VNS CHOICE
NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed. It also describes how you can get access to this information. Please review it carefully.
Thank you for being a member of VNS CHOICE, an affiliate of the Visiting Nurse Service of New York (VNSNY). VNS CHOICE health plans include a managed long term care plan under contract with the New York State Department of Health and a Medicare Advantage plan under contract to the United States Centers for Medicare and Medicaid Services (CMS). In order for you to obtain services through VNS CHOICE, we collect, create and maintain personal health information about you. VNS CHOICE is required by law to maintain the privacy of this information. This Notice of Privacy Practices describes how VNS CHOICE protects your personal health information, how we may use and disclose your health information, and explains certain rights you have regarding this information. VNS CHOICE is providing you with this Notice in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and will comply with the terms as stated.
How VNS CHOICE Uses and Discloses Your Health Information
VNS CHOICE protects your health information from inappropriate use and disclosure. Your health information is obtained in the course of providing services to you and is related to your medical records, health visits and claims payment information. VNS CHOICE will not disclose any personal health information without your written authorization, unless such disclosure is permitted or required by law.
The law permits VNS CHOICE to disclose your health information without a signed authorization from you when we are using it to provide you with your health benefits. Our staff and those organizations contracted by us to provide service or business support are required to comply with our requirements to protect the confidentiality of your information. Here are some examples of when we may disclose information:
Treatment and Care Management
Health information about you may be used or disclosed to assist treatment by health care providers. This would include treatment provided to you by our providers, and coordinating your care with other providers such as physicians, hospitals, or nursing homes. For example, your nurse care manager will discuss your health conditions with your doctor to plan the nursing services or physical therapy you might receive at home. Your care manager may also discuss with other health care providers the types of services that would help you such as a nutritional evaluation.
Payment
Health information about you may be disclosed for our own payment purposes and to assist in the payment activities of other health plans and health care providers. Our payment activities include obtaining premiums, determining your eligibility for benefits, reimbursing health care providers that treat you and obtaining payment from other insurers that may be responsible for providing coverage to you. For example, if a health care provider submits a bill to us for services you received, your health information may be used to determine whether these services are covered under your benefit plan and the appropriate amount of payment for the provider.
Health Care Operations
Health information may be used and disclosed to carry out health care operations, which includes care management, quality improvement activities, utilization review, actuarial analysis, internal audit, business management, program planning, accreditation, credentialing, certification, evaluating our own performance and resolving any complaints or grievances you may have. For example, we may collect and review records maintained by providers that have treated you to see whether they have provided you with preventive treatment and other important health services that are recommended by medical authorities. Your health information may also be used to assist other health plans and health care providers in performing certain health care operations, such as quality assurance, reviewing the competence and qualifications of health care providers and conducting fraud detection or compliance.
Business Associates
VNS CHOICE may use or disclose certain health information to its business associates who perform activities on our behalf. Business associates can include lawyers, pharmacy and dental benefit managers, accountants and other delegated entities. Their activities require the use or disclosure of personal health information in order to do their assignment for VNS CHOICE.
Government, Regulatory, and Law Enforcement Authorities
VNS CHOICE may also disclose certain personal health information to a variety of government, regulatory, or law enforcement authorities. For example, information may be disclosed to a health oversight agency such as the New York State Department of Health for the purposes of contract administration, inspections and audits. Information may be disclosed to a law enforcement agency to respond to a subpoena, to help identify or locate a suspect or missing person, or to provide information about a victim of a crime. Information may also be shared for certain types of public health efforts involving communicable diseases or the safety or quality of FDA-regulated products with agencies such as the New York City Department of Health, and the Food and Drug Administration. In addition, information may be disclosed to the appropriate governmental authorities to avoid a serious threat to your health and safety, or when there is reason to suspect neglect, abuse or domestic violence. Information will also be shared about a deceased person when necessary with coroners, medical examiners, funeral directors or with organizations involved with organ, eye or tissue donations.
Research. Your health information may be used and disclosed for research studies that might examine a type of care provided and its results. The research would only be done with the approval of the VNSNY Institutional Review Board, which must follow a special approval process. Before permitting any use or disclosure of your health information for research purposes, the VNSNY Institutional Review Board will balance the needs of the researchers and the potential value of their research against the protection of your privacy.
To individuals involved in your care. Your health information may be disclosed to a family member, other relative or close personal friend assisting you in receiving or obtaining payment for health care services. We will disclose your health information to these individuals only if you tell us to do this or if we can reasonably infer that you do not object. We may also disclose your health information to disaster relief organizations such as the Red Cross to assist your family members or friends in locating you or learning about your general condition in the event of a disaster.
Fundraising. As a not-for-profit health care organization, our parent agency, VNSNY, may identify you as a patient for purposes of fundraising. If you wish to be removed from any fundraising lists, please do so by writing to the VNSNY Privacy Officer, 107 East 70th Street, New York, New York 10021.
Appointments, Information or Services. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related services that may be of interest to you.
We may also use or disclose your health information for judicial or administrative proceedings, for specialized government functions, for workers’ compensation or similar purposes.
Special Treatment of Certain Alcohol and Drug Abuse Records. Health information we may receive about you from federally assisted alcohol or drug treatment programs is subject to special protection under federal law. We will not disclose this information without your express written authorization except: (a) to medical personnel who need this information for the purpose of providing you with emergency treatment; (b) to the Food and Drug Administration for the purpose of identifying potentially dangerous products; (c) for research purposes if approved by the VNSNY Institutional Review Board; (d) to authorized persons conducting on-site audits of our records, subject to the requirement that these persons not remove the information from our facilities and agree in writing to safeguard the information; and (e) in response to an appropriate court order.
Obtaining Your Authorization for Other Uses and Disclosures
VNS CHOICE will not use or disclose your health information for any purpose not specified in this Notice of Privacy Practices unless we obtain your express written authorization to do so. If you give us your authorization, you may revoke it at any time in writing, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent we have relied on your authorization in providing benefits. We may not refuse to enroll or continue to provide benefits to you if you decide not to sign an authorization form.
Your Rights Regarding Your Health Information
Right to Inspect and Copy. You have the right to inspect or request a copy of health information about you that we maintain and that we may use in making decisions about your benefits. Your request should describe the information you want to review. In limited circumstances, you may not be able to review or copy certain information. These include psychotherapy notes, or information collected in anticipation of a claim or legal proceeding. We may charge you a reasonable fee for copying.
Right to Request Amendments. You have the right to request changes to any health information we maintain about you if you state a reason why this information is incorrect or incomplete. We may not agree to make the changes you request. If we do not believe the changes you requested are appropriate, we will notify you in writing how you can have your objection to our decision included in our records.
Right to an Accounting of Disclosures. You have the right to receive a list of disclosures of your health information that have been made by VNS CHOICE. The list will not include disclosures made for certain types of purposes, such as disclosures for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period for which you want this list, which can be no longer than six years and may not include dates prior to April 14, 2003. The first time you ask for a list of disclosures in any 12-month period, we will provide it for free. If you request additional lists during a 12-month period, we may charge you a fee to cover our costs in providing the additional lists.
Right to Request Restrictions. You have the right to request restrictions on the ways in which we use and disclose your health information for treatment, payment and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. We may not agree to the restrictions you request.
Right to Request Confidential Communications. You have the right to ask us to send health information to you in a different way or at a different location if you believe that you may be endangered by our ordinary form of communication. You must state in your request that you believe you will be endangered by our ordinary form of communication but you do not have to explain why you believe this is the case. You may ask us to send health information to you in a different way or at a different location. Your request should also specify where and/or how we should contact you. We will accommodate all reasonable requests.
Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice of Privacy Practices at any time. You may receive a paper copy even if you have previously requested to receive this Notice electronically. You may also print out a copy of this Notice by going to the VNSNY website at www.vnsny.org.
To make a request as described in the section “Your Rights Regarding Your Health Information”, please submit it in writing to:
VNS CHOICE
HIPAA Privacy Officer
1250 Broadway – 11th Floor
New York, N.Y. 10001
Complaints
If you believe your privacy rights have been violated, you may file a complaint with VNS CHOICE or the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against by VNS CHOICE for filing a complaint. Please submit your complaint in writing to the above address.
Additional Information
If you have a question about the VNS CHOICE Notice of Privacy Practices, you may write to the above address or call 1-888-867-6555 and ask for the HIPAA Privacy Officer.
Changes to this Notice
VNS CHOICE may change the terms of this Notice of Privacy Practices at any time. If we change the terms of this Notice, the new terms will apply to all of your health information, whether created or received by VNS CHOICE before or after the date on which the Notice is changed. We will notify you of changes to this Notice by mailing you a copy of the new Notice within 60 days of the date on which it becomes effective.
Effective Date
This Notice of Privacy Practices is effective as of April 14, 2003, and was revised on December 1, 2006.
