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•
Disclosure to Plan vendors and accreditation
organizations.
We may disclose your PHI to companies
with whom we contract if they need the information to
perform the services they provide to us. We may also
disclose your PHI to accreditation organizations such as
the National Committee for Quality Assurance (NCQA)
when the NCQA auditors collect Health Employer Data and
Information Set (HEDIS
®
) data for quality measurement
purposes. When we enter into these types of arrangements,
we obtain a written agreement to protect your PHI.
•
Public health activities.
We may use and disclose your
PHI for public health activities authorized by law, such as
preventing or controlling disease, reporting child or adult
abuse or neglect to government authorities, or to close
friends or family members who are involved in or help pay
for your care. We may also advise your family members or
close friends about your condition or location (such as that
you are in the hospital).
•
Health oversight activities.
We may disclose your PHI
to a government agency that is legally responsible
for oversight of the healthcare system or for ensuring
compliance with the rules of government benefit
programs, such as Medicare or Medicaid, or other
regulatory programs that need health information to
determine compliance.
•
For research.
We may disclose your PHI for research
purposes, subject to strict legal restrictions.
•
To comply with the law.
We may use and disclose your
PHI as required by law.
•
Judicial and administrative proceedings.
We may
disclose your PHI in response to a court or administrative
order and, under certain circumstances, a subpoena,
warrant, discovery request or other lawful process.
•
Law enforcement officials.
We may disclose your PHI to
the police or other law enforcement officials, as required
by law in compliance with a court order, warrant, or other
process or request authorized by law to report a crime or
as otherwise permitted by law.
•
Health or safety.
We may disclose your PHI to prevent or
lessen a serious and imminent threat to your health or
safety or the health and safety of the general public or
other person.
•
Government functions.
Under certain circumstances,
we may disclose your PHI to various departments of
the government such as the U.S. military or the U.S.
Department of State.
•
Workers’ Compensation.
We may disclose your PHI when
necessary to comply with Workers’ Compensation laws.
State law may further limit the permissible ways we use
or disclose your PHI. If an applicable state law imposes
stricter restrictions, we will comply with that state law.
Uses and disclosures with your
written authorization
We will not use or disclose your PHI for any purpose other
than the purposes described in this Notice without your
written authorization. The written authorization to use or
disclose health information shall remain valid, which in no
event shall be for more than twenty-four (24) months. You
can revoke the authorization at any time.
Your individual privacy rights
When it comes to your health information, you have certain
rights. This section explains your rights and some of our
responsibilities.
•
Right to request additional restrictions.
You may
request restrictions on our use and disclosure of your PHI
for the treatment, payment and healthcare operations
purposes explained in this Notice. This may be done
by means of an oral, written or electronic request from
you. While we will consider all requests for restrictions
carefully, we are not required to agree to a requested
restriction. If we do agree to the restrictions, we will
abide by them.
•
Right to receive confidential communications.
You
may ask to receive communications of your PHI from
us by alternative means of communication or at
alternative locations, if you believe that communication
through normal business practices could endanger you.
While we will consider reasonable requests carefully, we
are not required to agree to all requests. Your request
must specify how or where you wish to be contacted.
•
Right to inspect and copy your PHI.
You may ask
to inspect or to obtain a copy of your PHI that is
included in certain records we maintain. Under limited
circumstances, we may deny you access to a portion of
your records. If you request copies, we may charge you
copying and mailing costs consistent with applicable
law. If your information is stored electronically and you
request an electronic copy, we will provide it to you in a
readable electronic form and format.
•
Right to amend your records.
You have the right to ask
us to amend your PHI that is contained in our records. If
we determine that the record is inaccurate, and the law
permits us to amend it, we will correct it. If your doctor
or another person created the information that you want
to change, you should ask that person to amend the
information.
•
Right to receive an accounting of disclosures.
Upon
your oral, written or electronic request, you may obtain
an accounting of disclosures we have made of your PHI,
except for disclosures made for treatment, payment or
healthcare operations; disclosures made earlier than six
years before the date of your request; and certain other
disclosures that are exempted by law. If you request an
accounting more than once during any 12-month period,
we may charge you a reasonable fee for each accounting
statement after the first one.
•
Right to receive a paper copy of this Notice.
You may
contact Customer Care at the number on your Plan ID card
to obtain a paper copy of this Notice.
If you wish to make any of the requests listed above
under “
Your Individual Privacy Rights
,” you must notify
the Plan in writing (unless otherwise noted).
For more information or if you have complaints
If you have any questions about your privacy rights, believe
that NMHC has violated your privacy rights or disagree with
a decision that we made about access to your PHI, or if you
want more information about your privacy rights or do not
understand your privacy rights, you may contact our Privacy
Officer at the following address or telephone number. If we
discover a breach involving your unsecured PHI, we will
notify you of the breach by letter or other method permitted
by law.
Privacy Officer
You may contact our Privacy Officer at: New Mexico Health
Connections • P.O. Box 36719 • Albuquerque, NM 87176
•
505-633-8020
If you believe NMHC may have violated your privacy
rights, you may also file a written complaint with the
Secretary of the U.S. Department of Health and Human
Services (HHS). Your complaint can be sent by email, fax, or
mail to the HHS’ Office for Civil Rights (OCR). You can file a
written complaint to: U.S. Department of Health and Human
Services • Office of Civil Rights • 200 Independence Ave., SW
• Washington, DC 20201 •
or
by calling
800-368-1019
. For
more information, go to the OCR website:
www.hhs.gov/ocr/
privacy/hipaa/complaints
.
We will not take any action against you if you exercise
your right to file a complaint with us or the Secretary.
We may change the terms of this Notice at any time, and
we may, at our discretion, make the new terms effective
for all of your PHI in our possession, including any PHI we
created or received before we issued the new Notice. The new
Notice will be available upon request, on our website, and we
will mail a copy to you.
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