This notice Describes How Information About You May be Used and Disclosed and How You Can Get Access to This Information. Please Review It Carefully.
Hospice of Southern Kentucky, Inc. is committed to treating and using protected health information about you responsibly. Hospice of Southern Kentucky is required by the federal law known as the Health Insurance Portability and Accountability Act (referred to as the HIPAA Privacy Rule) to take reasonable steps to ensure the privacy of your personally identifiable health information (Protected Health Information) and to inform you about:
- Hospice of Southern Kentucky’s uses and disclosures of Protected Health Information;
- your privacy rights with respect to your Protected Health Information;
- your right to file a complaint with Hospice of Southern Kentucky and to the Secretary of the U.S. Department of Health and Human Services; and
- the person or office to contact for further information about Hospice of Southern Kentucky’s privacy
Uses and Disclosures of Protected Health Information
Except as otherwise provided in this notice or otherwise permitted under the HIPAA Privacy Rule, uses and disclosures of Protected Health Information will be made only with your written authorization and will be subject to your right to revoke such authorization. If you provide Hospice of Southern Kentucky authorization to use or disclose PHI about you, you may revoke that permission, in writing, at any time by sending a notice of revocation to the Privacy Officer at 5872 Scottsville Road, Bowling Green, KY 42101. If you revoke your permission, Hospice of Southern Kentucky will no longer use or disclose PHI about you for the reasons covered by your written authorization. Hospice of Southern Kentucky will not be able to reverse any disclosures made prior to your revocation.
Hospice of Southern Kentucky may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Note: Special rules may apply with respect to the use and disclosure of genetic and HIV testing information. You may contact the Quality/Privacy Officer for more information about these rules. Uses and Disclosures that Require Your Written Authorization
Your written authorization is generally required before Hospice of Southern Kentucky will use or disclose psychotherapy notes about you from your psychotherapist. Psychotherapy notes are separately filed notes about your conversations with your mental health professional during a counseling session. They do not include summary information about your mental health
treatment. Hospice of Southern Kentucky may use and disclose such notes when needed by Hospice of Southern Kentucky to defend against litigation filed by you.
To the extent Hospice of Southern Kentucky uses and discloses your Protected Health Information for certain marketing purposes, it will obtain your specific authorization to the extent required by law.
Additionally, any disclosures that constitute the sale of your Protected Health Information will also require your specific authorization unless otherwise permitted or required by law.
Uses and Disclosures to Carry Out Treatment, Payment and Health Care Operations
The HIPAA Privacy Rule permits Hospice of Southern Kentucky and its respective Business Associates to use and disclose Protected Health Information without your consent, authorization, or opportunity to agree or object, to carry out Treatment, Payment and Health Care Operations.
- Treatment is the provision, coordination or management of health care and related For example, Hospice of Southern Kentucky may disclose your Protected Health Information to your primary care provider to assist in the coordination of your care.
- Payment includes but is not limited to actions to make coverage determinations and payment (including Medicare/insurance eligibility and coverage, and billing). For example, Hospice of Southern Kentucky may submit its charges for payment to your insurance carrier or Medicare for
- Health Care Operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, and working with vendors to coordinate your care. For example, Hospice of Southern Kentucky may share your medical records with peer review committees to assess and improve the level of care you are
- Fundraising Activities. Hospice of Southern Kentucky may place your name, email, and address on its mailing list to send you a copy of the agency’s e-newsletter, semi-annual newsletter and information about development activities. In addition, Hospice of Southern Kentucky may use your name, email, address, and phone number to contact you for the consent to use information about you and the services you received (e.g., nursing, homemaking, physical therapy) for the fundraising purposes of Hospice care. If you do not want the agency to contact you by phone or send any literature via the mail, please notify the Development Department at 1-270-746-9300 and indicate that you do not wish to be
- Annual Memorial Activities. Several times a year, Hospice of Southern Kentucky holds memorial activities to remember those patients who we have served and have died during the past year. Names are printed in programs and public announcements and may be read aloud during public If you do not wish to have your name included in this service, please notify the Bereavement Coordinator at 1-270-746-9300 and indicate that you wish to have your name omitted.
- Appointment The Agency may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.
Uses and Disclosures that Require that You be given an Opportunity to Agree or Disagree Prior to the Use or Release
Disclosure of your Protected Health Information to family members, other relatives and your close personal friends is allowed if:
- the information is directly relevant to the family or friend’s involvement with your care or payment for that care; and
- you have either agreed to the disclosure or have been given an opportunity to object and have not
Other Uses and Disclosures for which Consent, Authorization or Opportunity to Object is not Required
Use and disclosure of your Protected Health Information is allowed without your consent, authorization or request under the following circumstances:
- When required by
- When permitted for purposes of public health activities, including if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if authorized by
- When authorized by law to report information about certain abuse, neglect or domestic violence to public
- For public health oversight activities authorized by
- For certain judicial or administrative
- For certain law enforcement purposes
- To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law; and funeral directors, consistent with applicable
- Hospice of Southern Kentucky may use or disclose Protected Health Information for research, subject to conditions.
- For the purpose of facilitating organ, eye or tissue donation or
- When consistent with applicable law to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
- To the extent necessary to comply with workers’ compensation or other similar programs established by
Required Uses and Disclosures
Upon your request, Hospice of Southern Kentucky is required to give you access to certain Protected Health Information in order to inspect and copy it. Under certain circumstances, however, Hospice of Southern Kentucky may deny your request.
Use and disclosure of your Protected Health Information may be required by the Secretary of the Department of Health and Human Services to investigate or determine Hospice of Southern Kentucky’s compliance with the privacy regulations.
Rights of Individuals
In the event any of the following provisions require you to submit a written request to exercise such right, you must submit such request to the Director of Quality Assurance, Hospice of Southern Kentucky, Inc., 5872 Scottsville Road, Bowling Green, Kentucky 42104.
Right to Request Restrictions and Confidential Communications of Protected Health Information You may request that Hospice of Southern Kentucky restrict uses and disclosures of your Protected Health Information to carry out Treatment, Payment or Health Care Operations, or to restrict uses and disclosures to persons identified by you who are involved in your care or payment for your care.
Hospice of Southern Kentucky is not required to agree to your request; however, unless otherwise required by law, Hospice of Southern Kentucky must permit a request for a restriction on disclosures to another health plan for purposes of payment or health care operations where the PHI pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full.
Hospice of Southern Kentucky will accommodate reasonable requests to receive communications of Protected Health Information by alternative means or at alternative locations.
You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your Protected Health Information or to request confidential communications of Protected Health Information.
Right to Inspect and Copy Protected Health Information
You have a right to request to inspect and obtain a copy of your Protected Health
Information contained in a “Designated Record Set,” for as long as Hospice of Southern Kentucky maintains the Protected Health Information.
- “Designated Record Set” includes enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for a health plan, or other information used in whole or in part by or for the Covered Entity to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the Designated Record Set.
A hospice patient’s clinical record (whether hard copy or electronic form) must be made available to a patient, free of charge, within 7 business days. All other requests for PHI by a patient or legal representative must be “acted upon” – either provided or denied with a full written explanation within 30 days.
You or your personal representative will be required to complete a form to request access to the Protected Health Information in your Designated Record Set. If access is denied, you or your
personal representative will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise your rights to review this denial and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
Right to Amend Protected Health Information
You have the right to request Hospice of Southern Kentucky amend your Protected Health Information or a record about you in a Designated Record Set for as long as the Protected Health Information is maintained in the Designated Record Set.
Hospice of Southern Kentucky has 60 days after the request is made to act on the request. A single 30- day extension is allowed. If the request is denied in whole or part, Hospice of Southern Kentucky must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your Protected Health Information.
You or your personal representative will be required to complete a form to request amendment of
the Protected Health Information in your Designated Record Set. Any request for an amendment must be in writing and provide a reason to support a requested amendment.
Right to Receive an Accounting of Protected Health Information Disclosures
Upon your written request, Hospice of Southern Kentucky will also provide you with an accounting of disclosures by Hospice of Southern Kentucky of your Protected Health Information during the six years prior to the date of your request. However, such accounting need not include Protected Health Information disclosures made: (1) to carry out Treatment, Payment or Health Care Operations; (2) to individuals about their own Protected Health Information; (3) prior to the compliance date; or (4) based on your written authorization.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided. If you request more than one accounting within a 12-month period, Hospice of Southern Kentucky will charge a reasonable, cost-based fee for each subsequent accounting.
Right to Notification of Breach of Unsecured Protected Health Information.
In the event that a breach occurs with regard to your Protected Health Information, you have the right to be notified of the breach.
Right to Paper Copy of Electronic Notice of Privacy Practices.
If you received this notice in electronic format, upon your written request, Hospice of Southern Kentucky will provide you with a paper copy at no cost.
A Note About Personal Representatives
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your Protected Health Information or allowed to take any action for you.
Hospice of Southern Kentucky retains discretion to deny access to your Protected Health
Information to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
Hospice of Southern Kentucky’s Duties
Hospice of Southern Kentucky is required by law to maintain the privacy of Protected Health Information and to provide patients with notice of its legal duties and privacy practices. This notice is effective beginning September 13, 2013 and Hospice of Southern Kentucky is required to comply with the terms of this notice. However, Hospice of Southern Kentucky reserves the right to change its privacy practices and to apply the changes to any Protected Health Information received or maintained by Hospice of Southern Kentucky prior to that date.
If a privacy practice is changed, a revised version of this notice will be either mailed to you or posted on our website. In the event the revised notice is mailed to you, it shall be provided by first class mail to your last known address. Any revised version of this notice will be distributed/published within 60 days of the effective date of any material change to the uses or disclosures, the individual’s rights, the duties of Hospice of Southern Kentucky or other privacy practices stated in this notice.
Minimum Necessary Standard
When using or disclosing Protected Health Information or when requesting Protected Health Information from another Covered Entity, Hospice of Southern Kentucky will make reasonable efforts not to use, disclose or request more than the minimum amount of Protected Health
Information necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. However, the minimum necessary standard will not apply in the following situations:
- disclosures to or requests by a health care provider for treatment;
- uses or disclosures made to the individual or pursuant to your authorization;
- disclosures for compliance made to the Secretary of the U.S. Department of Health and Human Services;
- uses or disclosures that are required by law; and
- uses or disclosures that are required for Hospice of Southern Kentucky’s compliance with legal
Your Right to File a Complaint with Hospice of Southern Kentucky or the HHS Secretary
If you believe that your privacy rights have been violated, you may complain to Hospice of Southern Kentucky in care of the following officer: Director of Quality Assurance, Hospice of Southern Kentucky, 5872 Scottsville Road, Bowling Green, KY 42104.
You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C. 20201.
Hospice of Southern Kentucky will not retaliate against you for filing a complaint.
If you have any questions regarding this notice or the subjects addressed in it, you may contact the following officer: Director of Quality, Hospice of Southern Kentucky, 5872 Scottsville Road, Bowling Green, Ky 42104.
The HIPAA Privacy Rule is set out at 45 Code of Federal Regulations Parts 160 and 164. These regulations and additional information about the HIPAA Privacy Rule are available