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.
You are receiving health care at a facility that
is part of Munson Healthcare. We at Munson Home Health are required
by law to maintain the privacy of individually identifiable patient
health information (this information is "protected health
information" and is referred to herein as "PHI").
We are also required to provide patients with a Notice of Privacy
Practices regarding PHI. We are required to post this Notice in
a prominent place within our facility. We will only use or disclose
your PHI as permitted or required by applicable state law. This
Notice applies to your PHI in our possession including the medical
records generated by us.
Munson Home Health understands that your health
information is highly personal, and we are committed to safeguarding
your privacy. Please read this Notice of Privacy Practices thoroughly.
It describes how Munson Home Health will use and disclose your
PHI.
This Notice applies to the delivery of health care
by Munson Home Health and its medical staff. This Notice also
applies to the utilization review and quality assessment activities
of Munson Healthcare and Munson Home Health as a member of Munson
Healthcare.
I. Permitted Use or Disclosure
A. Treatment: Munson Home Health will use
and disclose your PHI in the provision and coordination of health
care to carry out treatment functions.
Munson Home Health will disclose all or any portion
of your patient medical record information to your attending physician,
consulting physician(s), nurses, pharmacists, technicians, medical
students, dieticians, spiritual/ethical care providers, and other
health care providers who have a legitimate need for such information
in your care and continued treatment.
Different departments will share medical information
about you in order to coordinate specific services, such as lab
work, x-rays and prescriptions.
Munson Home Health also will disclose your medical
information to people or entities outside Munson Home Health who
will be involved in your medical care after you leave Munson Home
Health, such as other care providers and family who will provide
services that are part of your care.
We will share certain information such as your name,
address, employment, insurance carrier, emergency contact information
and appointment scheduling information in an effort to coordinate
your treatment with us and with other health care providers.
Munson Home Health will use and disclose your PHI
to inform you of, or recommend possible treatment options or alternatives
that will be of interest to you.
Munson Home Health will use and disclose PHI to
contact you as a reminder that you have an appointment for treatment
or medical care at Munson Home Health.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, Munson Home
Health will disclose your PHI to the correctional institution
or law enforcement official.
B. Payment: Munson Home Health will disclose
PHI about you for the purposes of determining coverage, eligibility,
funding, billing, claims management, medical data processing,
stop loss/reinsurance and reimbursement.
The medical information will be disclosed to an insurance company,
third party payer, third party administrator, health plan or other
health care provider (or their duly authorized representatives)
involved in the payment of your medical bill and will include
copies or excerpts of your medical records which are necessary
for payment of your account. It will also include sharing the
necessary information to obtain pre-approval for payment for treatment
from your health plan.
The medical information may also be released to
independent health care providers who were involved in your treatment
(for example, Emergency Room physicians and Radiologists who are
not employed by Munson Home Health) or emergency delivery (via
ambulance service) to Munson Home Health so that they may seek
payment for caring for you.
Munson Home Health will disclose PHI to collection agencies and
other subcontractors engaged in obtaining payment for care.
C. Health Care Operations: Munson Home Health
will use and disclose your PHI during routine health care operations
including quality review, utilization review, medical review,
internal auditing, accreditation, certification, licensing or
credentialing activities of Munson Home Health, and for educational
purposes.
For instance, we will need to share your demographic information,
diagnosis, treatment plan and health status for population based
activities relating to improving health or reducing health care
costs, protocol development, case management and care coordination,
and contacting health care providers and patients with information
about treatment alternatives, in order for us to operate our business
in an efficient, safe and legal manner.
Munson Home Health may also use and disclose your
PHI to support the sale, transfer, or other corporate restructuring
of Munson Home Health's assets.
D. Other Uses and Disclosures: As part of
treatment, payment and health care operations, we may also use
your PHI for the following purposes:
Fundraising Activities: with the exception
of mental health and substance abuse PHI, Munson Home Health will
use and may also disclose some of your PHI to a related foundation
for certain fund raising activities. For example, Munson Home
Health will use your demographic information (e.g., name, address
and other contact information, age, gender, and insurance status)
and the dates Munson Home Health provided service to you. Any
communication sent to you will let you know how you may opt out
of receiving similar communications in the future. Munson Home
Health may disclose limited PHI to a company contracted to conduct
fundraising for Munson Home Health. This company will use your
PHI only for the purposes of fundraising for Munson Home Health.
(If you wish to opt-out, you may do so by contacting the Privacy
Official.)
Medical Research: Munson Home Health may disclose your PHI without
your Authorization to medical researchers who request it for approved
medical research projects; however, with very limited exceptions
such disclosures must be cleared through a special approval process
before any PHI is disclosed to the researchers. Researchers will
be required to safeguard the PHI they receive.
Information and Health Promotion Activities:
with the exception of mental health and substance abuse PHI, Munson
Home Health will use and disclose some of your PHI for certain
health promotion activities. For example, your name and address
will be used to send you newsletters or general communications.
We may send you cards for relevant events such as the birth of
your child. We will also send you information based on your own
health concerns. We may send you this information if we have determined
that a product or service may help you. The communication will
explain how the product or service relates to your well being
and can improve your health.
E. More Stringent State and Federal Laws:
The State law of Michigan is more stringent than HIPAA in several
areas. State law is more stringent when the individual is entitled
to greater access to records than under HIPAA and when under state
law the records are more protected from disclosure than under
HIPAA. Certain federal laws also are more stringent than HIPAA.
Munson Home Health will continue to abide by these more stringent
state and federal laws. The federal laws include applicable internet
privacy laws, such as the Children's Online Privacy Protection
Act and the federal laws and regulations governing the confidentiality
of health information regarding substance abuse treatment.
In Michigan patients have more rights of access
to behavioral health information under Michigan law than under
HIPAA and the state law defines a minimum necessary standard for
release of mental health information. Disclosure is permitted
with consent and for treatment without consent but only in an
emergency. Minors in Michigan have more rights to confidentiality
and protection of certain information (reproductive health, behavioral
health and substance abuse) than under HIPAA. State law requires
facilities to adopt policies regarding release of information
outside the facility. If the facility policy requires consent
for release, then consent will be required. State law genetic
and HIV testing and disclosure consents remain in place.
II. Permitted Use or Disclosure with an Opportunity
for You to Agree or Object
A. Family/Friends: Munson Home Health will
disclose PHI about you to a friend or family member who is involved
in your medical care. We will also give information to someone
who helps you pay for your care. In addition, we will disclose
PHI about you to an agency assisting in a disaster relief effort
so that your family can be notified about your condition, status
and location. You have a right to request that your PHI not be
shared with some or all of your family or friends.
B. Promotional Communications: Munson Home
Health does not share or sell your PHI to companies that market
health care products or services directly to consumers for use
by those companies to contact you, such as drug companies. Munson
Home Health does maintain a database of individuals for promotional
communications, disease management, health promotion, and fundraising
purposes. This database includes individuals to whom we may have
sent health improvement materials and news about Munson Home Health
previously and also individuals who have donated to Munson Home
Health or who have expressed an interest in donating to Munson
Home Health or other health-related activities. You may be included
in this database. Munson Home Health sends information to the
individuals in this database about the programs and services of
Munson Home Health. If you wish to be deleted from this database,
you may notify the Privacy Official.
C. Media Conditions Reports: Munson Home
Health may release information for an update to the media if the
media requests information about you using your full name and
after we have given you an opportunity to agree or object. The
following information may then be disclosed: your condition described
in general terms that do not communicate specific medical information,
such as "good", "fair", "serious",
or "critical".
III. Use or Disclosure Requiring Your Authorization
A. Marketing: Munson Home Health is not permitted
to provide your PHI to any other person or company for marketing
to you of any products or services other than Munson Home Health's
products or services unless you have signed an authorization.
B. Research: Munson Home Health will use
or disclose your PHI as part of research that includes providing
you with treatment. For example, if you are part of a research
study that includes treatment, we may require that you sign an
authorization to allow the researchers to use or disclose your
PHI for this research.
C. Other Uses: Any uses or disclosures that
are not for treatment, payment or operations and that are not
permitted or required for public policy purposes or by law will
be made only with your written authorization. Written authorizations
will let you know why we are using your PHI. You have the right
to revoke an authorization at any time, except to the extent that
Munson Home Health has taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public Policy
or Law without your Authorization
A. Law Enforcement Purposes: Munson Home
Health will disclose your PHI for law enforcement purposes as
required by law, such as responding to a court order or subpoena,
identifying a criminal suspect or a missing person, or providing
information about a crime victim or possible criminal conduct
as part of a criminal investigation.
Required by Law: Munson Home Health will
disclose PHI about you when required by federal, state or local
law to make reports or other disclosures. Munson Home Health also
will make disclosures for judicial and administrative proceedings
such as lawsuits or other disputes in response to a court order
or subpoena. Munson Home Health will disclose your medical information
to government agencies concerning victims of abuse, neglect or
domestic violence. Munson Home Health will report drug diversion
and information related to fraudulent prescription activity to
law enforcement and regulatory agencies. Specialized government
functions will warrant the use and disclosure of PHI. These government
functions will include military and veteran's activities, national
security and intelligence activities, and protective services
for the President and others. Munson Home Health will make certain
disclosures that are required in order to comply with workers'
compensation or similar programs.
B. Coroners, Medical Examiners, Funeral Directors:
Munson Home Health will disclose your PHI to a coroner or medical
examiner. For example, this will be necessary to identify a deceased
person or to determine a cause of death. We will also disclose
your medical information to funeral directors as necessary to
carry out their duties.
C. Organ Procurement: Munson Home Health
will disclose PHI to an organ procurement organization or entity
for organ, eye or tissue donation purposes when donation has been
authorized or to verify that appropriate organ procurement procedures
were followed.
D. Health or Safety: Following the requirements
of the Michigan Department of Commerce, Munson Home Health will
use and disclose PHI to avert a serious threat to health and safety
of a person or the public. Munson Home Health will use and disclose
PHI to Public Health Agencies for immunizations, communicable
diseases, etc. Munson Home Health will use and disclose PHI for
activities related to the quality, safety or effectiveness of
FDA-regulated products or activities, including collecting and
reporting adverse events, tracking and facilitating product recalls,
etc. and post marketing surveillance. Any patient receiving a
medical device subject to FDA tracking requirements may refuse
to disclose, or refuse permission to disclose, their name, address,
telephone number and social security number, or other identifying
information for the purpose of tracking.
V. Your Health Information Rights
Although we at Munson Home Health must maintain
all records concerning your treatment by Munson Home Health, you
have the following rights concerning your PHI:
A. Right to Inspect and Copy: You have the
right to access your PHI and to inspect and have a copy made of
your PHI as long as we maintain it except for: psychotherapy notes,
information that may be used in anticipation of, or that will
be used in a civil, criminal or administrative action or proceeding,
and where prohibited or protected by law. Munson Home Health will
deny your request for access to your PHI without giving you an
opportunity to review that decision if:
You don't have the right to inspect the information;
or it is otherwise prohibited or protected by law;
You are an inmate at a correctional institution
and obtaining a copy of the information would risk the health,
safety, security, custody or rehabilitation of you or other
inmates;
The disclosure of the information would threaten
the safety of any officer, employee or other person at the correctional
institution or who is responsible for transporting you;
You are involved in a clinical research project
and Munson Home Health created or obtained the PHI during that
research. Your access to the information will be temporarily
suspended for as long as the research is in progress;
Munson Home Health obtained the information that
you seek access to from someone other than the health care provider
under a promise of confidentiality and your access request is
likely to reveal the source of the information; or
Under other limited circumstances. In these instances,
however, Munson Home Health will allow the review of its decision
by a health care professional that Munson Home Health has chosen.
This person will not have been involved in the original decision
to deny your request.
You agree to pay a reasonable copying charge. You
must make your requests to access and copy your PHI in writing
to Munson Home Health. We will respond to your request within
30 days of its receipt. If we cannot, we will notify you in writing
to explain the delay and the date by which we will act on your
request. In any event, we will act on your request within 60 days
of its receipt.
B. Right to Amend: You have the right to
amend your PHI for as long as Munson Home Health maintains it.
However, we will deny your request for amendment if:
Munson Home Health did not create the information;
The information is not part of the designated
record set;
The information would not be available for your
inspection (due to its condition or nature); or
The information is accurate and complete.
If Munson Home Health denies your request for changes
in your PHI, we will notify you in writing with the reason for
the denial. We will also inform you of your right to submit a
written statement disagreeing with the denial. You may ask that
we include your request for amendment and the denial any time
that Munson Home Health discloses the information that you wanted
changed. Munson Home Health may prepare a rebuttal to your statement
of disagreement and will provide you with a copy of that rebuttal.
You must make your request for amendment of your
PHI in writing to Munson Home Health, including your reason to
support the requested amendment. We will respond to your request
within 60 days of its receipt. If we cannot, we will notify you
in writing to explain the delay and the date by which we will
act on your request. In any event, we will act on your request
within 90 days of its receipt.
C. Right to an Accounting: You have a right
to receive an accounting of the disclosures of your PHI that Munson
Home Health made, except for the following disclosures:
To carry out treatment, payment or health care
operations;
To you;
To persons involved in your care;
For national security or intelligence purposes;
To correctional institutions or law enforcement
officials in custodial situations; or
That occurred prior to April 14, 2003.
For each disclosure, you will receive: the date
of the disclosure, the name of the receiving organization and
address if known, a brief description of the PHI disclosed and
a brief statement of the purpose of the disclosure or a copy of
the written request for the information, if there was one.
You must make your request for an accounting of
disclosures of your PHI in writing to Munson Home Health. You
must include the time period of the accounting, which may not
be longer than 6 years. We will respond to your request within
60 days from its receipt. If we cannot, we will notify you in
writing to explain the delay and the date by which we will act
on your request. In any event, we will act on your request within
90 days of its receipt.
In any given 12-month period, Munson Home Health
will provide you with an accounting of the disclosures of your
PHI at no charge. Any additional requests for an accounting within
that time period will be subject to a reasonable fee for preparing
the accounting.
D. Right to Request Restrictions: You have
the right to request restrictions on certain uses and disclosures
of your PHI:
To carry out treatment, payment or health care
operations functions;
Restricting specific information to only specified
family members, relatives, close personal friends or other individuals
involved in your care; or
Limited information in the facility directory.
For example, you may ask that your name not be used
in the waiting room or that information about your expected discharge
date not be shared with your family. We will consider your request
but are not required to agree to the requested restrictions.
E. Right to Confidential Communications:
You have the right to receive confidential communications of your
PHI by alternative means or at alternative locations. For example,
you may request that we only contact you at work or by mail. We
will make every attempt to honor your request, but we reserve
the right to deny unreasonable requests.
F. Right to Receive a Copy of this Notice:
You have the right to receive a paper copy of this Notice of Privacy
Practices, upon request.
VI. Complaints
If you believe your privacy rights have been violated,
you may file a complaint with Munson Home Health or with the Secretary
of the Department of Health and Human Services. To file a complaint
with Munson Home Health, please contact Munson Home Health's Quality
Coordinator, at:
1105 6th Street
Traverse City, MI 49684 (800) 252-2065
All complaints must be submitted in writing directly
to Munson Home Health's Quality Coordinator. Munson Home Health
assures you that there will be no retaliation for filing a complaint.
VII. Sharing and joint use of your Health Information
In the course of providing care to you and in furtherance
of Munson Home Health's mission to improve the health of the community,
Munson Home Health will share your PHI with other organizations
as described below who have agreed to abide by the terms described
below:
A. Medical Staff: The medical staff and Munson
Home Health participate together in an organized health care arrangement
to deliver health care to you. Munson Home Health and its medical
staff have agreed to abide by the terms of this Notice with respect
to PHI created or received as part of delivery of health care
services to you in Munson Home Health. Physicians and allied health
care providers are members of Munson Home Health's medical staff
and will have access to and use your PHI for treatment, payment
and health care operations purposes related to your care within
Munson Home Health. Munson Home Health will disclose your PHI
to the medical staff for payment, treatment and health care operations.
B. Business Associates: Munson Home Health
will use and disclose your PHI to business associates contracted
to perform business functions on its behalf including Munson Healthcare,
who performs certain business functions for Munson Home Health.
Whenever an arrangement between Munson Home Health and another
company involves the use or disclosure of your PHI, that business
associate will be required to keep your information confidential.
C. Membership in Munson Healthcare: Munson
Home Health, members of Munson Healthcare and Munson Healthcare
participate together in an organized health care arrangement for
utilization review and quality assessment activities. We have
agreed to abide by the terms of this Notice with respect to PHI
created or received as part of utilization review and quality
assessment activities of Munson Healthcare and its members. Members
of Munson Healthcare will abide by the terms of their own Notice
of Privacy Practices in using your PHI for treatment, payment
or healthcare operations. As a part of Munson Healthcare, Munson
Home Health and other hospitals, nursing homes, and health care
providers in Munson Healthcare share your PHI for utilization
review and quality assessment activities of Munson Healthcare,
the parent company, and its members. Members of Munson Healthcare
also use your PHI for your treatment, payment to Munson Home Health
and/or for the health care operations permitted by HIPAA with
respect to our mutual patients.
VIII. Additional Information
For further information regarding the subjects covered
in this Notice of Privacy Practices, please contact Munson Healthcare's
Privacy Official at (231) 935-2335.
IX. Changes to this Notice
Munson Home Health will abide by the terms of the
Notice currently in effect. Munson Home Health reserves the right
to change the terms of its Notice and to make the new Notice provisions
effective for all PHI that it maintains. Munson Home Health will
provide you with the revised Notice at your first visit following
the revision of the Notice.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
