UTAH
DEPARTMENT OF HEALTH, DIVISION OF MEDICAID AND HEALTH
FINANCING,
NOTICE OF PRIVACY PRACTICES
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective: 04/14/2003
The
Utah Department of Health, Division of Medicaid and
Health Financing is committed to protecting your medical
information. The Division is required by law to maintain
the privacy of your medical information, provide this
notice to you, and abide by the terms of this notice.
CONFIDENTIALITY
PRACTICES AND USES
The Division may use your health information for conducting
our business. Examples:
Treatment - to appropriately determine
approvals or denials of your medical treatment. For
example, the Division's health care professionals
may review your treatment plan by your health care
provider for medical necessity if a Medicaid recipient
or for program listed services if a Primary Care Network
(PCN) recipient.
Payment - to determine your eligibility
in the Medicaid or PCN program and make payment to
your health care provider. For example, your health
care provider may send claims for payment to the Division
for medical services provided to you, if appropriate.
Health Care Operations - to evaluate
the performance of a health plan or a health care
provider. For example, the Division contracts with
consultants who review the records of hospitals and
other organizations to determine the quality of care
you received.
Informational Purposes - to give
you helpful information such as health plan choices,
program benefit updates, free medical exams and consumer
protection information.
YOUR
INDIVIDUAL RIGHTS
You have the right to:
- Request
restrictions on how we use and share your health
information. We will consider all requests for
restrictions carefully but are not required to
agree to any restriction.
- Request
that we use a specific telephone number or address
to communicate with you.
- Inspect
and copy your health information, including medical
and billing records. Fees may apply. Under limited
circumstances, we may deny you access to a portion
of your health information and you may request
a review of the denial. *
- Request
corrections or additions to your health information.
*
- Request
an accounting of certain disclosures of your health
information made by us. The accounting does not
include disclosures made for treatment, payment,
and health care operations and some disclosures
required by law. Your request must state the period
of time desired for the accounting, which must
be within the six years prior to your request
and exclude dates prior to April 14, 2003. The
first accounting is free but a fee will apply
if more than one request is made in a 12-month
period.*
- Request
a paper copy of this notice even if you agree
to receive it electronically.
- Requests
marked with a star (*) must be made in writing.
Contact the Medicaid or PCN Privacy Officer for
the appropriate form for your request.
SHARING YOUR HEALTH INFORMATION
There are limited situations when we are permitted
or required to disclose health information without
your signed authorization. These situations include
activities necessary to administer the Medicaid
and PCN programs and the following:
- For
public health purposes such as reporting communicable
diseases, work-related illnesses, or other diseases
and injuries permitted by law; reporting births
and deaths; and reporting reactions to drugs and
problems with medical devices
- To
protect victims of abuse, neglect, or domestic
violence
- For
health oversight activities such as investigations,
audits, and inspections
- For
lawsuits and similar proceedings
- When
otherwise required by law
- When
requested by law enforcement as required by law
or court order
- To
coroners, medical examiners, and funeral directors
- For
organ and tissue donation
- For
research approved by our review process under
strict federal guidelines
- To
reduce or prevent a serious threat to public health
and safety
- For
workers’ compensation or other similar programs
if you are injured at work
For
specialized government functions such as intelligence
and national security
All other uses and disclosures, not described in this
notice, require your signed authorization. You may
revoke your authorization at any time with a written
statement.
OUR
PRIVACY RESPONSIBILITIES
The Division is required by law to:
- Maintain
the privacy of your health information
- Provide
this notice that describes the ways we may use
and share your health information
- Follow
the terms of the notice currently in effect.
We reserve the right to make changes to this notice
at any time and make the new privacy practices
effective for all information we maintain. Current
notices will be posted in the Division offices
and on our website, http://health.utah.gov/hipaa.
You may also request a copy of any notice from
your Medicaid or PCN Privacy Officer listed below:
CONTACT
US
If you would like further information about your privacy
rights, are concerned that your privacy rights have
been violated, or disagree with a decision that we
made about access to your health information, Medicaid
recipients should contact the Division Privacy Officer:
Craig Devashrayee,
801-538-6641
288 North 1460 West, 3rd Floor
PO Box 143102
Salt Lake City, Utah 84114-3102
Primary
Care Network (PCN) recipients should contact the PCN
Privacy Officer:
Emma Chacon, 801-538-6577
288 North 1460 West, 4th Floor
PO Box 144102
Salt Lake City, UT 84114-4102
We will investigate all complaints and will not retaliate against
you for filing a complaint.
You may also file a written complaint with the Office of Civil Rights,
200
Independence Avenue, S. W. Room 509F HHH Bldg., Washington, DC 20201
Effective: 04/14/2003
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