted disease), we may report it to the State and take other actions to prevent the spread of disease.
  • Abuse, neglect or domestic violence: We may disclose medical information about you to a government authority (such as the Department of Social Services) if you are an adult and we are reasonable believe that you may be a victim of abuse, neglect or domestic violence.
  • Health oversight activities: We may disclose medical information about you to health oversight agency - which is basically an agency responsible for overseeing the health care system or certain government programs. For example, a government agency may request information from us while they re investigating possible insurance fraud.
  • Court proceedings: We may disclose medical information about you to a court or an officer of the court (such as an attorney). For example, we would disclose medical information about you to a court if a judge orders us to do so.
  • Law enforcement: We may disclose medical information about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or identify a missing person.
  • Coroners and others: We may disclose medical information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye and tissue transplants.
  • Worker's compensation: We may disclose medical information about you in order to comply with workers' compensation laws.
  • Research organizations: We may use or disclose medical information about you to research organizations if the organization has satisfied certain conditions about protecting the privacy of medical information.
  • Certain government functions: We may use or disclose medical information about you for certain government functions, including but not limited to military and veterans' activities and national security and intelligence activities. We may also use or disclose medical information about you to a correctional institution in some circumstances.

7. Authorization

Other that the uses and disclosures described above (#I-6), we will not use or disclose medical information about you without the "authorization" or signed permission of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask to disclose medical information and we will ask you to sign and authorization form. If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization or fill out an Authorization Revocation Form. Authorization Revocation Forms are available from our Privacy Officer. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action.


YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU

  1. Right to a Copy of This Notice: You have the right to have a paper copy of our Notice of Privacy Practice at any time. If you would bike to have a copy of our Notice, please call our office at (941) 925-5900
  2. Right of Access to Inspect and Copy: You have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person. If you would like a copy of this information we may charge a fee to cover the costs of the copy. We may be able to provide you with a summary or explanation of the information. Contact our office for more information on these services and any possible additional fees.
  3. Right to have Medical Information Amended: You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain groups or records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with the request in writing and explain why you would like us to amend the information. You may either write us a letter requesting an amendment or fill out an Amendment Request Form. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future.
  4. Right to an Accounting Disclosures We have Made: You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive an accounting, you may send us a letter requesting an accounting, fill out an Accounting Request Form, or contact our office. The accounting will not include several types of disclosures, including disclosures for treatment, payment or health care operations. It will also not include disclosures made prior to April 14,2003. If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting.
  5. Right to Request Restrictions on Uses and Disclosures: You have the right to request that we limit the use and disclosures of medical information about you for treatment, payment and health care operations. We are not required to agree to your request. If we do agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.
  6. Right to Request an Alternate Method of Contact: You have the right to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to a different address rather than your home address. We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternate method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative Contact Request Form. Alternative Contact Request Forms are available from our office.


YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with our Agency at (941) 925-5900 or with the Federal Government at 1- 888-419-3456 Monday through Friday, 8:00 a.m. - 5:00 p.m.

We will NOT take any action against you or change our treatment of you in any way if you file a compliant.

To file a compliant with the Federal Government, you may send your compliant to the Office of Civil Rights in the U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Washington, DC 20201.


CORPORATE COMPLIANCE PROGRAM

Doctor's Choice Home Care, Inc. has adapted a code of ethics and business conduct that summarizes the virtues and principles that guide our actions in providing quality care. We believe the following principles are essential to our work practice, respect, trust, honesty, integrity, responsibility and citizenship. You have the right and responsibility to express concerns, dissatisfactions or make complaints about services you receive or do not receive without fear of reprisal or discrimination. We, at Doctor's Choice Home tare, Inc. encourage you to discuss all concerns and complaints with us. The following are examples of issues that should be brought to our attention:

  • Criminal acts
  • Conflicts of Interest
  • Theft and Fraud
  • Health and Safety Issues
  • Discrimination
  • Bribes and Kickbacks
  • Harassment
  • Patient Rights
  • Confidentiality
  • Substance Abuse

The Agency has a formal grievance procedure that ensures that your concerns shall be reviewed and an investigation started within 24 hours. Every attempt shall be made to resolve all grievances within 7 days. You will be kept informed by telephone of the status of the investigation and receive a written report when resolution is determined. If you feel the need to discuss your concerns, dissatisfaction or complaints with other that Doctor's Choice Home Care, Inc. staff, the State provides a Home Health "Hot Line" at 1-888-419-3456, Monday through Friday, 8:00 a.m. - 5:00 p.m.


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