CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
MANAGED MEDICAID PROGRAM (STAR)

Health Insurance Portability and Accountability Act (HIPAA)
Privacy Notice

If you would like additional copies of this notice or require a translation of this notice in another language, please let us know. Member Services can be reached at 1-877-451-5598.

THIS NOTICE DESCRIBES HOW YOUR ORYOUR CHILD’S MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

In this Privacy Notice, Driscoll Children's Health Plan is referred to as “DCHP” and the Health and Human Services Commission is referred to as “HHSC.” The Texas Children’s Health Insurance Program is referred to as “CHIP.” The Texas Managed Medicaid program is referred to as “STAR”.

In this Notice “medical information” means the same as “health information.”
When your or your child receives CHIP or STAR benefits, DCHP may get health information about you or about your child. Health information includes any information that relates to (1) your or your child’s past, present, or future physical or mental health or condition; (2) providing health care to you or your child; or (3) the past, present, or future payment for your or your child’s health care.

This Notice tells you about privacy rights, DCHP’s duty to protect health information, and how DCHP may use or disclose health information without written permission.

Privacy Rights

The law gives you the right to:

• In most situations, look at or get a copy of the health information DCHP has about you or your child;
• ask DCHP to correct certain information, including certain health information about you or your child if you believe the information is wrong or incomplete. Most of the time, DCHP cannot change or delete information, even if it is incorrect. However, if DCHP decides it should make a change, it will add the correct information to the record and note that the new information takes the place of the old information. The old information will remain in the record. If DCHP denies your request to change the information, you can have your written disagreement placed in your child’s record;
• ask for a list of the times DCHP has disclosed health information about your or your child;
• ask DCHP to put more limitations on the use or disclosure of your or your child’s health information than the law requires. However, DCHP is not required to change the limitations;
• tell DCHP where and how to send messages that include health information, if you think sending the information to your usual address could put you or your child in danger. You must put this request in writing, and you must be specific about where and how to contact you;
• ask for and get a paper copy of this Notice from DCHP;
• withdraw permission you have given DCHP to use or disclose your or your child’s health information, unless DCHP has already taken action based on your permission. You must withdraw your permission in writing.

DCHP’s Duty to Protect Health Information

The law requires DCHP to protect the privacy of health information. It also requires DCHP to provide this Notice of its legal duties and privacy practices.

• In most situations, DCHP may not use or disclose health information without written permission. This Notice explains when DCHP may use or disclose health information without permission.
• For all other uses and disclosures, DCHP must obtain your written permission, which you may withdraw at any time.
• If DCHP changes its privacy practices, it must notify you of the changes by mailing a new Privacy Notice to your most recent address. DCHP will mail the new Privacy Notice within 60 days of the changes. The new practices will apply to all the health information about you or your child, regardless of when DCHP received or created the information.
  DCHP employees must protect the privacy of health information. DCHP does not give employees access to health information unless they need it to do their job. Reasons for needing access to health information include making benefit decisions, paying bills, and planning for the care needed. DCHP will punish employees who do not protect the privacy of health information.
  
  If you have questions about this Notice or need more information about your or your child’s privacy rights, you may contact DCHP at 1-877-DCHP-KIDS (324-7543).

If you believe DCHP has violated your or your child’s privacy rights, you may file a complaint by contacting DCHP’s Privacy Officer, at 1-877-DCHP-KIDS (324-7543). You may also file a complaint with:

• Texas Attorney General’s Office at 1-800-252-8011.
• U.S. Secretary of Health & Human Services The Office of Civil Rights at 1-214-767-4056.
  
  There will be no retaliation for filing a complaint.

How DCHP May Use and Disclose Health Care Information Without Written Permission

1. Payment
DCHP may use or disclose health information to pay or collect payment for health care. For example, determining eligibility is a use or disclosure for payment purposes.

2. Health care operations
DCHP may use or disclose health information for health care operations. Health care operations include:

• activities to assess and improve the quality of health care; reviewing the competence, qualifications, and performance of health plans; and
• engaging in business management or the general administrative activities of DCHP.
  Examples of uses and disclosures for health care operations include using or disclosing health information for case management or making sure providers bill only for care received. DCHP may also contact you to tell you about treatment alternatives or additional benefits you may be interested in.

3. Family member, other relative, or close personal friend
DCHP may disclose health information to a family member, other relative, or close personal friend if:

• the health information is related to that person’s involvement with your or your child’s care or payment for your or your child’s care; and
• you have had an opportunity to stop or limit the disclosure before it happens.

4. Government programs providing public benefits
DCHP may disclose health information to another government agency offering public benefits if:

• the information relates to whether you or your child and you qualify for or are enrolled in CHIP or STAR and the law requires or specifically allows the disclosure; or
• the other government agency has the same privacy protections DCHP does, has programs that serve similar types of people, and the disclosure is needed to coordinate or improve how the programs are run.

5. Health oversight activities
DCHP may use or disclose health information to another government agency authorized to conduct health oversight activities. Health oversight activities include investigating possible fraud in the CHIP or STAR program.

6. Public health
DCHP may disclose health information for public health activities, including to:

• a public health authority to prevent or control disease, injury, or disability; and
• a government agency authorized to receive reports of child abuse or neglect or reports of domestic violence.

7. Serious threat to health or safety
DCHP may use or disclose health information if it believes the use or disclosure is needed:

• to prevent or lessen a serious and immediate threat to the health and safety of a person or the public;
• for law enforcement authorities to identify or catch an individual who has admitted participating in a violent crime that resulted in serious physical harm to the victim, unless the information was learned while initiating or in the course of counseling or therapy; or
• for law enforcement authorities to catch an individual who has escaped from lawful custody.

8. For other law enforcement purposes
DCHP may disclose health information to a law enforcement official for the following law enforcement purposes, including:

• to comply with a subpoena;
• to comply with a lawful administrative request;
• to identify and locate a suspect, fugitive, witness, or missing person;
• in response to a request for information about an actual or suspected victim of a crime; or
• to alert a law enforcement official of a death that is suspected as the result of criminal conduct.

9. For judicial or administrative proceedings
DCHP may disclose health information for judicial and administrative purposes, including an order from a regular or administrative court.

10. As required by law
DCHP must use or disclose health information when a law requires the use or disclosure.

11. Contractors
DCHP may disclose health information to a contractor if the contractor:

• needs the information to perform services for DCHP; and
• agrees to protect the privacy of the information.

12. Secretary of Health and Human Services
Agencies must disclose health information to the Secretary of Health and Human Services when the Secretary wants it to enforce privacy protections.

13. Research
Agencies may use or disclose health information for research if a research board approves the use. The board will ensure that privacy is protected when health information is used in research. Uses and disclosures for research include:

• to allow a researcher to prepare a research project, as long as the researcher agrees to keep the information confidential;
• research on your or your child’s health information, if you or your child dies.

14. Other uses and disclosures
DCHP may use or disclose health information:

• to create health information that does not identify any specific individual;
• to the U.S. military or a foreign military for military purposes, if you or your child is a member of the group asking for the information;
• for purposes of lawful national security activities;
• to federal officials to protect the President and others;
• to a prison or jail, if you or your child is an inmate of that prison or jail, or to law enforcement personnel if you or your child is in custody;
• to comply with workers’ compensation laws or similar laws; and
• to tell or help in telling a family member or another person involved in your or your child’s care about your or your child’s location, general condition, or death.

Effective Date
This Notice takes effect on September 1, 2006 and replaces the existing notice effective April 14, 2003. This Notice stays in effect until it is replaced by another Notice.