NOTICE OF PRIVACY PRACTICES
This Notice of Privacy Practices is effective as of 01/01/05.
The Kansas CDDO Coalition
Disability Planning Organization of Kansas, Inc.
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.
This notice will tell you how we may use and disclose medical, personal and/or service information about you. The government laws describe "Protected Health Information" as any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In the header above, that information is referred to as "personal and/or service information." In this notice, we simply call all of that protected health information, "personal/service information" and will explain how we will safeguard all information we have about you.
This notice also will tell you about your rights and our duties with respect to personal/service information about you. In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.
PRIVACY OFFICER/CONTACT PERSON: For the purposes designated in this notice or if you have any questions about this notice or our privacy practices relating to your person/service information please contact the following person:
Disability Planning Organization of
Kansas, Inc. (DPOK)
119 W. Iron, 4th Floor, PO Box 1067
Salina, Ks 67402-1067
Telephone # (785) 823-3173
Fax # (785) 823-3299
How We May Use and Disclose Personal/Service Information About You.
We use and disclose personal/service information about you for a number of different purposes. Each of those purposes is described below.
For Service Delivery:
In order to determine your eligibility for services, information exchange may occur with individuals or organizations, with your authorization, who may have information about you. This information will be needed to determine if you qualify for services from or through the Kansas CDDO Coalition. These resources and individuals you identify may also share information with the Kansas CDDO Coalition to assist in assessing the amount of service you need.
Once you have selected service provider(s), the Kansas CDDO Coalition may use personal/service information about you to assist in coordinating the services, supports, and health care you receive from us and/or service providers. We may disclose personal/service information about you to consultants who contract with the Kansas CDDO Coalition, other Kansas CDDO Coalition staff or personnel that work for organizations you have chosen. All this information will be used to develop a plan for services and to better coordinate your services. Your person centered plan and plan of care defines for the Kansas CDDO Coalition, the services and providers you have consented to use and disclose your personal/service information.
For Quality Assurance:
The Kansas CDDO Coalition also must use and disclose personal/service information about you in order to assure the quality of the different services you receive. This may include gathering information from providers as well as family or those close to you. Assuring you service needs are being met and seeking information as to your health, safety and progress.
For Payment and Funding Management:
We may use and disclose personal/service information about you so we can be paid for the services you receive or assure you providers are paid for services you receive. This can include billing, authorizing or communicating with a third party payer, such as Medicaid or other state agency (for example, the State's Office of Health Care Policy), or your insurance company. For example, we may need to provide the State Medicaid program information about the services we provide or others provide to you to be reimbursed for those services. We also may need to provide the State Medicaid program with information to ensure you are eligible for the medical assistance program. We may need to give your health plan (health insurance company) information about your diagnosis and services so your health plan will pay us or reimburse you for specific services. We may also tell your health plan about a service you are going to receive in order to obtain prior approval or to determine whether your plan will cover the service.
For Administrative Operations:
We may use and disclose personal/service information about you for our own operations. These are necessary for us to operate the Kansas CDDO Coalition and to make sure that all consumers receive quality services. For example, we may use personal/service information to review services and to evaluate the performance of staff in providing services to you. We may disclose personal service information about you to train our staff. We may also combine personal/service information about many consumers to decide what additional services should be offered, what services are not needed, and whether certain new services are beneficial. We may combine the personal/service information we have with information from other service providers in our service area or the State of Kansas to compare how we are doing and see where we can make improvements in services. We may remove information that identifies you from this set of information so others may use it to study service delivery without learning who specific individuals are. Examples are State funding database and service association demographic databases. Additional uses and disclosures for "administrative operations" include:
activities relating to improving services or reducing service delivery costs,
training, accreditation, certification, licensing, credentialing or other related activities,
underwriting and other insurance related functions,
quality/peer review and auditing functions, including fraud and abuse detection, and compliance programs
conducting or arranging for legal services for DPOK, its staff or personnel business planning and development, business management and general
internal grievance resolution
How We Will Contact You:
Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see "Right to Receive Confidential Communications" on page 7 of this Notice.
We may use and disclose personal/service information about you to contact you to remind you of an appointment for service delivery or services.
Service Delivery and Service Alternatives:
We may use and disclose personal/service information about you to contact you about funding information, service delivery and service alternatives that may be of interest to you.
Disclosures to Family and Others:
We may disclose to a parent/guardian, personal representative, family member, other relative, a close personal friend, or any other person identified by you, personal/service information about you that is directly relevant to that person's involvement with the services and supports you receive or payment for those services and supports. We also may use or disclose personal/service information about you to notify, or assist in notifying, those persons of your location, general condition, or death. If there is a family member, other relative, or close personal friend that you do not want us to disclose information about you to, please notify a staff member of the Kansas CDDO Coalition.
We may use or disclose personal/service information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a parent/guardian, personal representative, family member, other relative, close personal friend, or other person identified by you of your location, general condition or death.
Required by Law:
We may use or disclose personal/service information about you when we are required to do so by law.
Public Health Activities:
We may disclose personal/service information about you for public health activities and purposes. This includes reporting personal/service information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease, or one that is authorized to receive reports of child abuse and neglect. Reporting work-related/workplace illnesses and injuries to OSHA would be included in these disclosures. We would also disclose deaths as required by law and Kansas Regulations.
Victims of Abuse, Neglect or Domestic Violence:
We may disclose personal/service information about you to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence, if we believe you are a victim of abuse, neglect, or domestic violence. This will occur to the extent the disclosure is: (a) required by law; (b) agreed to by you or your personal representative; or, (c) authorized by law and we believe the disclosure is necessary to prevent serious harm to you or to other potential victims, or, if you are incapacitated and certain other conditions are met, a law enforcement or other public official represents that immediate enforcement activity depends on the disclosure.
Health Oversight Activities:
We may disclose personal/service information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. These and similar types of activities are necessary for appropriate oversight of the health care system, developmental disabilities service system, government benefit programs, and entities subject to various government regulations.
Judicial and Administrative Proceedings:
We may disclose personal/service information about you in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal. We also may disclose personal/service information about you in response to a subpoena, discovery request, or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed.
Disclosures for Law Enforcement Purposes:
We may disclose personal/service information about you to a law enforcement official for law enforcement purposes:
As required by law.
In response to a court, grand jury or administrative order, warrant or subpoena.
To identify or locate a suspect, fugitive, material witness or missing person.
About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain that person's agreement, in limited circumstances, the information may still be disclosed.
To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.
About crimes that occur at our facility.
To report a crime in emergency circumstances.
Coroners and Medical Examiners:
We may disclose personal information about you to a coroner or medical examiner for purposes such as identifying a deceased person and determining cause of death.
If you are a member of the Armed Forces, we may use and disclose personal/service information about you for activities deemed necessary by the appropriate military command authorities to assure the proper execution of the military mission. We may also release information about foreign military personnel to the appropriate foreign military authority for the same purposes.
National Security and Intelligence:
We may disclose personal/service information about you to authorized federal officials for the conduct of intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President:
We may disclose personal/service information about you to authorized federal officials so they can provide protection to the President of the United States, certain other federal officials, or foreign heads of state.
We may disclose personal/service information about you to make medical suitability determinations and may disclose the results to the officials in the United States Department of State for purposes of a required security clearance or service abroad.
We may disclose personal information about you to funeral directors as necessary for them to carry out their duties.
To Avert Serious Threat to Health or Safety:
We may use or disclose personal/service information about you if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public. We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.
Inmates; Persons in Custody:
We may disclose personal/service information about you to a correctional institution or law enforcement official having custody of you. The disclosure will be made if the disclosure is necessary: (a) to provide health care or supports to you; (b) for the health and safety of others; or, (c) the safety, security and good order of the correctional institution.
We may disclose health information about you to the extent necessary to comply with workers' compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.
Other Uses and Disclosures:
Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying our Privacy Officer in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect on actions taken by us in reliance on it.
Your Rights With Respect to Information About You:
You have the following rights with respect to personal/service information that we maintain about you.
Right to Request Restrictions:
You have the right to request that we restrict the uses or disclosures of personal/service information about you to carry out service delivery, payment, or administrative operations. You also have the right to request that we restrict the uses or disclosures we make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) for to public or private entities for disaster relief efforts. For example, you could ask that we not disclose personal/service information about you to your brother or sister.
To request a restriction, you may do so at any time. If you request a restriction, you should do so to any Kansas CDDO Coalition staff member. Tell us: (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your father).
We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency service delivery. Even if we agree to a restriction, either you or we can later terminate the restriction.
Right to Receive Confidential Communications:
You have the right to request that we communicate personal/service information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why you are asking for the confidential communication.
If you want to request confidential communication, you must do so in writing. Your request must state how or where you can be contacted. We will accommodate your request. However, we may, if necessary, require information from you concerning how payment will be handled. We also may require an alternate address or other method to contact you.
Right to Inspect and Copy:
With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of personal/service information about you.
To inspect or copy information about you, you must submit your request in writing. Your request should state specifically what information you want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing.
We will act on your request within thirty (30) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.
We may deny your request to inspect and copy personal/service information if the information involved is information compiled in anticipation of, or use in, a civil, criminal or administrative action or proceeding; and we will deny your request to copy if the information involved was developed by another provider or entity.
If we deny your request, we will inform you of the basis for the denial, how you may have our denial reviewed, and how you may complain. If you request a review of our denial, the review will be conducted by a licensed health care professional who was not directly involved in the denial. We will comply with the outcome of that review.
Right to Amend:
You have the right to ask us to amend personal/service information about you. You have this right for so long as the information is maintained by us.
To request an amendment, you must submit your request in writing to the Privacy Officer. Your request must state the amendment desired and provide a reason in support of that amendment.
We will act on your request within sixty (60) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.
If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment with relevant other persons. We also will make the appropriate amendment by appending or otherwise providing a link to the amendment.
We may deny your request to amend personal/service information about you. We may deny your request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny your request to amend personal/service information if we determine that the information:
Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment (if we possess the necessary professional credentials to insert such amendments);
Is not part of the personal/service information maintained by us;
Would not be available for you to inspect or copy; or,
Is accurate and complete.
If we deny your request, we will inform you of the basis for the denial. You will have the right to submit a statement of disagreeing with our denial. Your statement may not exceed two pages. We may prepare a rebuttal to that statement. Your request for amendment, our denial of the request, your statement of disagreement, if any, and our rebuttal, if any, will then be appended to the personal/service information involved or otherwise linked to it. All of that will then be included with any subsequent disclosure of the information, or, at our election, we may include a summary of any of that information.
If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the personal information involved.
You also will have the right to appeal our denial of your request.
Right to an Accounting of Disclosures:
You have the right to receive an accounting of disclosures of personal/service information about you. The accounting may be for up to six (6) years prior to the date on which you request the accounting but not before January 1, 2005.
Certain types of disclosures are not included in such an accounting:
Disclosures to carry out service delivery, payment and administrative operations;
Disclosures of your information made to you;
Disclosures that are incident to another use or disclosure;
Disclosures that you have authorized;
Disclosures to persons involved in your care;
Disclosures for disaster relief purposes;
Disclosures for national security or intelligence purposes;
Disclosures to correctional institutions or law enforcement officials;
Disclosures that are part of a limited data set for purposes of research, public health, or administrative operations (a limited data set is where things that would directly identify you have been removed.
Disclosures made prior to January 1, 2005.
Under certain circumstances your right to an accounting of disclosures to a law enforcement official or an oversight agency may be suspended. Should you request an accounting during the period of time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official or to a service oversight agency.
To request an accounting of disclosures, you must submit your request in writing to the appropriate Privacy Officer.
Your request must state a time period for the disclosures. It may not be longer than six (6) years from the date we receive your request and my not include dates before April 14, 2003. Usually, we will act on your request within sixty (60) calendar days after we receive your request. Within that time, we will either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting and why the delay is necessary.
There is no charge for the first accounting we provide to you in any twelve (12) month period. For additional accountings, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and give you an opportunity to withdraw or modify your request to avoid or reduce the fee.
Right to Copy of this Notice:
You have the right to obtain a paper copy of our Notice of Privacy Practices. You may request a copy of our Notice of Privacy Practices at any time.
You may obtain a copy of our Notice of Privacy Practices over the Internet at our web site, www.dpok.com
To obtain a paper copy of this notice, contact to our Privacy Officer.
We are required by law to maintain the privacy of personal/service information about you and to provide individuals with notice of our legal duties and privacy practices with respect to that information. We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.
Our Right to Change Notice of Privacy Practices:
We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice's provisions effective for all personal/service information that we maintain, including that created or received by us prior to the effective date of the new notice.
Availability of Notice of Privacy Practices:
A copy of our current Notice of Privacy Practices will be posted in the administrative office.
At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting our Privacy Officer or any of our staff.
Effective Date of Notice:
The effective date of the notice will be stated on the first page of the notice.
You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us.
To file a complaint with us, contact our CDDO Director. All complaints should be submitted in writing.
To file a complaint with the United States Secretary of Health and Human Services, send your complaint to him or her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201.
You will not be retaliated against for filing a complaint.
Questions and Information:
If you have any questions or want more information concerning this Notice of Privacy Practices, please contact our Privacy Officer.
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