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Johns Hopkins Notice of Privacy (NPP) Practices for Health Plans

Overview

This is an overview of how health information about you may be used and disclosed by us and your rights with regard to your health information.  For a more adequate and complete description of these matters, you should review carefully the full Johns Hopkins Notice of Privacy Practices (NPP) that follows this overview.

Johns Hopkins is committed to protecting the privacy of your health information, both as our professional obligation to you as our plan member as well as a legal obligation.

Under applicable law, you have certain rights with regard to your health information, such as the right of access to that information and the right to request that we provide your information to others.  These rights are subject to some limitations and, as a general matter, they must be exercised in written form and submitted to us. 

In order to exercise some of these rights, you must provide us with written consent or permission, referred to as an “Authorization.”  Authorizations play an important role in this process and must contain certain required statements.  While you are not required to use one of our forms of Authorization, Johns Hopkins does have Authorization forms available for you to use.

See the discussion that follows in the NPP about your rights.

We also are allowed to use and disclose your health information in certain specified situations without your permission.  For example, we may use and disclose your health information to conduct medical necessity reviews, to process payment for services and to conduct our health care operations.  We also are permitted to disclose your health information to others in certain situations such as where required by law, for research purposes under certain circumstances, in connection with government oversight of our operations and other identified activities. 

See the discussion that follows in the NPP about how we may use and disclose health information about you.

For further information about the privacy practices at Johns Hopkins, you may contact the Privacy Officer at the number or e-mail address listed at the end of the NPP.

(This Overview is to be read in conjunction with the complete Johns Hopkins Notice of Privacy Practices below) 

________________________________________________________________________

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. A copy of the Johns Hopkins US Family Health Plan’s NPP may be obtained by calling Customer Service at 1-800-808-7347.
Effective Date: July 1, 2013

Our pledge regarding your health information

The health plans covered by this Notice are committed to protecting the privacy of health information about you. This Notice tells you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:

  • make sure that your health information is protected;
  • give you this Notice describing our legal duties and privacy practices with respect to your health information; and
  • follow the terms of the Notice that is currently in effect.

Definition of terms

When we say “Plan,” “we,” “our,” “us” or “Johns Hopkins,” we refer to your particular health plan. When we say “you” in this Notice, we refer to the member of the Plan. The plans covered by this Notice are listed at the end of this Notice. When we say “health information,” we include information that identifies you and tells about your past, present or future physical or mental health or condition and the provision of healthcare to you. This also includes information about payment for health care services, such as your claims records.

Who will follow this Notice?

The privacy practices described in this Notice will be followed by all health care professionals and staff of the plans listed at the end of this Notice.

How we may use and disclose health information about you

The following sections describe different ways that we may use and disclose your health information. For each category of uses or disclosures we will describe them and give some examples. Some information, such as certain genetic information, certain drug and alcohol information, HIV information and mental health information, is entitled to special restrictions by Maryland State and federal laws. We abide by all applicable state and federal laws related to the protection of this information. Not every use or disclosure will be listed. All of the ways we are permitted to use and disclose information, however, will fall within one of the following categories.

Treatment. We may use or disclose health information about you for treatment purposes.  For example, a doctor treating you for a particular condition may need to obtain information from us about prior treatment of a similar or different condition, including the identity of the health care provider who treated you previously. 

Payment. We may use and disclose health information about you for purposes related to payment for health care services. For example, we may use your health information to settle claims, to reimburse health care providers for services provided to you or give it to another health plan to coordinate benefits.

Health care operations. We may use and disclose health information about you for Plan operations. For example, we may use or disclose your health information for quality assessment and improvement activities, case management and care coordination, to comply with law and regulation, accreditation purposes, plan members’ claims, grievances or lawsuits, health care contracting relating to our operations, legal or auditing activities, business planning and development, business management and general administration, underwriting, obtaining re-insurance and other insurance activities and to operate the Plan.

Appointment reminders. We may contact you to remind you that you have an appointment with a provider.

Treatment alternatives. We may contact you to tell you about or recommend possible treatment options or alternatives that may be of interest to you. 

Health-related benefits and services. We may contact you about benefits or services that we provide.

Fund-raising activities. We may contact you to provide information about Plan-sponsored activities, including fund-raising programs and events. We would use only contact information, such as your name, address, phone number and the dates of service to do this. Your written authorization (permission) is required if we want to use your health information, such as the department where you were seen or the name of the physician you saw, in order to contact you about making a charitable contribution to Plan-related foundations to support research, teaching or patient care. 

News-gathering activities. We may contact you or one of your family members to discuss whether or not you want to participate in a news story for Plan-related publications or external

news media. For example, a reporter may be doing a story on care management programs. If you had participated in such a program, we might ask if you would be willing to talk to the

reporter. Your written authorization (permission) is required if we want to use or disclose any of your health information for these kinds of purposes.

Individuals involved in your care or payment for your care.  Unless you say no, we may release health information to anyone involved in your health care, such as a friend, family member or any individual you identify. We may also give information to someone who helps pay for your care.  Additionally, we may disclose information to a plan member representative.  If a person has the authority under law to make healthcare decisions for you, Johns Hopkins will treat that plan member representative the same way we would treat you with respect to your health information.  Parents and legal guardians are generally plan member representatives of minors unless the minors are permitted by law to act on their own behalf and make their own medical decisions. 

Disaster-relief efforts. We may disclose health information about you to an organization assisting in a disaster-relief effort so that your family can be notified about your condition, status and location. If you do not want us to disclose your health information for this purpose, we will not make the disclosure unless we must to respond to the emergency.

Research and related activities. Plan-related organizations conduct research to improve the health of people throughout the world. All research projects must be approved through a special review process to protect plan member safety, welfare and confidentiality. Your health information may be important to further research efforts and the development of new knowledge. We may use and disclose health information about our enrollees for research purposes under specific rules determined by the confidentiality provisions of federal and state law.

Researchers may contact you regarding your interest in participating in certain research studies after receiving your authorization (permission) or approval of the contact from a special review board. Enrollment in those studies may occur only after you have been informed about the study, had an opportunity to ask questions and indicated your willingness to participate by signing a consent form.

In some instances, federal law allows us to use your health information for research without your authorization (permission), provided we get approval from a special review board. These studies will not affect your eligibility benefits, treatment or welfare, and your health information will continue to be protected. For example, a research study may involve a record review to compare the outcomes of plan members who received different types of treatment. In addition, federal law allows us to create a “limited data set”—a limited amount of health information from which almost all identifying health information, such as your name, address, Social Security number and plan member record number, has been removed—and share it with those who have signed a contract promising to use it only for research, public health and health care operations purposes and to protect its privacy.

As required by law. We will disclose health information about you when required to do so by federal or state law.

To avert a serious threat to health or safety. We may use and disclose health information about you when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to help stop or reduce the threat.

Organ, eye and tissue donation. If you are an organ, eye or tissue donor, we may release health information to organizations that handle organ, eye or tissue procurement or transplantation, or to an organ-, eye- or tissue-donation bank, as necessary to help with organ, eye or tissue procurement, transplantation or donation.

Military. If you are a member of the armed forces, we may release health information about you to military authorities as authorized or required by law. We may also release health information about foreign military personnel to the appropriate military authority as authorized or required by law.

Workers’ compensation. We may disclose health information about you for workers’ compensation or similar programs as authorized or required by law. These programs provide benefits for work-related injuries or illness.

Public-health disclosures. We may disclose health information about you for public-health purposes. These purposes generally include the following:

  • preventing or controlling disease (such as cancer and tuberculosis), injury or disability;
  • reporting vital events such as births and deaths;
  • reporting child abuse or neglect;
  • reporting adverse events or surveillance related to food, medications or defects or problems with products;
  • notifying persons of recalls, repairs or replacements of products they may be using;
  • notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition;
  • reporting to the employer findings concerning a work-related illness or injury or workplace-related medical surveillance; and
  • notifying the appropriate government authority as authorized or required by law if we believe an enrollee has been the victim of abuse, neglect or domestic violence.

Health-oversight activities. We may disclose health information to governmental, licensing, auditing and accrediting agencies as authorized or required by law.

Legal proceedings, lawsuits and other legal actions. We may disclose health information to courts, attorneys and court employees when we get a court order, subpoena, discovery request, warrant, summons or other lawful instructions from those courts or public bodies and in the course of certain other lawful, judicial or administrative proceedings or to defend ourselves against a lawsuit brought against us.

Law enforcement. If asked to do so by law enforcement, and as authorized or required by law, we may release health information for law enforcement. For example, we may disclose health information about a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement, or about a death suspected to be the result of criminal conduct.

Coroners, medical examiners and funeral directors. In most circumstances, we may disclose health information to a coroner or medical examiner. We may also disclose health information to funeral directors as necessary to carry out their duties.

National-security and intelligence activities. As authorized or required by law, we may disclose health information about you to authorized federal officials for intelligence, counterintelligence and other national-security activities.

Protective services for the U.S. President and others. As authorized or required by law, we may disclose health information about you to authorized federal officials so they may conduct special investigations or provide protection to the U.S. President, other authorized persons or foreign heads of state.

Inmates. If you are an inmate of a correctional institution or under the custody of law enforcement officials, we may release health information about you to the correctional institution as authorized or required by law.

Government programs providing public benefits. We may disclose your health information relating to eligibility for or enrollment in the Plan to another agency administering a government program providing public benefits, as long as sharing the health information or maintaining the health information in a single or combined data system is required or otherwise authorized by law.

Plan sponsor. We may disclose certain health and payment information about you to the Plan sponsor to obtain premium bids for the Plan or to modify, amend or terminate the Plan. We may release other health information about you to the Plan sponsor for purposes of Plan administration, but only if certain provisions have been added to the Plan to protect the privacy of your health information, and the sponsor agrees to comply with the provisions.

Business Associates.  We may share your health information with third parties referred to as “business associates” that provide various services on our behalf, such as consulting, software maintenance and legal services. 

Other uses of health information

Other uses and disclosures of health information not covered by this Notice will be made only with your written authorization (permission).

If you provide us authorization (permission) to use or disclose health information about you, you may revoke (withdraw) that authorization (permission), in writing, at any time. However, uses and disclosures made before your withdrawal are not affected by your action and we cannot take back any disclosures we may have already made with your authorization (permission). If your withdrawal relates to research, researchers are allowed to continue to use the health information they have gathered before your withdrawal if they need it in connection with the research study or follow-up to the study.

Your rights regarding health information about you

The records of your health information are the property of the Plan. You have the following rights, however, regarding health information we maintain about you:

Right to inspect and copy. With certain exceptions (such as information collected for certain legal proceedings and health information restricted by law), you have the right to inspect and/or receive a copy of your health information that is maintained by us or for us in enrollment, payment, claims settlement and case or medical management record systems, or that is part of a set of records that is otherwise used by us to make a decision about you.

You are required to submit your request in writing. We may charge you a reasonable fee for copying your records. We may deny access, under certain circumstances, such as if we believe it may endanger you or someone else. You may request that we designate a licensed health care professional to review the denial.

Right to request an amendment. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan in enrollment, payment, claims settlement and case or medical management record systems, or that is part of a set of records that is otherwise used by us to make a decision about you.

You are required to submit your request in writing, as explained at the end of this Notice, with an explanation as to why the amendment is needed. If we accept your request, we will tell you we agree and we will amend your records. We cannot change what is in the record. We add the supplemental information by an addendum (an addition to the records). With your assistance, we will notify others who have the incorrect or incomplete health information. If we deny your request, we will give you a written explanation of why we did not make the amendment and explain your rights.

We may deny your request if the health information:

  • was not created by the Plan (unless the person or entity that created the health information is no longer available to respond to your request);
  • is not part of the enrollment, payment, claims settlement and case or medical management record systems maintained by or for us, or part of a set of records that we otherwise use to make decisions about you;
  • is not part of the information which you would be permitted to inspect and copy; or
  • is determined by us to be accurate and complete.

Right to an accounting of disclosures. You have the right to receive a list of the disclosures we have made of your health information in the six years prior to your request.

This list will not include disclosures made:

  • to carry out treatment, payment and health care operations;
  • to you or your plan member representative;
  • incident to a permitted use or disclosure;
  • to parties you authorize to receive your health information;
  • to your family members, other relatives or friends who are involved in your care, or who otherwise need to be notified of your location, general condition or death;
  • for national security or intelligence purposes;
  • to correctional institutions or law enforcement officials; or
  • as part of a “limited data set” (as explained above).

You are required to submit your request in writing, as explained at the end of this Notice. You must state the time period for which you want to receive the accounting, which may not be longer than six years.  You may receive the list in paper or electronic form.  The first accounting you request in a 12-month period will be free. We may charge you for responding to any additional requests in that same period.  We will inform you of any costs before you will be charged anything.

Right to request restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information to a family member about a surgery you had.

To request a restriction, you must submit a written request. We are not required to agree to your request. If we do agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency treatment or we are required or permitted by law to disclose it. We are allowed to end the restriction if we tell you. If we end the restriction, it will affect health information that was created or received only after we notify you.

Right to request confidential communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you only at home or only by mail. If you want us to communicate with you in a special way, you will need to give us details about how to contact you, including a valid alternative address. You also will need to give us information as to how payment will be handled. We may ask you to explain how disclosure of all or part of your health information could put you in danger. We will honor reasonable requests. However, if we are unable to contact you using the requested ways or locations, we may contact you using any information we have.

Right to request a disclosure. You have the right to request that we disclose your health information for reasons not provided in this Notice. For example, you may want your lawyer to have a copy of your health records. These requests must be provided to us in writing and must be on a HIPAA compliant authorization (permission) form.  You have the right to withdraw this authorization (permission) at any time.  Disclosures made based on your authorization (permission) cannot be taken back once they have been made.

Right to a paper copy of this Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. Copies of this Notice are available from Johns Hopkins HealthCare LLC or by contacting the Privacy Officer as explained at the end of this Notice. You also may obtain an electronic copy at the Johns Hopkins Web site, http://www.hopkinsmedicine.org/patientcare.html.

Future changes to Johns Hopkins’ privacy practices and this Notice

We reserve the right to change this Notice and the privacy practices of the Plans covered by this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. Copies of the current Notice will be available from Johns Hopkins HealthCare LLC or by contacting the Privacy Officer as explained at the end of this Notice. The current Notice will also be posted to the Johns Hopkins Web site, http://www.hopkinsmedicine.org/patientcare.html. At any time you may request a copy of the Notice currently in effect.

Our right to check your identity

For your protection, we may check your identity whenever you have questions about your treatment or payment activities.  We will check your identity whenever we get requests to look at, copy or amend your records or to obtain a list of disclosures of your health information.

Exercise of rights, questions or complaints

If you would like to obtain an appropriate request form to (i) inspect and/or receive a copy of your health information, (ii) request an amendment to your health information, (iii) request an accounting of disclosures of your health information, or (iv) request a disclosure of your health information, or for other questions, please contact

Plan Administration
c/o Johns Hopkins HealthCare LLC
Compliance Department
6704 Curtis Court
Glen Burnie, MD 21060
Phone: 410-424-4996

If you believe that your privacy rights have not been followed as directed by federal regulations and state law, or as explained in this Notice, you may file a written complaint with us. Please send it to the Privacy Officer at the address provided below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services.  The Privacy Officer can provide you with the appropriate contact information.  You will not be penalized for filing a complaint.  If you have any questions or would like further information about this Notice, please contact:

Johns Hopkins Privacy Officer
5801 Smith Avenue
McAuley Hall, Suite 310
Baltimore, MD 21209
Phone: 410-735-6509
Fax: 410-735-6521
E-mail: hipaa@jhmi.edu

This Notice is effective July 1, 2013, and replaces earlier versions.

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