Effective date: April 14, 2003
Listen to the Privacy Notice - click here
NORTHCARE NETWORK NOTICE OF PRIVACY PRACTICES
NorthCare Network is a department of Pathways Community Mental Health Authority. We do not provide direct services. We are the managed care organization for Medicaid Specialty Mental Health and Substance Abuse (SA) Services provided to residents of the Upper Peninsula. NorthCare has 2 administrative branches. One branch manages the Mental Health servicesand the second branch, the Center for Diagnostics and Referral Services (CDR) manages the Substance Abuse services.This notice applies to all NorthCare employees, volunteers, and contract providers who have access to your Protected Health Information (PHI).
Protecting
your health information is important. We will receive Protected
Health Information(PHI) about you. PHI is any information that
is received or created by NorthCare which identifies you and relates to
your past, present or future physical or mental health condition. This
includes information necessary for us to administer business and to provide
customer service.This notice will tell you about the ways in which we may
use and disclose medical information about you. We also describe your rights
and certain obligations we have regarding the use and disclosure of medical
information. We are required by law to make sure that medical information
that identifies you is kept private; to give you this notice describing
our legal duties and privacy practices with respect to medical information
about you; and to follow the terms of the current notice.
NORTHCARE MUST USE AND GIVE OUT YOUR PHI TO PROVIDE INFORMATION:
| · | To you or someone who has the legal right to act for you (your personal representative), | ||||||
| · | To the Secretary of the Department of Health and Human Services if necessary to make sure your privacy is protected, and | ||||||
| · | Where required by law. We will disclose medical information about you where required to do so by federal, state or local law. Some possible situations are:
|
NORTHCARE HAS THE RIGHT TO USE AND GIVE OUT YOUR PHI:
· To Provide Treatment: You may require treatment services that are not available in our region. NorthCare may play a role in helping facilitate treatment being provided by an out-of network provider. We would need to disclose your treatment needs to the provider.
· For Payment: We may use and disclose medical information about you so that the treatment and services you receive through Community Mental Health agencies in the Upper Peninsulamay be authorized and billed to Medicaid.For example, if you are admitted to a psychiatric inpatient unit for care, NorthCare would be responsible to review your stay at the hospital for payment purposes.
· For
Health Care Operations: We may use and disclose medical information
about you for NorthCare Network business operations. These uses and disclosures
are necessary to run NorthCare and make sure that all of our members
receive quality care. We may mail you our newsletter to keep you up to
date on our activities. We may contact you to review the treatment and
services you have received and to evaluate the performance our staff
or the staff of other mental health centers. We may also combine medical
information about our members to determine whether additional services
should be offered in our region; what services are not needed; and whether
certain new treatments are effective. We may also disclose information
to doctors, nurses, therapists, case managers, students, and other personnel
for review and learning purposes. We may remove information that identifies
you from this set of medical information so others may use it to study
health care and health care delivery without learning who the specific
recipients are.
NORTHCARE MAY USE OR GIVE OUT YOUR PHI FOR THE FOLLOWING PURPOSES UNDER CERTAIN CIRCUMSTANCES:
· Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We will always ask for your specific authorization if the researcher needs to have access to your name, address or other information that reveals who you are.
· Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
· Workers Compensation: We may disclose medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
· Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
· Public Health Risks: We may disclose medical information about you for public health activities. These activities may include the following:
| Prevention or the control of disease, injury or disability; | |
| Reporting births and deaths. | |
| Reporting child abuse or neglect. | |
| Reporting reactions to medications or problems with products. | |
| Notifying members of recalls of products they may be usin | |
| Notifying a person who may have been exposed to a disease or may be at risk forcontracting or spreading a disease or condition. | |
| Averting a serious threat to health or safet |
· Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
· National
Security and Intelligence Activities: We may release medical information
about you to authorized federal officials for intelligence, counterintelligence,
and other national security activities authorized by law. We may disclose
medical information about you to authorized federal officials if required
for special investigations.
IF THE NEED FOR A USE OR DISCLOSURE ARISES THAT IS NOT IN ONE OF THE PERMITTED CATEGORIES ABOVE, A VALID AUTHORIZTION MUST BE OBTAINED BY NORTHCARE BEFORE RELEASING THE REQUESTED PHI.
If
you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time. If you revoke
your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization. We are
unable to take back any disclosures we have already made with your permission,
or any we are required to retain in our records of the care we provided
to you.
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. If you wish to inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by NorthCare will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right
to Amend: If you feel that medical information we have about you is wrong
or incomplete, you may ask us to amend the information. You have the right
to request an amendment for as long as the information is kept by us. If
you wish to request an amendment your request must be made in writing.We
may deny your request if:
| · | The request is not made in writing; |
| · | There is not a reason to support the request; |
| · | The information was not created by us, unless the person or entity that created the information is no longer available to make the amendment; |
| · | The information is not part of the information which you would be permitted to inspect and copy; |
| · | The information is accurate and complete. |
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you other than for treatment, payment or healthcare operations. If you wish to request an accounting of disclosures, you must submit your request in writing. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for payment or health care operations. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limit to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications: You have the right to request that we communicate with you about NorthCare in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you your reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a paper copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.You may obtain a copy of this notice at our website:www.northcare-up.org . To obtain a paper copy of this notice, please call 1-888-333-8030
We
reserve the right to change this Notice. We reserve the right to make
the revised notice effective for medical information we already have
about you as well as any information we receive in the future. If there
is a significant revision of the Notice, we will mail you a notification
within 60 days of that revision. We will maintain a current notice on
our website, WWW.northcare-up.org. The effective
date of the Notice will be at the top of the page. If you remain an active
member, we will remind you every 3 years of our privacy practices and
how you may obtain a copy of the current notice.
If you believe your privacy rights have been violated, you may file a complaint with:
NNorthCare
Network Privacy officer, Mary Swift1-888-333-8030
AND / OR
U.S. Department of Health and Human Services
Office of Civil Rights Division
233 N. Michigan Ave Suite 240
Chicago, IL 60601 Toll free 1-800-368-1019
Funding for this publication was provided in part by the Michigan Department of Community Health