HIPAA Privacy Practices – Kentucky
What is This Notice?
This Notice of Privacy Practices is required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. 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.
Members receive notice annually in the member newsletter that the Notice of Privacy Practices is available on our website. Members are also advised as to how they can request a copy of the notice from us.
This notice tells you:
- How Humana – CareSource® and its contracted business partners may use and give out your protected health information to carry out treatment, payment or health care operations and for other purposes permitted or required by law.
- What YOUR rights are regarding the access and control of your Medicaid health information.
- How Humana – CareSource protects your health information.
Our Duty to Protect Your Privacy
Your health information is personal. Humana – CareSource is legally required to protect the privacy of your data. It does so in all aspects of its business. Humana – CareSource has policies about protecting the privacy of your data. These policies comply with state and federal laws. Humana – CareSource uses and gives out your health information only where required by law or where necessary for business.
Where Do I Send Questions or Requests?
To submit questions about your privacy rights or to submit a written request to Humana – CareSource regarding your privacy rights, contact the Humana – CareSource Privacy Officer at:
Humana – CareSource
Attn: Privacy Officer
P.O. Box 221459
Louisville, KY 40252
Or, you may contact Humana – CareSource at 1-855-852-7005. If you have a hearing impairment, you may call the TDD/TTY number at 1-800-648-6056 or 711.
What Types of Information does Humana – CareSource Have?
The Department for Community Based Services (DCBS) or Social Security Administration (SSA) for Supplemental Security Income (SSI) approved you for Medicaid. DCBS and SSA send your information to Humana – CareSource. Humana – CareSource then pays your provider for claims they send in. Information sent to Humana – CareSource includes:
- Your individual information including: name, address, phone number, date of birth, social security number, eligibility program information, Medicaid number
- Information on other health insurance policies you may have
- Your medical records (when necessary)
- Your provider’s claims for your services. Provider claims contain information on your treatment given and may include x-rays and lab results.
All this information is considered to be your Protected Health Information (PHI).
Humana – CareSource Privacy Responsibilities
Humana – CareSource is required to:
- Follow the terms of this notice
- Support your privacy rights under the law
- Give you a paper copy of this privacy notice and post it on our website
- Mail out a new notice if our privacy practices change
- Treat your data as confidential by not using or giving out your information without your written permission, except to support normal business or under the allowable circumstances given in this notice
- Tell you what types of information we collect on you
- Release your health information without your permission in the event of an emergency. The release of your data must be in your best interest.
- Follow state laws regarding the release of your data in the instances where state law provides stronger protection of your data than the HIPAA law.
How Humana – CareSource May Use or Give Out Your Information
Humana – CareSource can use and give out your information without an authorization (special permission from you) for our normal business and where required by law. This document tells you of some of the ways this can occur. All the ways Humana – CareSource may use and give out your information without your express permission will fall within one of the groups listed below.
Data for Treatment and Payment Purposes
Humana – CareSource and businesses we work with receive and give out your health information for:
- The coordination of your treatment with medical professionals and facilities
- The billing and payment of your claims
- The review of your health care and use of benefits
- The prior authorization of your requested services
Data exchanged for your treatment and claim payment involves communications between your health care providers, Humana – CareSource, your insurance carriers and other organizations necessary to receive, review, approve, process and successfully pay for your health care claims.
For example, your doctor must submit a bill to Humana – CareSource listing the treatment he or she provided to you. Humana – CareSource will then review the bill and may forward it to other organizations for payment. Humana – CareSource may also exchange your data with providers to authorize any requested services or disclose your data to providers to facilitate any treatments you may be requesting.
Data for Health Care Operations
Humana – CareSource may use and disclose your health information to carry out insurance-related activities related to its operation.
Activities may include:
- Submitting claims to other insurance companies
- Conducting or arranging for medical review for certain medical problems you may be experiencing
- Legal services
- Audit services
- Fraud and abuse detection programs
- Business planning, management and general administration
Case and Utilization Management
Humana – CareSource may use your medical information to approve services or treatments. We may give out information to others who must make decisions about your care.
Other Allowable Uses of Your Health Information Without Permission (Authorization)
- Public Health: We may give your data to public health agencies to prevent or control disease, injury or disability; reporting child abuse or neglect; and reporting domestic violence. Humana – CareSource may also report your data to the Food and Drug Administration (FDA) to notify them of problems with products and reactions to medications.
- Coroners, Medical Examiners and Funeral Directors: Humana – CareSource may give your protected health information to coroners, medical examiners and funeral directors if needed.
- Organ and Tissue Donation: Humana – CareSource may give your data to groups involved in finding, banking or transplanting organs and tissues. Humana – CareSource can only give this information when you have agreed to organ or tissue donations.
- Public Safety: Humana – CareSource may give your data in order to prevent a serious threat to the health or safety of a particular person or to the general public.
- Security: Humana – CareSource may give your data for military, national security, and prisoner care purposes.
- Government Eligibility: Humana – CareSource will give your data to government entities involved with your health care benefit eligibility.
- Worker’s Compensation: Humana – CareSource may give your data as necessary to comply with worker’s compensation or similar laws.
- Marketing: Humana – CareSource may use your data to contact you to give your information about relative health-related benefits and services. An example would be notices for Well Baby or Women, Infants and Children(WIC) clinics to be held in your area. However, Humana – CareSource CANNOT give your information to companies for advertising or solicitation without your permission.
- Research: Humana – CareSource may give your data to people not working for Humana – CareSource that are conducting research ONLY if an independent institutional review board (IRB) approves the disclosure. The research group must also promise to protect the data it receives.
- Business Associates: Humana – CareSource must share your data with other state, federal and commercial partners it contracts with to perform its normal business. We ask these groups to protect your data through formal agreements.
- Health Oversight and Quality Assurance: Humana – CareSource may use and give out your data to doctors and nurses to help improve you care. Humana – CareSource staff, committees and outside agencies that monitor Medicaid quality of care may also see your data.
- Appointment Reminders: Humana – CareSource may use your health information to remind you of medical appointments. Examples are shot and checkup reminders and health screening reminders.
- Health Promotion and Disease Prevention: Humana – CareSource may use your health information to tell you about disease prevention and health care.
- Individuals Involved with Payment of Your Care: Humana – CareSource may give out your health information to a friend or family member who is helping with your care or with payment for your care if necessary.
- Member and Provider Claims Services Department: Humana – CareSource Member Services and Provider Claim Services will answer provider and member calls that involve your protected data.
- Medical and Administrative Appeals: Humana – CareSource at times may make decisions about claims for services provided to you. You or your provider may appeal these decisions. Your health information may be used to make appeal decisions.
- Lawsuits and Disputes: Humana – CareSource must give your data under a court order. Humana – CareSource must give your data out to court officers and lawyers, if you are involved in a lawsuit.
- Law Enforcement: Humana – CareSource will give out your data to law enforcement only where allowed by federal or state law or required under a court order.
When Humana – Caresource May Not Use or Disclose Your Health Information Without Authorization
Other than for the allowed reasons listed above, Humana – CareSource will not use or disclose your data without written permission (authorization) from you. If you do authorize us to use or disclose your data in other ways, you may revoke your permission in writing at any time. Once you revoke your permission, Humana – CareSource will no longer be able to use or disclose your data for the reasons stated in your original authorization.
Your Individual Privacy Rights Under HIPAA
Right to Request Confidential Communications
You have the right to ask Humana – CareSource to communicate with you at a certain alternative number or location other than your home of record. Humana – CareSource will do this only when necessary to protect your safety or health.
Requests to change our communication with you should be submitted to Humana – CareSource Privacy Officer. The address is listed above. Please be sure to tell us how you want us to contact you in your written request.
Right to Request Restrictions
You have the right to ask that your protected health data not be given out or used. This is called requesting a restriction. Humana – CareSource has the right to deny any requests for restrictions that prevent Humana – CareSource from conducting its required business processes.
To ask for a restriction on the use of your information, send a written request to Humana – CareSource Privacy Officer at the address above. The request should include:
- What information you wish to restrict and how you want it restricted.
- Whether you wish to restrict the use or information, the disclosure of information, or both.
Right to Withdraw Authorization for Usage and Disclosure
Humana – CareSource must have your written permission (authorization) to use or give out your information for reasons other than the special exceptions described above. Humana – CareSource may ask you to give permission by signing a form called an authorization.
- You may cancel this permission at any time. To cancel, send a letter to the Humana – CareSource Privacy Officer at the address above.
- When Humana – CareSource receives your cancellation, we will stop using or giving out the information permitted by your authorization. Releases made before we received your authorization cancellation cannot be taken back.
Right to Access
You have the right to look at and get a copy of your personal health information maintained by Humana – CareSource. This is called a designated record set. Humana – CareSource designated record set includes enrollment, claims data and payment records made in your behalf.
Please Note: Humana – CareSource does NOT keep complete copies of your medical records. If you would like a copy of your medical records, please contact your doctor.
If you would like a copy of your information, please send a written request to the Humana – CareSource privacy officer. The address is listed above.
- Humana – CareSource will provide one copy of records per 12-month period free of charge. You may be charged for additional copies.
- Humana – CareSource will respond to requests within 30 days of receipt. Humana – CareSource may ask for an extra 30 days if necessary. We will let you know if we need the extra time.
- Humana – CareSource has the right to keep you from having or seeing all or parts of your records for specific reasons related to HIPAA and state law. Humana – CareSource will tell you the reasons in writing. Humana – CareSource will give you information on how to file an appeal if you disagree with our decision.
Right to Amend
You have the right to ask that information in your records be changed, if they are not correct. Humana – CareSource will respond within 60 days of receipt.
Please Note: If you wish to change your medical records, you must contact the doctor or facility who wrote the record to request a change.
Humana – CareSource may deny the request for change if:
- The information was not written or is not kept by Humana – CareSource.
- The information is information you are not allowed to see and copy.
- The information is already correct and complete.
To request a change, you must do the following:
- Send a written request to the Humana – CareSource Privacy Officer at the address listed earlier.
- Include the reason you are asking for a change.
Right to Accounting of Disclosures
You have the right to ask for a list of people who have asked for your health records. This will tell you every time Humana – CareSource gave your personal data to people or organizations, other than you, that was not a part of normal Humana – CareSource business activities (e.g., treatment, payment, operations).
To request this report:
- Send a written request to the Humana – CareSource address above.
- Specify the time period that you want to know about. The time period may not be longer than six years. It also may not involve dates before the law’s effective date of April 14, 2003.
- Humana – CareSource will respond within 60 days of receipt.
Right to Paper Copy of Notice
You have the right to receive a paper copy of this notice at any time. To receive a paper copy, send a written request to the address above. You can also find it online at http://chs.ky.gov/dms/.
Changes to This Notice of Privacy Practices
Humana – CareSource has the right to change this privacy notice at any time. If we do make a change, we will revise this notice and promptly distribute it to all Medicaid recipients. Humana – CareSource is required by law to comply with the current version of this notice until a new version has been mailed out.
If you believe your privacy rights have been violated and wish to make a complaint, you may file a complaint by calling/writing:
- The Humana – CareSource Privacy Officer at the address above.
- The Secretary of Health and Human Services at:
Secretary of Health and Human Services, Room 615F
200 Independence Ave. SW
Washington, D.C. 20201
- For additional information, call 877-696-6775.
- United States Office of Civil Rights by calling 866-OCR-PRIV (866-627-7748) or 866-788-4989 TTY.
Policy of Non-Retaliation
Humana – CareSource cannot take away your health care benefits or retaliate in any way if you choose to file a privacy complaint or exercise any of your privacy rights.