JOINT NOTICE REGARDING THE USE AND DISCLOSURE OF

PROTECTED HEALTH INFORMATION

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

This Notice is effective beginning April 14, 2003 (and amended Sept. 30, 2008).

            MERCY COMMUNITY HEALTH, INC. is a health care system located in West Hartford, CT.  This Notice applies to the use and disclosure of protected health information by the following health care providers who are part of the MERCY COMMUNITY HEALTH, INC. health care systems:  Mercy Community HomeCare, Saint Mary Home, and The McAuley.  This Notice also applies to uses and disclosures of your protected health information by the physicians and other practitioners who are part of the medical staff of Saint Mary Home.  Your health information will be shared among all of the entities covered by the Notice for treatment, payment and health care operations purposes.

MERCY COMMUNITY HEALTH is required by law to maintain the privacy of protected health information including, but not limited to, your social security number, and to provide you with notice of its legal duties and privacy practices with respect to such information.  MERCY COMMUNITY HEALTH will abide by the terms of the Notice currently in effect; however, MERCY COMMUNITY HEALTH reserves the right to change the terms of this Notice as well as make the new provisions effective for all protected health information maintained.  If there is a change, MERCY COMMUNITY HEALTH will provide you a new Notice upon your request.  In addition, a copy of this Notice will be posted at all times in various conspicuous locations notifying you of the most recent update to this Notice.

            As a resident/client/patient of MERCY COMMUNITY HEALTH, information about you must be used and disclosed to other parties for purposes of treatment, payment, and health care operations.  These uses and disclosures do not require your consent and include, but are not limited to, a release of information contained in financial records, medical records, laboratory test results, medical history, treatment progress or any other related information to:

1.                  Your insurance company, self-funded or third-party health plan, Medicare, Medicaid, or any other person or entity that may be responsible for paying or processing for payment any portion of your bill for services;

2.                  Any person or entity affiliated with or representing us for purposes of administration, billing, quality and risk management;

3.                  Any hospital, nursing home, or other health care facility to which you may be admitted;

4.                  Any assisted living or personal care facility of which you are a resident;

5.                  Any physician providing you care;

6.                  Any business associate of MERCY COMMUNITY HEALTH that agrees to abide by the privacy requirements regarding your protected health information; and

7.                  Licensing and accrediting bodies, including the information sent to the State agency acting as a representative of the Medicare/Medicaid program.

In addition, MERCY COMMUNITY HEALTH may contact you:

1.                  To provide appointment reminders or information about other health activities we provide; and

2.                  To raise funds for MERCY COMMUNITY HEALTH.

MERCY COMMUNITY HEALTH is also permitted to use or disclose information about you without consent or authorization in the following circumstances:

1.                  Where the use or disclosure is required by another law, but only to the extent that it is required and complies with such other law;

2.                  For certain public health activities;

3.                  Where MERCY COMMUNITY HEALTH reasonably believes you are a victim of abuse, neglect, or domestic violence, but only to a government authority authorized to receive abuse, neglect or domestic violence;

4.                  Health care oversight activities;

5.                  Certain judicial and administrative proceedings;

6.                  Certain law enforcement purposes;

7.                  To coroners, medical examiners and funeral directors, in certain circumstances;

8.                  For cadaveric organ, eye or tissue donation purposes;

9.                  For certain research purposes;

10.              To avert a serious threat to health and safety;

11.              For specialized government functions, including military and veterans’ activities, national security and intelligence activities, protective services for the President of the United States and others, medical suitability determinations, correctional institution and custodial situations; and

12.              For workers’ compensation purposes.

MERCY COMMUNITY HEALTH is permitted to use or disclose information about you without consent or authorization provided you are informed in advance and given the opportunity to agree to or prohibit or restrict the disclosure in the following circumstances:

1.                  For use in a directory of individuals served by MERCY COMMUNITY HEALTH (such information is limited to the individual’s name, location within the facility, condition in general terms, and religious affiliation to clergy only);

2.                  To a family member, other close relative, close personal friend, or other identified person, the information relevant to such person’s involvement in your care or payment for care; and 

3.                  To a public or private entity authorized by law or charter to assist in disaster relief efforts, but only for the purpose of coordinating with such entities.

Other uses and disclosures not specifically addressed earlier in this Notice will be made only with your written authorization.  In addition, Connecticut law requires an authorization to disclose highly sensitive information, including communicable diseases such as Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), drug/alcohol abuse, psychiatric diagnosis and treatment records, and certain mental health information. Examples of when authorization is required for MERCY COMMUNITY HEALTH to use or disclose your protected health information include:

1.                  Psychotherapy notes (notwithstanding the provisions that allow the use and disclosure of protected health information without consent and authorization for treatment, payment and healthcare operations, the law specifically requires an authorization to use or disclose psychotherapy notes); and

2.                  Marketing, except if the communication is in the form of a face-to-face communication made by MERCY COMMUNITY HEALTH to you or a promotional gift of nominal value provided by MERCY COMMUNITY HEALTH.

These authorizations may be revoked, in writing, at any time, except in limited situations. 

YOUR RIGHTS

            The Health Insurance Portability and Accountability Act (HIPAA) gives you certain rights with regard to your protected health information.  Any of these rights may be exercised by contacting MERCY COMMUNITY HEALTH and in some situations, may require you to fill out a written request.  You have the right, subject to certain conditions, to:

1.                  Request restrictions on the use and disclosure of information about you for treatment, payment and healthcare operations, and to friends and family involved in your care with respect to health information maintained by Mercyknoll and Saint Mary Home.  MERCY COMMUNITY HEALTH is required to agree to the requested restriction with respect to the release of your health information to any individual outside MERCY COMMUNITY HEALTH unless you are being transferred to another health care institution, or the release is required by law, or you require emergency care, or the release is for third party payment;

2.                  Receive confidential communication of protected health information;

3.                  Request, either orally or in writing, your medical or billing records, or other written information that may be used to make decisions about your care;

4.                  Amend protected health information;

5.                  Receive an accounting of disclosures of protected health information; and

6.                  Obtain a paper copy of this Notice, even if you agreed to receive this Notice electronically.  In addition, you may obtain a copy of this Notice at our website: www.mercycommunityhealth.org.

In addition, Connecticut state law or other federal law may provide you with greater protection than HIPAA.  In situations where this is the case, MERCY COMMUNITY HEALTH will be in compliance with the applicable Connecticut law.

COMPLAINTS

            If you believe that your privacy rights have been violated, you may complain to both MERCY COMMUNITY HEALTH and the Office of the Secretary of the U.S. Department of Health and Human Services.  There will be no retaliation against you for filing a complaint. 

Complaints may be made to Stephen Surprenant, HIPAA Compliance Privacy Officer for Mercy Community Health at (860) 570-8388.  We recommend that complaints be given to Stephen Surprenant in writing, stating the specific incident(s) in terms of subject, date, and other relevant matters.  Complaints should be sent to Stephen Surprenant, HIPAA Compliance Officer, Mercy Community Health,

Complaints to the Office of the Secretary of Health and Human Services may be made in writing to the following address: Office for Civil Rights, U.S. Department of Health and Human Services, Government Center,  J.F. Kennedy Federal Building – Room 1875, Boston, MA, 02203.  Complaints may also be made by phone to: (617) 565-1340; or by Facsimile to:        (617) 565-3809; or by TDD to: (617) 565-1343; or by calling Toll Free:  1-877-696-6775.