NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION (PHI) ABOUT YOU OR YOUR CHILD MAY BE USED AND/OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
PURPOSE:Driscoll Children's Health Plan (DCHP) is required by law to maintain the privacy of Protected Health Information (PHI). We are required to provide you with this notice of our legal duties and privacy practices with regard to uses of PHI as well as inform you regarding your individual rights. This notice explains the purposes for which DCHP is permitted to use and disclose your PHI.
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 Medicaid Program is referred to as "STAR". Protected health information is referred to as medical information or PHI.
HOW DCHP MAY USE AND DISCLOSE YOU OR YOUR CHILDS PHI:
DCHP may use or disclose you or your child's PHI to pay or collect payment for you or your child's health care.
- Health care operations
DCHP may use or disclose you or your child's PHI for health care operations. This includes:
- activities to assess and improve the quality of you or your child's health care;
- reviewing the competence, qualifications, and performance of health plans; and
- engaging in business management or the general administrative activities of CHIP or STAR.
- Family member, other relative, or close personal friend
DCHP may disclose you or your child's PHI to a family member, other relative or close personal friend if:
- the health information is related to that person's involvement with you or your child's care or payment for you or your child's care; and
- you have had an opportunity to stop or limit the disclosure before this occurs.
- Government programs
DCHP may disclose you or your child's PHI to another government agency offering public benefits if:
- the information relates to whether you or your child 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 as DCHP, has programs that serve similar types of people, and the disclosure is needed to coordinate or improve how the programs are run.
- Health oversight activities
DCHP may use or disclose you or your child's PHI to another government agency authorized to conduct health oversight activities. Health oversight activities may include investigating possible fraud in the CHIP or STAR program.
- Public health
DCHP may disclose you or your child's PHI for public health activities, which include:
- 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.
- Serious threat to health and/or safety
DCHP may use or disclose you or your child's PHI if 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.
- Other law enforcement purposes
DCHP may disclose you or your child's PHI to a law enforcement officials, for one or more for the following purposes:
- 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 occurred from criminal conduct
- For judicial or administrative proceedings
CHP may disclose you or your child's PHI for judicial and administrative purposes, including an order from a regular or administrative court.
- As required by law
DCHP must use or disclose you or your child's PHI when a law requires the use or disclosure.
DCHP may disclose you or your child's PHI to a contractor if the contractor:
- needs the information to perform services for DCHP; and
- agrees to protect the privacy of the information.
- Secretary of Health and Human Services
DCHP has to disclose you or your child's PHI to the Secretary of Health and Human Services when the Secretary requests the information to enforce privacy protections.
DCHP may use or disclose you or your child's PHI for research if the Institutional Review Board or a Privacy Board approves the use. The board will ensure that your privacy is protected. 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 child's health information, if your child dies.
- Other uses and disclosures
DCHP may use or disclose you or your child's PHI:
- to create health information that does not identify any specific individual;
- to the U.S. military or a foreign military for military purposes, if your child is a member of the group asking for the information;
- for purposes of lawful national security;
- to federal officials to protect the President and others;
- to a prison or jail, if your child is an inmate of that prison or jail, or to law enforcement personnel if your child is in custody;
- to comply with workers' compensation laws or similar laws; and
- to assist in telling a family member/s or another person involved in your child's care about your child's location, general condition, or death.
YOUR RIGHTS:You have the following rights regarding the PHI we maintain about you and/or your child:
Right to Request Restrictions
You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. We are not required to agree to or abide by your request. If we do agree, we will comply with your request unless the PHI is required to provide you with emergency treatment or the agreement has been terminated in accordance HIPAA guidelines. Requests must be received in writing.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. Your request must specify how, where, or when you wish to be contacted. We will attempt to accommodate all reasonable requests.
Right to Inspect and Receive a Copy
You have the right to request access to inspect, receive a physical or electronic copy, or be provided a summary of you or your child's PHI or accounting information. Under federal law, you may request an accounting for a period of three years prior to the date the accounting is requested
Right to Amend
If you believe that the PHI we have about you is incorrect or incomplete, you may request an amendment. You have the right to request an amendment for as long as the PHI is kept by or for DCHP. You must include a reason that supports your request. All requests for amendment should be made in writing. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend PHI that: (1) was not created by us, unless the person or entity that created the PHI is no longer available to make the amendment; (2) is not part of the PHI kept by or for DCHP; (3) is not part of the PHI that you would be permitted to inspect and copy; or (4) is accurate and complete. DCHP will notify you if we deny the request and will include instructions as to how you may appeal the request or file a complaint.
Right to be Notified
You have a right to be notified regarding an unlawful breach of unsecured PHI.
Right to an Accounting of Disclosures
You have the right to request an accounting of disclosures regarding your health information.
Information Maintained in Paper Records
You may request a record of disclosures that have been made to persons or entities other than for treatment, payment, or health care operations that have taken place in the past six (6) years.
Right to a Copy of This Notice
You have the right to a paper copy of this notice at any time. You may also obtain an electronic copy of this notice at our web site, http://www.dchpkids.com/
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.
If you have questions about this Notice or need more information about your privacy rights, you may contact DCHP at 1-877-DCHP-KIDS (324-7543).
- If you believe DCHP has violated your privacy rights, you may file a complaint by contacting DCHP's Privacy Officer, at the phone number provided above. You may also file a complaint with the Texas Attorney General's Office at: 1-800-252-8011
- U.S. Secretary of Health & Human Services at The Office of Civil Rights at: 1-214-767-4056.
If you would like additional copies of this notice or require a translation of this notice in another language, please contact us at 1-877-324-7543.