NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
Overview
THIS NOTICE DESCRIBES HOW MEDICAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Purpose
The purpose of this notice is to:
- Provide you with notice of TSI's information protection practices and
- Explain your rights as a TSI client/employee.
TSI's Responsibilities
TSI is required to abide by the terms of this notice currently in effect by:
- Maintaining the privacy of your Protected Health Information, and
- Providing you with notice of our legal duties and privacy practices with respect to Protected Health Information.
Notice Revisions
TSI reserves the right to revise the terms of this notice, and to make the revised terms effective for all Protected Health Information that it maintains. If TSI revises this notice, we will make the revised notice available within sixty (60) days.
Definitions
Business Associate
A person or entity that uses Protected Health Information to perform a service for TSI. These services include, but are not limited to:
- behavior consultant
- billing and claims processing
- case management
- data entry
- day habilitation
- diet consultant
- pharmacy consultant
- nursing consulting
- psychiatric evaluation consultant
- D & E assessments consultant
- Vocational assessment and training consultant
Health Care Operations
Activities related to TSI's operations, including but not limited to:
- diet plans
- eligibility assessments
- individual habilitation and support plans
- medical assessments
- person centered planning
- psychological assessments
- quality assessment and improvement
Payment
TSI's collection of medicaid reimbursement funds, acting as rep payee for client social security benefits, client liability, State of Indiana funds, the pass through of client earnings and income, and residential living allowance funds.
Protected Health Information
Information relating to a TSI client's or staff's past present, or future health or condition, the provision of care services to a TSI client, Protected Health Information includes, but is not limited to:
- Patient name
- Social Security number/member ID
- Client Medicaid number
- Service and eligibility dates
- Diagnosis information
- Claim information
- Behavior and habilitation plans
Treatment
The provision, coordination, or management of active treatment and direct care and supported living, and health plan related services by TSI as a licensed provider.
Know Your Rights
Review Your Protected Health Information
You have a right to inspect and obtain a copy of your Protected Health Information.
Important: If you feel your Protected Health Information is incorrect, you have the right to request that it be amended.
Request to Restrict Your Protected Health Information
You can request restrictions on the use and disclosure of your Protected Health
Information. TSI is not required to agree to a requested restriction.
Example: If a restriction request prevents us from providing service to you or from performing payment-related functions, we will not be able to agree to the request.
Confidential Communication
When necessary, TSI sends your Protected Health Information to your home.
If you feel receiving a copy of your Protected Health Information at your home would compromise your safety, you may request in writing, an alternate communication method and/or location.
Important: TSI will not ask for an explanation for such requests, but may request payment for this service.
Examples: The client or employee may decide, for his or her safety, to have correspondence containing his or her Protected Health Information sent somewhere other than to his or her home or workplace, or to have the information sent via fax rather than mailed.
Accounting of Disclosures
If a disclosure of your Protected Health Information was made for a reason other than treatment, payment, or health care operations, you have a right to receive an accounting of the disclosure.
Important: If the disclosure was made to you, TSI will not provide an accounting.
Receive a Copy
You can request a copy of this Notice of Privacy Practices through your regional office coordinator. You may also request a copy from your Benefits Coordinator at TSI.
Complaints
If you believe that your privacy rights have been violated, you may submit a complaint to TSI or to the U.S. Secretary of Health and Human Services at any time. TSI will not retaliate against you for filing a complaint.
File complaints with TSI at vdeems@tsiin.com or by calling TSI's compliance officer at 1-812-433-3333, extension 113, for complaints regarding:
- restrictions on the use or disclosure of your Protected Health Information
- amendments to your Protected Health Information, or
- accounting of the use or disclosure of your Protected Health Information.
File complaints with the U.S. Secretary of Health and Human Services using the HIPAA Complaint Security Blvd., C5-24-04, Baltimore, MD 21244, for complaints regarding:
- TSI's business practices, or
- The use of your Protected Health Information
Contact Information
Contact TSI
Contact us through vdeems@tsiin.com, or call our compliance officer at 1-812-433-3333, ext. 113 to request:
- restrictions on the use of disclosure of your Protected Health Information,
- amendments to your Protected Health Information,
- revoking authorizations,
- accounting of the use or disclosure of your Protected Health Information, or
- a copy of your Protected Health Information.
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