Notice of Privacy Practices
Effective Date: February 1, 2020
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.
Driscoll Health Plan (DHP) is required by law to maintain the privacy of Protected Health Information (PHI). DHP is required to provide you with this notice of our legal duties and privacy practices with regard to uses of PHI, as well as to inform you regarding your individual rights. This notice explains the purposes for which DHP is permitted to use and disclose your PHI.
In this Privacy Notice, Driscoll Health Plan is referred to as “DHP” and the Texas 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 DHP MAY USE AND DISCLOSE YOUR PHI:
DHP may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of health care with a third party. DHP may also disclose protected health information, from time to time, to a physician, or health care provider (for example, a specialist, pharmacist, or laboratory). At the request of your physician, a health care provider may become involved in your care by providing assistance with your health care diagnosis or treatment. This may also include a pharmacist who may be provided information on other drugs you have been prescribed to identify potential interactions. In emergencies, DHP may need to use and disclose your protected health information to provide the treatment you require.
Your protected health information may be used, if needed, to obtain payment for your health care services. This may include certain activities that DHP might undertake before DHP approves or pays for the health care services recommended for you, such as determining eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay might require that your relevant protected health information be disclosed to obtain approval for the hospital admission.
- Health care operations
DHP may use or disclose, if needed, your protected health information to support the daily activities related to health care. These activities include, but are not limited to: quality assessment activities, investigations, oversight, licensing, communications about a product or service, and conducting or arranging for other health care related activities.
DHP may share your protected health information with third-party “business associates” who perform various activities. The business associates are also required to protect your health information.
DHP may use or disclose your protected health information, if necessary, to provide you with information about treatment alternatives or other health-related benefits and services that might interest you. For example, your name and address may be used to send you a newsletter about the services DHP offers. DHP may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
- Family member, other relative, or close personal friend
DHP may disclose your PHI to a family member, other relative or close personal friend if:
a. the health information is related to that person’s involvement with your care or payment for your care; and
b. you have had an opportunity to stop or limit the disclosure before this occurs.
- Government programs
DHP may disclose your PHI to another government agency offering public benefits if:
the information relates to whether 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 as DHP, 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
DHP may use or disclose your PHI to another government agency authorized to conduct health oversight activities. Health oversight activities may include, but are not limited to: investigating possible fraud, waste, or abuse in the CHIP or STAR program.
- Public health
DHP may disclose your 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
DHP may use or disclose your 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
DHP may disclose your PHI to a law enforcement official/s, 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
DHP may disclose your PHI for judicial and administrative purposes, including an order from a regular or administrative court.
- As required by law
DHP must use or disclose your PHI when a law requires the use or disclosure.
DHP may disclose your PHI to a contractor if the contractor:
needs the information to perform services for DHP; and
agrees to protect the privacy of the information.
- Secretary of Health and Human Services
DHP must disclose your PHI to the Secretary of Health and Human Services when the Secretary requests the information to enforce privacy protections.
DHP may use or disclose your 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
DHP may use or disclose your 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.
Most uses and disclosures of psychotherapy notes or PHI for marketing purposes or sale require prior authorization.
Restrictions may be placed on disclosures where you have paid out of pocket-in full for the treatment provided.
You have the following rights regarding your PHI we maintain.
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. DHP is not required to agree to or abide by your request. If DHP agrees, DHP 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. You may revoke a previously agreed upon restriction, at any time, 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 DHP only contacts you by telephone at work or that we only contact you by mail at home. Your request must be in writing and specify how, where, or when you wish to be contacted. DHP will attempt to accommodate all reasonable requests. Any changes to the request must be made in writing as well.
Right to Inspect and Receive a Copy
You have the right to look at or get a copy of the health information DHP has about you. If DHP maintains an electronic health record of your information you have the right to receive a copy in electronic format. Request must be made in writing.
Right to Amend
If you believe that the PHI DHP has 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 DHP. You must include a reason that supports your request. All requests for amendment should be made in writing. DHP 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, DHP 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 DHP; (3) is not part of the PHI that you would be permitted to inspect and copy; or (4) is accurate and complete.
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 may request that DHP provide you with an accounting of the disclosures we have made of your protected health information. The disclosure must have been made after April 14, 2003, and no more than 6 years from the date of request or 3 years for an access report of Electronic Health Information indicating who has accessed electronic protected health information in a designated record set. Request must be made in writing and must be responded to within 30 days.
Right to Revoke
You may withdraw permission you have given DHP to use or disclose your health information, unless DHP has already taken action based on your permission. You must withdraw your permission in writing.
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.driscollhealthplan.com.
If DHP privacy practices are changed, DHP must notify you of the changes by mailing a new Privacy Notice to your most recent address. DHP will mail the new Privacy Notice within 60 days of the changes. The new practices will apply to all the health information about you regardless of when DHP received or created the information.
If you have questions about this Notice or need more information about your privacy rights, you may contact DHP at 1-877-324-7543.
- If you believe DHP has violated your privacy rights, you may file a complaint by contacting DHP’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.
- DHP encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
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.