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PRIVACY NOTICE – UNITED METHODIST
HOMES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. General Information
This Privacy Notice describes how the United Methodist Homes
(“UMH”) may use and disclose your protected health
information to carry out treatment, payment or healthcare
operations and for other purposes that are permitted or
required by law. This notice also describes your rights to
access and control your protected health information.
“Protected health information” is information about you that
may identify you and that relates to your past, present or
future physical or mental health or condition and related
health care services.
UMH is required to follow the terms of this notice but we
may change the terms of the notice at any time. The new
notice will be effective for all protected health
information that we maintain at that time. Upon your
request, UMH will provide you with any revised notice, which
you can obtain by contacting the privacy officer at UMH as
stated below.
2. Uses and Disclosures of Protected Health
Information
Treatment: UMH may use or
disclose your protected health information, as needed, to
provide, coordinate or manage your health care and any
related services. For example, we may disclose your
protected health information to health care professionals
who become involved in your care such as physicians, hospice
personnel, a pharmacist in order to fill a prescription or a
radiologist to fulfill a physician’s order.
Payment: UMH may use or disclose
your protected health information, as needed, to obtain
payment for your health care services. For example, UMH
anticipates that your protected health information may be
provided to third-party payers, such as Medicare, Medicaid,
Medical Assistance or insurance companies, for billing
purposes.
Healthcare Operations: UMH may
use or disclose your protected health information in order
to support the business activities of UMH. These activities
include, but are not limited to, health care consulting,
auditing, and business planning activities.
Marketing: In most
circumstances, UMH is required by law to receive your
written authorization before using or disclosing your health
information for marketing purposes. However, UMH may provide
you with promotional gifts of nominal value. UMH will not,
under any circumstances, sell resident lists or your health
information to a third party without your written
authorization.
Newsletters and Other Communications:
UMH may use your name and address to send you a newsletter
or other information about healthcare treatment options or
other related benefits and services that may be of interest
or beneficial to you.
Fundraising: UMH may use your
demographic information and dates you received treatment for
fund raising activities. If you do not want to receive fund
raising materials, please contact our privacy officer as
noted below.
Appointment Reminders: UMH may
use or disclose your protected health information to remind
you of an appointment. You may request that UMH provide such
reminders only in a certain way or only at a certain place,
and UMH will endeavor to accommodate all reasonable
requests.
Business Associates: Whenever
UMH has an arrangement with a third party where UMH shares
your protected health information, UMH will have a written
agreement with that third-party “business associate” that
contains terms that will protect the privacy of your
protected health information.
Health Related Benefits and Services:
UMH may use and disclose health information to you to tell
you about health-related benefits or services that may be of
interest to you. In face-to-face communications, UMH may
tell you about other products and services that may be of
interest to you.
Authorizations: Other
disclosures and uses will be made only with your written
authorization unless otherwise permitted by law as described
below. You may revoke the authorization to release protected
health information at any time except to the extent that UMH
has relied on the use or disclosure indicated in the
authorization.
Uses and Disclosures Unless You Object:
Unless you object, we will use and disclose in our facility
directory your name, location, general condition, and your
religious affiliation, to members of the clergy or
individuals who ask for you by name. You have the right to
notify us that you do not want to be included within the
facility directory.
Unless you object, UMH may disclose to a member of your
family, a relative, a close friend, or any person you
identify, your protected health information that directly
relates to that person’s involvement in your health care or
payment related to your health care. If you are not able to
agree or object to such disclosure, we may disclose such
information as necessary if we determine that it is in your
best interest based upon UMH’s professional judgment.
Other Uses and Disclosures:
UMH may use or disclose your protected health information to
the extent that the use or disclosure is required by law.
UMH may use and disclose your health information in order to
inform you of alternative treatments.
Your protected healthcare information may be disclosed to a
public health organization or federal organization in the
event of a communicable disease or to report a defective
device or untoward event involving a biological product
(food or medication), or when required by law.
Your protected health information may be disclosed for
public health activities and purposes to a public health
authority that is permitted by law to collect or receive the
information.
UMH may disclose protected health information to a public
health authority authorized to receive reports of abuse or
neglect or where UMH believes you have been a victim of
abuse, neglect or domestic violence.
UMH may disclose your protected health information as
required by the Food and Drug Administration.
UMH may disclose your protected health information in the
course of any judicial or administrative proceeding, in
response to an order of a court or administrative tribunal,
in certain conditions in response to a subpoena, discovery
request or other lawful process.
UMH may disclose protected health information for law
enforcement purposes, to a coroner or medical examiner for
identification purposes, determining cause of death, or for
other duties of the coroner or medical examiner authorized
by law.
UMH may disclose health information to funeral directors so
that they may carry out their duties.
UMH may disclose your health information in disaster relief
situations where disaster relief organizations seek your
health information to coordinate your care, or notify family
and friends of your location and condition. UMH will provide
you with an opportunity to agree or object to such a
disclosure whenever UMH can practicably do so.
Under most circumstances, without your written authorization
UMH may not disclose the notes a mental health professional
took during a counseling session. However, UMH may disclose
such notes for treatment and payment purposes, for state and
federal oversight of the mental health profession, for the
purposes of medical examiners and coroners, to avert a
serious threat to health or safety, or as otherwise
authorized by law.
UMH may disclose your protected health information to
researchers when a waiver has been issued by an
institutional review board or a privacy board that has
reviewed the research proposal and protocols for compliance
with standards to ensure the privacy of your protected
health information.
3. Your Rights
You have the right to request restrictions on certain uses
and disclosures of your protected health information.
However, UMH is not required to agree to that request. UMH
will notify you if UMH does not agree to a requested
restriction. UMH may use or disclose your protected health
information in an emergency treatment situation.
You have the right to request a restriction or limitation on
the medical information UMH uses or discloses about you for
treatment, payment, or health care operations. If you paid
out-of-pocket in full for a specific item or service, you
have the right to request that medical information with
respect to that item or service not be disclosed to a health
plan for purposes of payment or health care operations, and
UMH is required to honor that request. You also have the
right to request a limit on the medical information UMH
communicates about you to someone who is involved in your
care or the payment for your care.
Except as noted above, UMH is not required to agree to your
request. If UMH does agree, UMH will comply with your
request unless the restricted information is needed to
provide you with emergency treatment.
To request restrictions, you must make your request in
writing to the UMH privacy officer. In your request, you
must tell UMH:
-
What information you want to limit;
-
Whether you want to limit UMH’s use, disclosure, or both; and
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To whom you want the limits to apply.
You have the right to inspect and copy
any and all portions of your protected health information,
except psychotherapy notes. If your health information is
maintained in an electronic health record you also have the
right to request that an electronic copy of your health
information be sent to you or to another individual or
entity. UMH may charge you a reasonable cost based fee
limited to the labor costs associated with transmitting the
electronic health record.
You have the right to request that UMH communicate with you
about medical matters in a certain way or at a certain
location. To request confidential communications, you must
make your request in writing to the UMH privacy officer. UMH
will not ask you the reason for your request. UMH will
accommodate all reasonable requests. Your request must
specify how or where you wish to be contacted.
You have the right to request an amendment to your protected
health information.
You have the right to know who has accessed your protected
health information and for what purpose. In your accounting,
UMH is not required to list certain disclosures, including:
-
Disclosures made for treatment, payment, and health care operations purposes or disclosures made incidental to treatment, payment, and health care operations, however, if the disclosures were made through an electronic health record, you have the right to request an accounting for such disclosures that were made during the previous 3 years;
-
Disclosures made pursuant to your authorization;
-
Disclosures made to create a limited data set;
-
Disclosures made directly to you.
To request an accounting of disclosures,
you must submit your request in writing to UMH’s privacy
officer. Your request must state a time period which may not
be longer than six years and may not include dates before
April 14, 2003. Your request should indicate in what form
you would like the accounting of disclosures (for example,
on paper or electronically by e-mail). The first accounting
of disclosures you request within any 12 month period will
be free. For additional requests within the same period, UMH
may charge you for the reasonable costs of providing the
accounting of disclosures. UMH will notify you of the costs
involved and you may choose to withdraw or modify your
request at that time, before any costs are incurred. Under
limited circumstances mandated by federal and state law, UMH
may temporarily deny your request for an accounting of
disclosures.
You have the right to obtain a paper copy of this Privacy
Notice from UMH upon request, even if you have agreed to
receive the notice electronically.
UMH is required to notify you by first class mail or by
e-mail (if you have indicated a preference to receive
information by e-mail), of any breaches of Unsecured
Protected Health Information as soon as possible, but in any
event, no later than 60 days following the discovery of the
breach. “Unsecured Protected Health Information” is
information that is not secured through the use of a
technology or methodology identified by the Secretary of the
U.S. Department of Health and Human Services to render the
protected health information unusable, unreadable, and
undecipherable to unauthorized users. The notice is required
to include the following information:
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A brief description of the breach, including the date of the breach and the date of its discovery, if known;
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A description of the type of Unsecured Protected Health Information involved in the breach;
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Steps you should take to protect yourself from potential harm resulting from the breach;
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A brief description of actions UMH is taking to investigate the breach, mitigate losses, and protect against further breaches;
-
Contact information, including a toll-free telephone number, e-mail address, Web site or postal address to permit you to ask questions or obtain additional information.
In the event the breach involves 10 or
more residents whose contact information is out of date UMH
will post a notice of the breach on the home page of UMH’s
Web site or in a major print or broadcast media. If the
breach involves more than 500 residents in a state or
jurisdiction, UMH will send notices to prominent media
outlets. If the breach involves more than 500 residents, UMH
is required to immediately notify the Secretary of Health
and Human Services. UMH also is required to submit an annual
report to the Secretary of a breach that involved less than
500 residents during the year and UMH will maintain a
written log of breaches involving less than 500 residents.
UMH is required by law to maintain the privacy of protected
health information and to provide individuals with notice of
UMH’s legal duties and privacy practices with respect to
protected health information.
UMH is required to abide by the terms of the notice
currently in effect. UMH reserves the right to make changes
to this notice and the notice will be effective for all
protected health information that UMH maintains at that
time. Upon your request, UMH will provide you with a copy of
the revised notice. UMH will mail a copy of the revised
Privacy Notice to residents when there is a material change
to the notice. A revised notice reflecting a material change
will be mailed promptly after making the change.
UMH will accommodate reasonable requests you may have to
communicate health information by alternative means or at
alternative locations.
4. Complaints
You have the right to complain to UMH and the Department of
Health and Human Services if you believe your rights to
privacy have been violated. If you feel your privacy rights
have been violated and have been unresolved by the facility
administrator, please mail your complaint to UMH:
Attn: Compliance Officer
United Methodist Homes
10 Acre Place
Binghamton, NY 13904
All complaints will be investigated. The individual making
the complaint will not be retaliated against for filing a
complaint.
For further information about this Privacy Notice, please
contact:
Compliance Officer
(607) 775-6400, ext. 290
Or the Hotline at 1-800-646-9066
Effective: April 14, 2003
Updated: November 16, 2011