Lutheran Home of Southbury

HIPPA Policy

The Lutheran Home of Southbury

NOTICE OF PRIVACY PRACTICES

Effective Date: 4/13/03
Revision Date: 4/26/05

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

The Lutheran Home of Southbury respects the privacy of your health information and is committed to maintaining our residents’ confidentiality. This notice describes your rights and our obligations under the Health Insurance Portability and Privacy Act’s (HIPAA’S) Privacy Rule regarding your health information and informs you about possible uses and disclosures of your health information. This notice applies to all records related to your care that the Lutheran Home of Southbury has received or created, or will receive or create. It extends to information received or created by our employees, staff, and volunteers as well as by doctors and/or health care practitioners practicing at the Lutheran Home of Southbury.

We are required by law to:

Maintain the privacy of your protected health information
Provide you with this detailed Notice of our legal duties and privacy practices relating to your protected health information
Abide by the terms of the Notice that are currently in effect.

The Lutheran Home of Southbury is an affiliate of Lutheran Social Services of New England, Inc. and a subsidiary of Lutheran Social Ministries in New England, Inc. These related corporations comply and are bound by this notice.

THE LUTHERAN HOME OF SOUTHBURY MAY USE AND DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

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

The following lists various ways in which we may use or disclose your health information for purposes of treatment, payment and health care operations.

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, nurses, nurse aides, as well as by physical therapists, pharmacists, lab technicians, dieticians, and suppliers of medical equipment or other persons involved in your care within the facility and may be disclosed to other health care providers in connection with your treatment. We may also disclose health information to individuals or facilities that will be involved in your care after you leave the facility. For example, we will contact your physician to discuss your plan of care.
For Payment. We may use and disclose your health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your health information to an insurance or managed care company, Medicare, Medicaid or another third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for services that will be provided to you.
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 our quality of care. 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 health care fraud and abuse detection or compliance activities. For example, health information of many patients may be combined and analyzed for purposes such as evaluating and improving quality of care and planning for services.

II. SPECIFIC USES AND DISCLOSURES OF YOUR HEALTH INFORMATION THAT MAY BE MADE WITHOUT WRITTEN AUTHORIZATION

Under the Privacy Rule, the Lutheran Home of Southbury is permitted and may be required to use or disclose your health information without your written authorization in limited situations. The following lists the limited situations in which the Lutheran Home may use or disclose your health information.

As Required By Law. We may use or disclose your health information when required by law to do so.
Public Health Activities. We may disclose your health information for public health activities. These activities may include, for example,

Reporting to a public health or other government authority for preventing or controlling disease, injury or disability; reporting child or elder abuse; or neglect or reporting deaths.
Reporting to the Federal Food and Drug Administration (FDA) concerning the quality, safety or effectiveness of an FDA regulated product or activity, concerning adverse events, or problems with products, to enable product recalls or to comply with other FDA requirements.
To notify a person who may have been exposed to or at risk of spreading a communicable disease, if authorized by law to do so. If the Lutheran Home of Southbury makes a lawful disclosure of HIV related information, we will enclose a statement that notifies the recipient of the information that they are prohibited from further disclosing the information.
For certain purposes involving workplace illness or injuries.

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 personal 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. These may include, for example surveys, audits, investigations, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system, government payment or regulatory programs, and compliance with civil rights laws.
To Avert a Serious Threat to Health or Safety. We may use or disclose your personal health information 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.
Report emergencies or suspicious deaths.
To comply with a court order, warrant, subpoena, summons; investigative demand or similar legal process.
To identify or locate a suspect or missing person.
To answer certain requests for information concerning crimes.
To provide information about criminal conduct occurring at the facility.

Research. We may use or disclose your health information for research purposes if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board, 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.
Military and Veterans. 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 also use and disclose personal health information about foreign military personnel as required by the appropriate foreign military authority or we may use or disclose personal health information for purposes related to receiving benefits.
National Security and Intelligence Activities, Protective Services for the President and Others. We may disclose personal health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States or certain other persons or foreign heads of state or to conduct certain special investigations.
Workers' Compensation. We may use or disclose your health information to comply with laws relating to workers' compensation or similar programs.
Inmates/Law Enforcement Custody. If you are under the custody of a law enforcement official or a correctional institution, we may disclose your health information to the institution or official for certain purposes including the health and safety of you and others.

III. USES AND DISCLOSURES THAT MAY BE MADE WITHOUT WRITTEN AUTHORIZATION, UNLESS YOU OBJECT

The Lutheran Home of Southbury may use or disclose your personal health information in the following ways, unless you object to the use or request that we limit the use.

Facility Directory. Unless you object we will include certain limited information about you in our facility directory while you are a resident at our facility. This information may include your name, your location in the facility, and your general condition and your religious affiliation. Our directory does not include specific medical information about you. We may release information in our directory, except for your religious affiliation, to people who ask for you by name. We may provide the directory information, including your religious affiliation, to any member of the clergy.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, 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. These disclosures are limited to information relevant to the person’s involvement in your care or in arranging payment for your care.
Disaster Relief. We may disclose health information about you to a disaster relief organization
Fundraising Activities. We may use certain personal health information to contact you in an effort to raise money for the facility and its operations and our affiliates, We may disclose personal health information to a foundation related to the facility so that the foundation may contact you in raising money for the facility. In doing so, we would only release contact information, such as name, address and phone number, family members and the dates you received treatment at the facility.
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.
Health-Related Benefits and Services. We may use or disclose personal health information to inform you about health related benefits and services that may be of interest to you.

IV. YOUR AUTHORIZATION IS REQUIRED FOR ALL OTHER USES AND DISCLOSURES OF HEALTH INFORMATION

Except as described above in this Notice, we will use and disclose your personal health information only with your written Authorization. Such an Authorization must specify other particular uses and disclosures that you may allow, and it will be limited to a certain time or event. You may revoke an Authorization to use or disclose personal health information, in writing, at any time. If you revoke an Authorization, we will no longer use or disclose your personal health information for the purposes covered by that Authorization, except where we have already relied on the Authorization.

V. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

Listed below are your rights regarding your personal health information at the facility. These rights may be exercised by submitting a request to the facility. Each of these rights is subject to certain requirements, limitations and exceptions. At your request, the facility will supply you with the appropriate form to complete. You have the right to:

Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment, or health care operations. 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 required to agree to your requested restriction with respect to release of your health information to any individual outside the facility unless you are being transferred to another health care institution, the release of records is required by law, third-party payment or to provide you with emergency care.
Right to Access to Personal Health Information. You have the right, upon written request, to inspect and, upon written request, obtain a copy of your medical or billing records or other written information that may be used to make decisions about your care. We must allow you to inspect your records within 24 hours of your request. If you request copies of the records, we must provide you with copies within two days of that request. We may charge a reasonable fee consistent with State law for our costs in copying and mailing your requested information.
Right to Request Amendment. You have the right to request amendment of your health information maintained by the facility for as long as the information is kept by or for the facility. Your request must be made in writing and must state the reason for the requested amendment.

We may deny your request for amendment if the information

Is not part of the health information maintained by or for the facility;
Is not part of the information to which you have a right of access;
Is already accurate and complete, as determined by the facility.
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 certain disclosures of your health information. This is a listing of disclosures made by the facility or by others on our behalf, but this does not include disclosures for treatment, payment and health care operations or certain other exceptions. To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 13, 2003, that is within six years from the date of your request. An accounting will include, if requested: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or a copy of the authorization or request; or certain summary information concerning multiple disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. In addition, you may obtain a copy of this Notice at our website, www.LHSouthbury.org
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning your health matters in a certain manner. We will accommodate your reasonable requests.

SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION

Under Connecticut or Federal law, additional restrictions may apply to disclosures of health information that relates to care for psychiatric conditions, substance abuse or HIV-related testing and treatment. This information may not be disclosed without your specific written permission,* except as may be specifically required or permitted by Connecticut or Federal law. The following are examples of disclosures that may be made without your specific written permission*:

Psychiatric information. The facility may disclose psychiatric information to a mental health program if needed for your diagnosis or treatment. The facility may also disclose very limited psychiatric information for payment purposes.
HIV-related information. The facility may disclose HIV-related information for purposes of treatment or payment, but your authorization will be necessary for other disclosures, except as otherwise permitted by state or federal law. If the facility makes a lawful disclosure of HIV related information, we will enclose a statement that notifies the recipient of the information that they are prohibited from further disclosing the information.
Substance abuse treatment. The Lutheran Home of Southbury is not a substance abuse treatment facility and does not use or maintain or disclose substance abuse records.

VI. FOR FURTHER INFORMATION

If you have any questions about this Notice or would like further information concerning your privacy rights, please contact

Privacy Officer/Director of Nursing Services (203)-264-9135

VII. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint in writing with the facility or with the Office of Civil Rights in the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint.

To file a complaint with the facility, contact: RN Privacy Officer/Director of Nursing Services, 990Main Street North, Southbury, CT 06488, (203) 264-9135

To file a complaint with the Office for Civil Rights, send a written statement to: Office for Civil Rights, US Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building – Room 1875, Boston, MA 02203.

The facility will not retaliate against you if you file a complaint.

VIII. CHANGES TO THIS NOTICE

The Lutheran Home of Southbury will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all health information already received and maintained by the facility as well as for all health information we receive in the future. We will post a copy of the current Notice in the facility. We will provide a copy of the revised Notice upon request. You will be notified by mail that the notice has been revised.