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.
Arbor Hospice understands that medical information about you and your health is personal and we are committed to protecting your medical information. This notice applies to all of the records of your care generated by Arbor Hospice and this notice will tell you ways in which we may use and disclose your medical information.
USE AND DISCLOSURE OF PHI
Arbor Hospice may use and disclose your health information, information that constitutes protected health information (PHI) as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Arbor Hospice has established policies to guard against unnecessary use and disclosure of your PHI. This Notice describes how we protect your PHI and what rights you have regarding your PHI.
Organized Health Care Arrangement. In our facility, care and services are provided to you by our Agency staff as well as by other health care providers. Although these providers are all independent, as you would expect they cooperate to provide an integrated system of care to you. This type of clinically integrated setting in which you receive health care from more than one health care provider is called an organized health care arrangement ("OHCA") under the HIPAA Privacy Standards. We may share your PHI with participants in the OHCA for treatment, payment and health care operations of the OHCA. This Notice of Privacy Practices is being provided on behalf of Arbor Hospice, Arbor Palliative Care and any physician who serves as a Medical Director for the Agency that provides services for Arbor Hospice and Arbor Palliative Care patients.
Arbor Hospice will comply with the more stringent Michigan state law and/or Federal Regulations that place restrictions on the use and disclosure pertaining of PHI related to HIV/AIDS, mental health, substance abuse and genetic testing. In some instances, your specific authorization may be required.
Treatment, Payment and Health Care Operations
The most common reason we use your PHI is for treatment, payment or health care operations.
To Provide Treatment. We may use your PHI to provide hospice services and to coordinate your care with others involved in your care, such as your attending physician, members of the interdisciplinary team and other health care professionals who have agreed to assist us in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Unless you object, we may disclose your health care information to individuals outside of the Agency involved in your care, including family members, clergy who you have designated, pharmacists, suppliers of medical equipment, consultant physicians or other health care professionals.
To Obtain Payment. We may include your PHI in invoices to collect payment from third parties for the care you receive from us. For example, we may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Arbor Hospice. We also may need to obtain prior approval from your insurer and may need to explain to the insurer your need and the services that will be provided to you.
To Conduct Health Care Operations. We may use and disclose minimum necessary PHI about you in order to facilitate the function and operation of the Agency and as necessary to provide quality care to all of the Agency's patients. Health care operations includes such activities as:
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care costs.
- Training programs including those in which students, trainees or practitioners in health care learn under supervision.
- Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
For example we may use your PHI to evaluate staff performance, combine your PHI with other Agency patients in evaluating how to more effectively serve all Agency patients, and disclose your PHI to our staff and contracted personnel for training purposes.
OTHER USES AND DISCLOSURES NOT REQUIRING AN AUTHORIZATION
Inclusion in Patient Directory. We may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in the Agency's facility in a directory if you are in The Residence inpatient facility. We may disclose this information to people who ask for you by name. Please inform us if you do not want your information to be included in the directory.
For Appointment Reminders. We may use and disclose your PHI to contact you as a reminder that you have an appointment for a home visit. Unless you object, we will use post cards for this purpose or leave messages for you on an answering machine or with someone who answers the telephone in your place of residence.
For Treatment Alternatives. We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Business Associates. We will disclose your PHI to Business Associates that are contracted to perform business functions on our behalf. Whenever an arrangement between Arbor Hospice and a Business Associate involves the use or disclosure of your PHI, that Business Associate will be required to keep your PHI confidential. Business Associates are permitted to use your PHI only for purposes authorized by Arbor Hospice.
Individuals Involved in Your or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care or responsible for the payment for your health care, unless you object in whole or in part. We may disclose medical information about you to a friend or family member should an emergent situation arise while you are in our care.
Incidental Disclosures. An authorization is not needed to cover disclosure of your PHI that is an unavoidable by-product of permitted use and disclosure.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR PHI MAY ALSO BE USED AND DISCLOSED
When Legally Required. We will disclose your PHI when it is required to do so by any Federal, State or local law.
When There Are Risks to Public Health and Safety. We may disclose your PHI for public activities and purposes in order to:
- Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
- Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
- Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease, if such notification is authorized by law.
To Report Abuse, Neglect Or Domestic Violence. We are allowed to notify government authorities if the Agency believes a patient is the victim of abuse, neglect or domestic violence. Arbor Hospice will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
To Conduct Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, we may not disclose your PHI if you are the subject of an investigation and your PHI is not directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when the Agency makes reasonable efforts to either notify you about the request or to obtain an order protecting your PHI.
For Law Enforcement Purposes. As permitted or required by State law, we may disclose your PHI to a law enforcement official for certain law enforcement purposes as follows:
- As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime.
- To a law enforcement official if the Agency has a suspicion that your death was the result of criminal conduct including criminal conduct at Arbor Hospice.
- In an emergency in order to report a crime.
To Coroners And Medical Examiners. We may disclose your PHI to coroners and medical examiners for purposes of determining your cause of death, identifying a deceased person or for other duties, as authorized by law.
To Funeral Directors. We may disclose your PHI to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, we may disclose your PHI prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
In the Event of A Serious Threat To Health Or Safety. We may, consistent with applicable law and ethical standards of conduct, disclose your PHI if the Agency, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize Arbor Hospice to use or disclose your PHI to:
- Military command authorities for veterans or members of any armed forces,
- National security and authorized federal officials for intelligence actvities,
- Protective services for the President and others,
- And law enforcement custody for the institution to provide you with health care; to protect your health and safety or the health and safety of others and security of the correctional institution.
For Worker's Compensation. Arbor Hospice may release your PHI for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE PHI
Other than is stated above, Arbor Hospice will not disclose your PHI other than with your written authorization. If you or your representative authorizes Arbor Hospice to use or disclose your PHI, you may revoke that authorization in writing at any time. If you revoke your permission, we will no longer use or disclose your PHI for the reasons in your written authorization. We are unable to take back any disclosures we have already made with your permission, and we are required to retain our records of the care that we provided to you.
For Research Purposes. The Agency will obtain a written authorization from you before it discloses your protected PHI for research purposes, unless the information is needed only for activities in preparation of research, the information is about deceased people or the Agency has received a copy of a proper waiver of authorization from an Institutional Review Board or Privacy Board in compliance with HIPAA.
For Fundraising Activities. The Agency may use and disclose demographic information about you (such as your name, address, and phone number), including the dates of health care provided to you by Arbor Hospice, in order to contact you or your personal representative in the future to raise money for our Agency. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, please notify the Privacy Official, (734) 662-5999 extension 158. The Agency will include in all its fundraising materials information about how you may opt out or let the Agency know that you do not want to be contacted for the Agency's fundraising. The Agency will obtain a written authorization from you before it uses any other protected PHI about you in fundraising.
For Marketing Purposes. Marketing means any communication by the Agency that encourages the person receiving the communication (recipient) to purchase our services. The Agency will obtain a written authorization from you before it uses or discloses your PHI in making a communication about a product or service that encourages the recipient to buy or use our service, or before making an arrangement with another entity under which the Agency receives direct or indirect payment from the entity in exchange for disclosing your PHI for marketing purposes by that entity. In other words, arrangements to use or sell your protected PHI for marketing are prohibited unless you give authorization for the Agency to do so, except when we market our own products or services, when the marketing communication is made as part of treatment, case management or care coordination, when we talk to you face to face or when we distribute promotional gifts of nominal value to you.
YOUR RIGHTS WITH RESPECT TO YOUR PHI
You have the following rights regarding your PHI that Arbor Hospice maintains:
- Right to request restrictions. You may request restrictions or limitations on the PHI we use and disclose for treatment, payment or health care operations. This request must be in writing to the individual and address at the end of this Notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. Arbor Hospice is not required to agree to your restriction request.
- Right to receive confidential communications involving your PHI. You have the right to request that Arbor Hospice communicate with you in a certain way or location. For example, you may ask that we only conduct communications pertaining to your PHI with you privately with no other family members present, or mail PHI to a Post Office Box rather than your home. If you wish to receive confidential communications, please contact the individual and address at the end. Arbor Hospice will not request that you provide any reasons for your request and will attempt to honor your requests for confidential communications so long as we can easily provide it in the format you requested.
- Right to Restrict Release of Information for Certain Services. You have the right to restrict the disclosure of information regarding services for which you have paid in full or on an out of pocket basis. This information can be released only upon your written authorization.
- Right to inspect and receive a copy your PHI. In most cases, you have the right to inspect and receive a copy of your PHI, used by us to make decisions about your care.This includes medical and billing records, but not psychotherapy notes. You must make this request in writing to the individual and address at the end of this Notice. We will respond within 30 days after receiving your written request and we may charge a reasonable fee for copying and assembling. In certain situations, we may deny your request, but we will do so in writing, and provide you with a reason for the denial and how to have the denial reviewed.
- Right to Breach Notification. You or your representative has the right to be notified of any breach or unsecured PHI.
- Right to amend health care information. You or your representative have the right to request that Arbor Hospice amend your records, if you believe that your PHI is incorrect or incomplete. That request may be made as long as the information is maintained by the Agency. A request for an amendment of records must be made in writing to the individual, and address listed at the end. We will respond within 60 days of receiving your request. Arbor Hospice may deny the request if it is: (1) not in writing or (2) does not include a reason for the amendment, (3) if your PHI records were not created by Arbor Hospice, (4) if the records you are requesting are not part of the Agency's records, (5) if the PHI you wish to amend is not part of the PHI you or your representative are permitted to inspect and copy, or (6) if, in the opinion of the Agency, the records containing your PHI are accurate and complete.
- Right to a list of disclosures we have made. You or your representative have the right to request an accounting of disclosures of your PHI made by Arbor Hospice for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the individual and address listed at the end of this Notice. We will respond within 60 days of receiving your request, unless a shorter time period is requested. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. Arbor Hospice would provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
- Right to a paper copy of this notice. You or your representative have a right to request a paper copy of this Notice be mailed to you. Please contact the individual and address below. It is also available at www.arborhospice.org.
Other Uses of Medical Information
DUTIES OF ARBOR HOSPICE
(1) Arbor Hospice is required by law to maintain the privacy of your PHI and to provide to you and your representative this Notice of its duties and privacy practices. (2) Arbor Hospice is required to abide by the terms of this Notice as may be amended from time to time. Arbor Hospice reserves the right to change the terms of its Notice and our privacy policies and to make the new Notice provisions effective for all PHI that it maintains. Any changes will apply to the PHI we already have. (3) If the Agency changes its Notice, Arbor Hospice will provide a copy of the revised Notice to you or your appointed representative while you are an active patient of the Agency. You may also read a copy of our Notice on the Arbor Hospice website at www.arborhospice.org. (4) You or your personal representative has the right to express complaints to Arbor Hospice and to the Secretary of DHHS if you or your representative believes that your privacy rights have been violated. Any complaints to Arbor Hospice should be made in writing to the Privacy Official at (888) 992-CARE (2273) ext. 158 or (734) 662-5999 ext. 158. Arbor Hospice encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
The Agency has designated the Director of Organizational Quality and Education as Arbor Hospice's Privacy Official. The Privacy Official is the contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.
This Notice is effective April 14, 2003. Revised August 17, 2013.
IF YOU HAVE ANY WRITTEN REQUESTS OR QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT:
2366 Oak Valley Road
Ann Arbor, MI 48103
(734) 662-5999 ext. 158 or (888) 992-CARE (2273) ext. 158