Notice of Privacy Practices

Notice: The privacy statement below is an excerpt of the complete HIPAA Privacy Policy. Please visit the HIPAA website to view the full HIPAA Privacy Policy.

Your Health Information Rights

1. You have the right to ask for restrictions on certain uses and disclosures of your health information. DHCF does not have to agree to the restriction that you ask for.

2. You have the right to get your health information through a reasonable alternative means or at an alternative location. You must present a DHCF form which tells your specific request. There may be charges to get this information. You will be told in advance.

3. You have the right to see and copy your health information. There may be fees and charges for the time it takes to copy, prepare, supervise, and mail the information you ask for.

4. You have a right to request that DHCF change your health information that is not correct or not complete. DHCF does not have to change your health information and will give you information about DHCF not changing the information. You will be told how you can disagree with the denial.

5. You have a right to get a list of disclosures of your health information made by DHCF, except that DHCF does not have to include disclosures for: 1(treatment), 2 (payment), 3 (health care operations), 4 (information provided to you), and 16 (certain government functions) of Section I of this Notice of Privacy Practices.

6. You have a right to a paper copy of this Notice of Privacy Practices and can get this Notice in another format..

Changes to this Notice of Privacy Practices

DHCF reserves the right to change this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it keeps, including information that was created or received prior to the date of such change. Until such change is made, DHCF must by law comply with this Notice. Upon a material change of this Notice, DHCF will send a new Notice with the changes and effective date of change to each current recipient.

If you do not speak and/or read English, please call (202) 442-5988 between 8:15 a.m. and 4:45 p.m. A representative will assist you.

The Department of Health Care Finance or DHCF keeps your protected health information (PHI) confidential. The Income Maintenance Administration (IMA) approved you for Medicaid. IMA then sent information about you to DHCF. DHCF uses this information to pay for your health care. Your PHI includes your name, address, birth date, and phone number. It also includes your social security number, Medicare number (if any), and health insurance policy information. It may include information about your health condition.

The claims by health care providers include your diagnoses. The claims list your medical treatment and supplies. Claims also include physician's statements, x-rays, and lab test results. Your PHI is this information too. The law requires us to keep your PHI private. We must provide you with this Notice of our legal duties and privacy practices. The law requires DHCF to abide by this Notice.

We use your PHI to allow a doctor or nurse to treat you. We allow a business office to process payment for your medical services with your PHI. Administrative personnel reviewing the quality of the care you receive use your PHI too. This Notice also governs how DHCF and the Income Maintenance Administration will use and disclose your health information to each other. We may also use and/or disclose your PHI without your permission when permitted by law.

Treatment: To a health care provider to treat you. (EXAMPLE: DHCF may share your PHI with a clinical laboratory.)

Payment: To pay claims for services delivered to you. (EXAMPLE: DHCF shares your PHI with a claims processor. The contractor verifies that you receive treatment)

Health Care Operations: To perform health care operations including:

. Assessing health care quality
. Reviewing accreditation, certification, licensing, and credentialing
. Conducting medical reviews, audits, and legal services
. Underwriting and other insurance functions
(EXAMPLE: DHCF sends your PHI to a quality review committee.)

Previous Provider: To your current or past health care provider.

Public Health and Benefit Activities:For the following kinds of public health/interest activities:

. For public health
. For health care oversight . For research
. To coroners, medical examiners, funeral directors, and organ procurement organizations.
. As authorized by DC workers' compensation laws

To Avoid Harm or Other Law Enforcement Activities: We may disclose your PHI:

. To stop a serious threat to health or safety
. In response to court/administrative orders
. To law enforcement officials
. To the military and intelligence activities
. To correctional institutions

Communication: Contact you personally to keep you informed. (EXAMPLE: DHCF may send appointment reminders or information about other treatment opportunities to you.)

DHCF will only use or disclose your PHI for purposes this Notice mentions. DHCF will obtain your written authorization for other uses and disclosures. You may revoke your authorization in writing any time. You may contact the DHCF Privacy Officer at the address listed at the end of this Notice.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights with respect to your PHI. In writing, you may:

. Ask us to limit how your PHI is used or given out. We are not required to agree to your request. If we do agree, we will honor it.
. Ask DHCF to talk to you in a different manner.
. Generally, see and copy your PHI. You may ask that any refusal to do so be reviewed. You may be charged a reasonable fee for copies.
. Ask DHCF to change your PHI. We may not make your requested changes. If so, we will tell you why we cannot change your PHI. You may respond in writing to any denial. You may ask that both our denial and your response be added to your PHI.
. Get a listing of certain entities that received your PHI from DHCF after April 14, 2003. This list will not include a listing of disclosures made for treatment or payment. Nor will it include disclosures for healthcare operations, information you authorized us to provide, and government functions.
. Request a paper copy of this Notice of Privacy Practices.

For more information about our privacy practices, you may contact the Privacy Officer at either of the following addresses.

DHCF Privacy Officer
DC Department of Health
Department of Health Care Finance
One Judiciary Square
441 4th Street, NW Suite 1000 S
Washington, D.C. 20001
Voice: (202) 442-5988
Fax: (202)442-4790
E-mail: maaprivacy@dc.gov

District of Columbia Privacy Official
DC Office of Health Care Privacy and Confidentiality in the Office of the Deputy Mayor for Children, Youth, Families, and Elders
1350 Pennsylvania Avenue NW
Suite 307
Washington, D.C. 20004
Voice: (202) 727-8001
Fax: (202) 727-0246
E-mail: dcprivacy@dc.gov

You may also contact the Privacy Officer for additional copies of this Notice. You have the right to complain to us. You may also complain to the U. S. Department of Health and Human Services. Complaints will not cause you any harm. To complain to us, please contact DHCF at either of the District offices. You also may send a written complaint to the Secretary of the U. S. Department of Health and Human Services at the following address:

Office for Civil Rights- Region III
U.S. Department of Health and Human Services
150 S. Independence Mall West, Suite 372
Public Ledger Building
Philadelphia, PA 19106-9111
Main Line (215) 861-4441
Hotline (800)368-1019
FAX(215) 861-4431
TDD(215) 861-4440
TTY: (886) 788-4989
E-mail: Qcnnail@hhs.gov

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice. If we change the terms of this Notice, we will post a revised notice in the DHCF offices. In addition, the current Notice of Privacy Practices will be posted on the Internet at http://www.dchealth.dc.gov