Medi-Cal - Forms and Publications:
NOTICE OF PRIVACY PRACTICES - HIPAA
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. THIS NOTICE ALSO DESCRIBES HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Why am I receiving this Notice?
Partnership Health Plan of California (PHC) is required by law to maintain the privacy of your health information. We are required to inform you of our legal duties and privacy practices where your protected health information (PHI) is concerned.
We agree to follow the terms of this Notice of Privacy Practices. We also have the right to change the terms of this notice if it becomes necessary, and to make the new notice effective for all health information we maintain. If we need to make any changes, we will provide you an updated copy of this notice by mailing it to you at your address in our records. If you received this notice electronically, you have the right to request a paper copy from us at any time.
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How does Partnership HealthPlan of California use and disclose my health information?
PHC stores health-related records about you, including your claims history, health plan enrollment information, case management records, and prior authorizations for health services. We use this information and disclose it to others for the following purposes:
- Treatment. PHC uses your health information to coordinate your health care, and we disclose it to hospitals, clinics, physicians and other health care providers to enable them to provide health care services to you. For example, PHC maintains your health information in electronic form, and allows health care providers to have on-line access to it to provide treatment to you.
- Payment. PHC uses and discloses your health information to make payment for health care services you receive, including determining your eligibility for benefits, and your provider's eligibility for payment. For example, we inform providers that you are a member of our plan, and tell them your eligible benefits.
- Health care operations. PHC uses and discloses your health information as necessary to enable us to operate our health plan. For example, we use our members' claims information for our internal financial accounting activities, and for quality assurance purposes.
We also disclose health information to our contractors and agents who assist us in these functions, but we obtain a confidentiality agreement from them before we make such disclosures for payment or operational purposes. For example, companies that provide or maintain our computer services may have access to computerized health information in the course of providing services to us.
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Why are we contacting you?
We may contact you to provide appointment reminders or information about treatment options available to you. We may also contact you about other health-related services that may interest you.
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Can others involved in my care receive information about me?
Yes, we may release medical information to a friend or family member who is involved in your care, or whose paying for your care, to the extent we judge it necessary for their participation. This includes responding to telephone enquiries about eligibility and claim status.
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Can my health information ever be released without my permission?
Yes, we may disclose health information without your authorization to government agencies and private individuals and organizations in a variety of circumstances in which we are required or authorized by law to do so. Here are the general kinds of disclosures we may be required or allowed to make without your authorization:
- Disclosures that are required by state or federal law
- Disclosures to public health authorities or to other persons in connection with public health activities
- To government agencies authorized to receive reports of abuse or neglect of children or dependent adults, or domestic violence
- To agencies responsible for overseeing the health care system, for audits, inspections or investigations
- For judicial and administrative proceedings, such as lawsuits
- To law enforcement agencies
- To coroners and medical examiners
- To organ procurement agencies, if you are an organ donor or a possible donor
- To researchers conducting research under the auspices of an Institutional Review Board or privacy board
- To avert a serious threat to health or safety
- To assist authorized federal officials in national security activities, or for the provision of protective services to officials
- If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the institution or official
- To other agencies administering government health benefit programs, as authorized or required by law
- To comply with workers' compensation laws.
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Are there instances when my PHI is not released?
Your health information may be subject to restrictions that may limit or prevent some uses or disclosures. For example, there are special restrictions on the disclosure of health information relating to HIV/AIDS status, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment. We comply with these restrictions in our use of your health information.
We will not permit other uses and disclosures of your health information without your written permission, or authorization which you may revoke at any time in the manner described in our authorization form.
Your Individual Rights
What rights do I have as a PHC member?
As a PHC member you have the following rights:
- You have the right to ask us to restrict certain uses and disclosures of your health information. However, PHC is not required to agree to any restrictions requested by its members.
- To protect your privacy, you have the right to receive confidential communications from PHC at a particular phone number, P.O. Box, or some other address that you specify to us.
- You have the right to see and copy any of your health records that PHC maintains on you. We must receive your request in writing. We will respond to your request within 30 days. If your records are stored in another location, please allow 60 days for us to respond to your request. We may charge a fee to cover the cost of copying your records. Under certain circumstances, PHC may deny your request. If your request is denied, we will tell you the reason why in writing. You have the right to appeal the denial.
- If you feel the information in our records is wrong, you have the right to request us to amend the records. We may deny your request in certain circumstances. If your request is denied, you have the right to submit a statement for inclusion in the record.
- You have the right to receive a report of non-routine disclosures that we have made of your health information, up to six years prior from the date of your request (but not earlier than April 14, 2003). There are some exceptions: for example, we do not maintain records of disclosures made with your authorization; disclosures made for the purposes of health care treatment, determining payment for health services, or conducting the health plan operations of PHC; disclosures made to you; and certain other disclosures.
- If you received this notice electronically, you have the right to request a paper copy from us at any time.
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How do I exercise these rights?
You can exercise any of your rights by sending a written request to our Privacy Official at the address below. To facilitate processing of your request, we encourage you to use our request form, which you can obtain from our Internet site at www.partnershiphp.org or by calling us at the telephone number below. You can also obtain a complete statement of your rights, including our procedures for responding to requests to exercise your rights, by calling or writing to the Privacy Official at the address below.
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How do I file a complaint if my privacy rights are violated?
As a PHC member, you have the right to file a complaint with our Privacy Official. You must provide us with specific, written information to support your complaint. You may also file a complaint with the Secretary of Health and Human Services.
PHC will not retaliate against you in any way for filing a complaint. Filing a complaint will not adversely affect the quality health care services you receive as a PHC member.
| Contact us at: |
| Privacy Official: Partnership Health Plan of California |
| Mailing address: |
360 Campus Lane, Ste 100 |
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Fairfield, CA 94534 |
| Telephone Number: |
707-863-4133 or 800-226-2140 for Hearing and Speech Impaired Members |
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| PHC's Complaint Hot-Line is 1-800-601-2146 and is operated 24 hours a day and 7 days a week |
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| California's Department of Health Services Privacy Official: |
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Senior Counsel and Privacy |
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Office California Department of Health Service |
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714 P Street, Room 650 |
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PO BOX 942732 |
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Sacramento, CA 95814 |
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(916) 657-0044 |
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| Contact the Secretary of Health and Human Services at: |
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Secretary of Health and Human Services |
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Office for Civil Rights |
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200 Independence Avenue SW |
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Room 509F, HHH Building |
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Washington, DC 20201 |
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PATIENT SAFETY INITIATIVE
The purpose of Partnership HealthPlan of California's (PHC) Patient Safety Initiative is to distribute information to members and practitioners about safe health practices and quality improvement initiatives. The overall objective is to promote informed decision-making. Links to key information are provided below to assist you in finding this important information.
Health care accreditation/certification and licensing information.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provides a comprehensive guide to the more than 15,000 JCAHO-accredited health care organizations and programs throughout the United States. http://www.jointcommission.org/
National Committee on Quality Assurance's (NCQA) Health Choices web site provides health plan report cards for consumers. http://www.healthchoices.org/
Medical Board of California provides licensing information for doctors, registered dispensing opticians, spectacle lens dispensers, contact lens dispensers, licensed midwives, and research psychoanalysts: http://www.medbd.ca.gov/
Ratings of nursing homes, home health, and hospice services in California. http://calnhs.org/
National initiatives that are either a broad approach to decreasing medical errors or are focused studies and interventions.
The Leapfrog Initiative was initiated by the Business Roundtable, a collaborative of large purchasers of healthcare. This group worked with medical experts and has identified three key processes within hospitals that if implemented, are believed to reduce medical errors and negative outcomes. These processes are:
Computer Physician Order Entry- Reduces prescribing errors and delays in care.
Evidence-Based Hospital Referral- Identified hospitals with extensive experience in certain high-risk surgeries and conditions and encourages patients to use this information in making decisions and practitioners in making referrals.
ICU Physician Staffing- Requires ICU trained specialists for the management of patients who are admitted to Intensive and Coronary Care units.
Members and practitioners can access specific results from surveys completed by hospitals that describe the progress an organization has made toward these three processes. If no information is available for a hospital, that organization did not complete the voluntary survey. http://www.leapfroggroup.org/
Other national organizations such as the Agency for Healthcare Research and Quality (AHRQ) and the National Patient Safety Foundation (NPSF) are also working toward decreasing medical errors. The AHRQ website http://www.ahcpr.gov offers information about safety studies and activities from various healthcare delivery settings. The NPSF website http://www.npsf.org/html/resources.html offers printable resources, a safety bibliography and a speaker's bureau.
The Institute of Medicine (IOM) is a non-profit organization that provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large. http://www.iom.edu
The Integrated Healthcare Association's (IHA) California Pay for Performance Initiative, launched in 2002, engaged six health plans in a collaborative to improve preventive services, chronic care management, and patient satisfaction. http://www.iha.org/payfprfd.htm
The following printable resources are available for health care practitioners:
Printable member safety information and tools for members and medical practices.
Quality improvement activities undertaken by facilities, medical groups and clinics.
The California Health Care Foundation (CHCF) funded a quality improvement collaborative initiative to improve diabetes and asthma care for low-income Californians. Thirty-eight health centers participated in this collaborative. http://www.chcf.org/topics/view.cfm?itemID=60048
The Pacific Business Group on Health publishes information to help consumers choose the health care plans, providers and services that best meet their needs. Their HealthScope web site at www.healthscope.org provides quality ratings and other performance information on health plans, doctors, hospitals and medical groups. Consumers can customize report cards to view ratings of the plans and providers of interest to them.
A search of the web using "best hospitals" will provide numerous articles about the current year's top ranking facilities and ratings for specialty services such as cardiovascular or cancer care.
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HEALTH SITES
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