Bell
County Health Services
County Indigent Health Care Program
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.
If you have any questions about this Notice please contact: Rita
Kelley by calling 254-519-1257.
This
Notice of Privacy Practices becomes effective on April 14, 2003.
We are required by law
to maintain the privacy of protected health information and to provide
participants in the County’s indigent health program with notice of our legal
duties and privacy practices with respect to protected health information. This Notice of Privacy Practices describes
how we may use and disclose your protected health information to carry out
treatment, payment or health care operations and for other purposes that are
permitted or required by law. It also
describes your rights to access and control your protected health information. “Protected health information” (PHI) is
information about you, including demographic information, that may identify you
and that relates to your past, present or future physical or mental health or
condition and related health care services.
We are required to abide
by the terms of this Notice of Privacy Practices. We may change the terms of
our notice, at any time. The new notice will be effective for all protected
health information that we maintain at that time. If we make
a material change to our Notice, we will mail a revised Notice to the address
that we have on record for you.
The
following is a description of how we are most likely to use and/or disclose
your PHI.
·
Treatment,
Payment and Health Care Operations
We have the right to use and disclose your PHI for
all activities that are included within the definitions of “treatment,”
"payment" and "health care operations" as set out in the
HIPAA Privacy Rule (45 CFR parts 160 and 164).
·
Treatment
We may use and disclose
your PHI for treatment purposes, such as coordinating or managing health care
and related services by one or more of your health care providers.
·
Payment
We will use or disclose your PHI to pay claims for
services provided to you or to otherwise fulfill our responsibilities for
coverage and providing benefits. For
example, we may disclose your PHI when a provider requests information
regarding your eligibility for coverage under the County’s indigent health
program, or we may use your information to determine if a treatment that you
received was medically necessary. Other
payment purposes include, but are not limited to, pre-authorizations,
utilization review activities, coordination of benefits, and subrogation.
·
Health Care Operations
We will use or disclose your PHI to support our
business functions. These functions
include, but are not limited to:
quality assessment and improvement, reviewing provider and vendor
performance, licensing, and business planning.
For example, we may use or disclose your PHI: (1) to respond to a customer service inquiry from you; or (3) in
connection with fraud and abuse detection and compliance programs. Health care operations may also include, but
are not limited to, case management, legal reviews, handling appeals and
grievances, plan or claims audits, and other general administrative activities.
·
Business
Associates
We may contract with individuals and entities
(Business Associates) to perform various functions on our behalf or to provide
certain types of services. To perform
these functions or to provide the services, our Business Associates may
receive, create, maintain, use, or disclose PHI, but only after we require the
Business Associates to agree in writing to contract terms designed to
appropriately safeguard your information.
For example, we may disclose your PHI to a Business Associate to
administer claims or to provide service support, utilization management,
subrogation, or pharmacy benefit management.
In the event a Business
Associate is a “health care component” as designated by our governing body, no
written agreement regarding the safeguarding of your information is required by
law, and we will not enter into such an agreement with those health care
components.
·
Other
Covered Entities
We may use or disclose your PHI to assist health care
providers in connection with their treatment or payment activities, or to
assist other covered entities in connection with payment activities and certain
health care operations. For example, we may disclose your PHI to a health care
provider when needed by the provider to render treatment to you, and we may
disclose PHI to another covered entity to conduct health care operations in the
areas of quality assurance and improvement activities, or accreditation,
certification, licensing or credentialing.
This also means that we may disclose or share your PHI with other
insurance carriers or governmental programs providing or paying for health care
in order to coordinate benefits if you or your family members have coverage
through such other carrier or governmental program.
·
Plan Sponsor
We may disclose your PHI to the County for purposes
of plan administration or pursuant to an authorization request signed by you.
The
following is a description of other possible ways in which we may, and are
permitted to, use and/or disclose your PHI.
·
Required by
Law
We may use or disclose your protected
health information to the extent that the use or disclosure is required by law.
The use or disclosure will be made in compliance with the law and will be
limited to the relevant requirements of the law. If required by law, you will
be notified of any such uses or disclosures.
·
Public Health
Activities
We may disclose your protected health
information for public health activities and purposes to a public health
authority that is permitted by law to collect or receive the information. The
disclosure will be made for the purpose of controlling disease, injury or
disability. We may also disclose your protected health information, if directed
by the public health authority, to a foreign government agency that is
collaborating with the public health authority.
·
Health
Oversight Activities
We may disclose your PHI to a health oversight agency
for activities authorized by law, such as: audits; investigations; inspections;
licensure or disciplinary actions; or civil, administrative, or criminal
proceedings or actions. Oversight agencies seeking this information include
government agencies that oversee: (1)
the health care system; (2) government benefit programs; (3) other government
regulatory programs; and (4) compliance with civil rights laws.
·
Abuse or
Neglect
We may disclose your protected health
information to a public health authority or other government authority that is
authorized by law to receive reports of child abuse or neglect. In addition, if
we believe that you have been a victim of abuse, neglect or domestic violence
we may disclose your protected health information to the governmental entity or
agency authorized to receive such information. In this case, the disclosure
will be made consistent with the requirements of applicable federal and state
laws.
·
Legal
Proceedings
We may disclose your PHI: (1) in the course of any judicial or administrative proceeding;
(2) in response to an order of a court or administrative tribunal (to the
extent such disclosure is expressly authorized); and (3) in response to a
subpoena, a discovery request, or other lawful process, once we have met all
administrative requirements of the HIPAA Privacy Rule. For example, we may disclose your PHI in
response to a subpoena for such information, but only after we first meet
certain conditions required by the HIPAA Privacy Rule.
·
Law
Enforcement
Under certain conditions, we also may disclose your
PHI to law enforcement officials. For
example, some of the reasons for such a disclosure may include, but not be
limited to: (1) it is required by law
or some other legal process; (2) it is necessary to locate or identify a
suspect, fugitive, material witness, or missing person; and (3) it is necessary
to provide evidence of a crime that occurred on our premises.
·
Coroners,
Medical Examiners, Funeral Directors, and Organ Donation
We may disclose PHI to a coroner or medical examiner
for purposes of identifying a deceased person, determining a cause of death, or
for the coroner or medical examiner to perform other duties authorized by
law. We also may disclose, as
authorized by law, information to funeral directors so that they may carry out
their duties. Further, we may disclose
PHI to organizations that handle organ, eye, or tissue donation and
transplantation.
·
Research
We may disclose your PHI to researchers when an institutional
review board or privacy board has: (1) reviewed the research proposal and
established protocols to ensure the privacy of the information; and (2)
approved the research.
·
To Prevent a
Serious Threat to Health or Safety
Consistent with applicable federal and state laws, we
may disclose your PHI if we believe that the disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety of a person or
the public. We also may disclose PHI if
it is necessary for law enforcement authorities to identify or apprehend an
individual.
·
Military
Activity and National Security, Protective Services
Under certain conditions, we may disclose your PHI if
you are, or were, Armed Forces personnel for activities deemed necessary by
appropriate military command authorities. If you are a member of foreign
military service, we may disclose, in certain circumstances, your information
to the foreign military authority. We also may disclose your PHI to authorized
federal officials for conducting national security and intelligence activities,
and for the protection of the President, other authorized persons, or heads of
state.
·
Inmates
If you are an inmate of a correctional institution,
we may disclose your PHI to the correctional institution or to a law
enforcement official for: (1) the
institution to provide health care to you; (2) your health and safety and the
health and safety of others; or (3) the safety and security of the correctional
institution.
·
Workers'
Compensation
We may disclose your PHI to comply with Workers'
Compensation laws and other similar programs that provide benefits for work‑related
injuries or illnesses.
·
Others
Involved in Your Health Care
Using our best judgment, we may make your PHI known
to a family member, other relative, close personal friend or other personal
representative that you identify. Such
a use will be based on how involved the person is in your care, or payment that
relates to your care. We may release
information to parents or guardians, if allowed by law.
We also may disclose your information to an entity assisting in a
disaster relief effort so that your family can be notified about your
condition, status, and location.
If you are not present or able to agree to these
disclosures of your PHI, then, using our professional judgment, we may
determine whether the disclosure is in your best interest.
Required Disclosures of Your
Protected Health Information
The following is a description of
disclosures that we are required by law to make.
·
Disclosures to
the Secretary of the U.S. Department of Health and Human Services
We are required to disclose your PHI to the Secretary
of the U.S. Department of Health and Human Services when the Secretary is
investigating or determining our compliance with the HIPAA Privacy Rule.
·
Disclosures
to You
We are required to disclose to you most of your PHI
in a "designated record set" when you request access to this
information. Generally, a
"designated record set" contains medical and billing records, as well
as other records that are used to make decisions about your health care
benefits. We also are required to
provide, upon your request, an accounting of most disclosures of your PHI that
are for reasons other than treatment, payment, and health care operations and
are not disclosed through a signed authorization.
We will disclose your PHI to an individual who has
been designated by you as your personal representative and who has qualified
for such designation in accordance with relevant Texas law. However, before we will disclose PHI to such
a person, you must submit a written notice of his/her designation, along with
the documentation that supports his/her qualification (such as a power of
attorney).
Even if
you designate a personal representative, the HIPAA Privacy Rule permits us to elect not to treat the person as
your personal representative if we have a reasonable belief that: (1) you have
been, or may be, subjected to domestic violence, abuse, or neglect by such
person; (2) treating such person as your personal representative could endanger
you; or (3) we determine, in the exercise of our professional judgment, that it
is not in your best interest to treat the person as your personal
representative.
Other
uses and disclosures of your PHI that are not described above will be made only
with your written authorization. If you
provide us with such an authorization, you may revoke the authorization in
writing, and this revocation will be effective for future uses and disclosures
of PHI. However, the revocation will
not be effective for information that we already have used or disclosed,
relying on the authorization.
The
following is a description of your rights with respect to your PHI.
Following is a statement of your rights with respect to your
protected health information and a brief description of how you may exercise
these rights.
·
You have the right to request a restriction of your protected
health information. This means you may ask us not to use or
disclose any part of your protected health information for the purposes of
treatment, payment or healthcare operations. You may also request that any part
of your protected health information not be disclosed to family members or
friends who may be involved in your care or for notification purposes as
described in this Notice of Privacy Practices. Your request must state the
specific restriction requested and to whom you want the restriction to apply.
We are not required to agree to a restriction
that you may request. If we believe it
is in your best interest to permit use and disclosure of your protected health
information, your protected health information will not be restricted. If we
agree to the requested restriction, we may not use or disclose your protected
health information in violation of that restriction unless it is needed to
provide emergency treatment. With this in mind, please discuss any restriction you
wish to request with your health care provider. You may request a restriction
by completing a “Restriction of use and Disclosures Request Form,” which you
may obtain from our Contact Person designated in this Notice.
·
You have the right to request to receive confidential
communications from us by alternative means or at an alternative location. We will accommodate
reasonable requests, but only if you state that disclosure of all or part of
the communications in a manner inconsistent with your instructions would put
you in danger. We may also condition this accommodation by asking you for
information as to how payment will be handled or specification of an
alternative address or other method of contact. We will not request an
explanation from you as to the basis for the request. Please make this request
in writing to our Contact Person designated in this Notice.
·
You have the right to inspect and copy your protected health
information. This means you may inspect and obtain a copy of
protected health information about you that is contained in a designated record
set for as long as we maintain the protected health information. A “designated
record set” contains medical and billing records and any other records that we
use for making decisions about you.
Under federal law, however, you may not inspect
or copy the following records: psychotherapy notes; information compiled in
reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding; and protected health information that is subject to any
law that prohibits access to protected health information. Depending on the circumstances, a decision
to deny access may be reviewable. Please contact our Contact Person designated
in this Notice if you have questions about access to your medical record.
·
You may have the right to have us amend your protected health
information. This means you may
request an amendment of protected health information about you in a designated
record set for as long as we maintain this information. Requests for amendment
must be in writing and must provide a reason to support each requested
amendment. In certain cases, we may
deny your request for an amendment. If
we deny your request for amendment, you have the right to file a statement of disagreement
with us and we may prepare a rebuttal to your statement and will provide you
with a copy of any such rebuttal. Please contact our Contact Person designated
in this Notice if you have questions about amending your protected health
information.
·
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information. This right applies to
disclosures for purposes other than treatment, payment or healthcare operations
as described in this Notice of Privacy Practices. It excludes disclosures we
may have made to you, to family members or friends involved in your care, for
notification purposes, and for other purposes, as permitted by law. You have
the right to receive specific information regarding these disclosures that
occurred after April 14, 2003 and during the six years prior to your request.
You may request a shorter timeframe. The right to receive this information is
subject to certain exceptions, restrictions and limitations.
·
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to
accept this notice electronically.
You may complain to us or to the
Secretary of Health and Human Services if you believe your privacy rights have
been violated by us. You may file a complaint with us by notifying the person
named below of your complaint. We will not retaliate against you for filing a
complaint.
For further information about the
complaint process, or to file a complaint, contact:
Bell County
ATTENTION: Rita Kelley
PO Box 880
Killeen, TX 76540
Phone: 254-519-1257
Fax: 254-618-4179
For further information about
filing a complaint with the Secretary of Health and Human Servers, or to file a
complaint, contact:
U.S. Department of
Health and Human Services, Office for Civil Rights
Region VI - AR, LA, NM, OK, TX
Office for Civil Rights
U.S. Department of Health & Human Services
1301 Young Street - Suite 1169
Dallas, TX 75202
Phone: (214) 767-4056; (214) 767-8940 (TDD)
(214) 767-0432 FAX