PACE Participant Rights

Notice of Privacy Practices

Effective Date: April 14, 2003 
Revised: August 2013

THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact CEI’s HIPAA Compliance Officer at (510) 433-1150.

We are required by law to maintain the privacy of your health information; to provide you this detailed Notice of our legal duties and privacy practices relating to your health information; and to abide by the terms of the Notice that are currently in effect. This Notice applies to our use and disclosure of your health information for purposes of enrollment, eligibility and payment under Center for Elders’ Independence (CEI), as well as our use and disclosure of your health information for purposes of providing you with treatment under CEI.

WHO WILL FOLLOW THIS NOTICE 
This notice describes CEI’s practices and that of:

• Any health care professional authorized to enter information into your medical record.
• All departments and disciplines of CEI.
• Any member of a volunteer group we allow to help you while you are at CEI
• All employees, staff and other CEI personnel.

This notice applies to all of the above persons and entities at any site or location owned or operated by CEI. In addition, these entities, sites and locations may share medicalinformation with each other for treatment, payment or operations purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION: 
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at CEI. We need this record to provide you with quality care and to comply with certain legal requirements. 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;
• give you this notice of our legal duties and privacy practices with respect to medical information about you;
• notify you following a breach of unsecured protected health information; and
• follow the terms of the notice that is currently in effect.

I. USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS 

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within 
one of the categories.

For Treatment. We will use and disclose your health information in providing you with treatment and services and coordinating your care, and may disclose information to other providers involved in your care. Your health information may be used by doctors involved in your care and by nurses and home health aides as well as by physical therapists, social workers, personal care attendants or other persons involved in your care. For example, members of the interdisciplinary team (which includes your primary care physician, a registered nurse, a social worker, physical and occupational therapists, and other care givers) will discuss your plan of care and contact any specialists regarding care provided to you.

For Payment. We may use and disclose your health information for billing and payment purposes. We may disclose your health information to your personal representative, or to an insurance or managed care company, Medicare, Medi-Cal or CA Department of Health Care Services (CA DHCS), which is charged with administering CEI. For example, we may disclose health information to Medicare or CA DHCS in order to determine your continued eligibility for CEI services. We will also require you to sign a release permitting the disclosure of personal information to Medicare, Medi Cal, and CA DHCS for these purposes as a condition of your enrollment agreement.

For Health Care Operations. We may use and disclose your health information as necessary for health care operations, such as management, personnel evaluation, education and training and to monitor quality of care. For example, we will use data about your treatment in order to conduct quality assessment activities. We may disclose your health information to another entity with which you have or had a relationship if that entity requests your information for certain of its health care operations or for health care fraud and abuse detection or compliance activities.

II. SPECIFIC USES AND DISCLOSURES OF YOUR HEALTH INFORMATION 

The following lists various ways in which we may use or disclose your health information.

Individuals Involved in Your Care or Payment for Your Care. Unless you object in writing, we may disclose health information about you to a family member, close personal friend or other person you identify, including clergy, who is involved in your care.

Emergencies. We may use or disclose your health information as necessary in emergency treatment situations.

As Required By Law. We may use or disclose your health information when required by law to do so.

Business Associates. Our business associates are individuals and organizations that carry out functions or activities on our behalf that involve protected health information. We may disclose your protected health information to a contractor or business associate who needs the information to perform services for the CEI. Our business associates are committed to preserving the confidentiality of this information.

Public Health Activities. We may disclose your health information for public health activities. These activities may include, for example, reporting to a public health authority for preventing or controlling disease, injury or disability; reporting elderly abuse or neglect or reporting deaths.

Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your health information to notify a government authority, if authorized by law or if you agree to the report.

Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure actions or for activities involving government oversight of the health care system. As a condition of enrollment, we will require you to sign a release permitting the disclosure of personal information to Medicare, Medi-Cal, and CA DHCS for these purposes.

To Avert a Serious Threat to Health or Safety. When necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person, we may use or disclose health information, limiting disclosures to someone able to help lessen or prevent the threatened harm.

Judicial and Administrative Proceedings. We may disclose your health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.

Law Enforcement. We may disclose your health information for certain law enforcement purposes, including, for example, to comply with reporting requirements; to comply with a court order, warrant, or similar legal process; or to answer certain requests for information concerning crimes.

Research. We may use or disclose your health information for research purposes if the privacy aspects of the research have been reviewed and approved, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.

Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.

Disaster Relief. We may disclose health information about you to a disaster relief organization. Military, Veterans and other Specific Government Functions. If you are a member of the armed forces, we may use and disclose your health information as required by military command authorities. We may disclose health information for national security purposes or as needed to protect the President of the United States or certain other officials or to conduct certain special investigations.

Fundraising Activities. We may use certain limited information to contact you in an effort to raise funds for CEI and its operations. You have the right to opt out of receiving such communications.

Appointment Reminders. We may use or disclose health information to remind you about appointments.

Treatment Alternatives and Health-Related Benefits and Services. We may use or disclose your health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you.

NOTE: IF YOU ARE A MEDI-CAL PATIENT, THE LAW MAY NOT ALLOW SHARING SOME OF THE INFORMATION LISTED ABOVE. MEDI-CAL RULES SAY INFORMATION CAN ONLY BE USED OR SHARED FOR REASONS DIRECTLY CONNECTED TO THE OPERATION OF THE MEDI-CAL PROGRAM.

III. USES AND DISCLOSURES WITH YOUR AUTHORIZATION 
Except as described in this Notice, we will use and disclose your health information only with your written Authorization. You may revoke an Authorization in writing at any time. If you revoke an Authorization, we will no longer use or disclose your health information for the purposes covered by that Authorization, except where we have already relied on the Authorization.

IV. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION 
Listed below are your rights regarding your health information. Each of these rights is subject to certain requirements, limitations and exceptions. Exercise of these rights may require submitting a written request to CEI. At your request, CEI will supply you with the appropriate form to complete. You have the right to:

Request Restrictions. You have the right to request restrictions on our use or disclosure of your health information for treatment, payment, or health care operations. This includes the right to submit a written consent limiting the degree of information disclosed and the persons to whom information is disclosed. You also have the right to request restrictions on the health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care.

We are not required to agree to your request. We are not required to agree to your requested restriction on how we use your health information within CEI. We will limit disclosures outside CEI (except for disclosures to Medicare, Medi-Cal and CA DHCS) in accordance with your written consent. We will grant requests to restrict use of protected health information within CEI if they are reasonable and can be accommodated. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to:

Center for Elders’ Independence 
Medical Records Department 
510 17th Street 
Oakland, CA 94612

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 limits to apply, for example, disclosures to your spouse.

Right to Inspect and Copy. You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. To inspect and copy medical information, you must submit your request in writing to:

Center for Elders’ Independence 
Medical Records Department 
510 17th Street 
Oakland, CA 94612

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.

Right to Amend. If you feel that the medical information we have about you is incorrect 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 or for CEI.

To request an amendment, your request must be made in writing and submitted to:

Center for Elders’ Independence 
Medical Records Department 
510 17th Street 
Oakland, CA 94612

In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

Is not part of the medical information kept by or for CEI

Is not part of the information which you would be permitted to inspect and copy; or

Is accurate and complete.

If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.

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.

To request this list or accounting of disclosures, you must submit your request in writing to:

Center for Elders’ Independence 
Medical Records Department 
510 17th Street 
Oakland, CA 94612

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 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 costs 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.

Request a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice. You may request a copy of this Notice at any time by contacting CEI’s Medical Records Department at (510) 433-1150. You may also obtain a copy from CEI’s website.

Request Confidential Communications. You have the right to request that we communicate with you concerning your health matters in a certain manner. To request confidential communications, you must make your request in writing to:

Center for Elders’ Independence 
Medical Records Department 
510 17th Street 
Oakland, CA 94612

We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.