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PRIVACY RESPONSIBILITY
Wisconsin’s Department of Health and Family Services (DHFS)
Medicaid program is committed to protecting the privacy of your
medical information. Your privacy is already protected under Medicaid
and Wisconsin law. In addition, federal law now requires health plans,
such as Medicaid, to protect your medical information and to let you
know how your medical information may be used and released to others.
This notice tells you what Medicaid may do with your medical
information and what your privacy rights are under the law. Medical
information described in this notice may include information about you
that appears on enrollment, claims, or other records used to make
decisions about your health care services.
If you are in an HMO or other managed care plan you may get a
privacy notice from them describing their privacy policies, as well.
Medicaid Privacy responsibilities include:
- Protecting the privacy of any medical information created or
received about you.
- Sending you this notice describing Medicaid’s medical
information privacy policies and the legal reason for those
policies.
- Using or sharing medical information only as described in this
notice.
- Sending you a new notice, if Medicaid privacy policies change.
WHEN YOUR MEDICAL INFORMATION MAY NOT BE USED
Medicaid will not use or disclose your medical information for any
reason other than those described on page 2 of this notice, without
your written authorization. You may withdraw an authorization at
anytime by submitting a completed request form to the address listed
in the "To Use Your Rights" section of this document. If you
withdraw your authorization, Medicaid will no longer be able to use or
disclose health information about you for those purposes covered by
your written authorization. If authorization is withdrawn, Medicaid
will be unable to take back any previous disclosures made with your
authorization. In the event of an emergency, information may be
released without your permission if, medically, it is in your best
interest. You will be told as soon as possible after the information
is released.
HOW YOUR MEDICAL INFORMATION IS USED OR DISCLOSED WITHOUT
WRITTEN PERMISSION
Your medical information may be used or disclosed for treatment,
payment, and health care operations, without your written permission.
For examples of these functions, see below. Some services are provided
through contracts with other state agencies or private companies. Some
or all of your information may be disclosed, without written
permission, to the other agency or company so they can do the job we
have asked them to do. The other agency or company must also keep your
information confidential.
Not all types of uses and releases are listed in this notice.
Following are some common ways medical information is used or
disclosed without written permission for treatment, payment, and
health care operations. For each category we will explain what we mean
and give an example.
Treatment – Medical information may be used or disclosed
to make sure that needed medical treatment is received. For example,
your medical information may be given to a pharmacist when you need a
prescription filled.
Payment – Your medical information may be used and
disclosed to others to bill and collect payment for the treatment and
services you received. Medical information may also be shared with
other government programs such as Worker’s Compensation, Medicare,
or private insurance to manage your benefits and payments. For
example, your doctor sends a claim form to Medicaid for payment. This
claim form includes information identifying you, your diagnosis, and
treatment.
Health Care Operations – Medical information may be used
or disclosed in order to carry out necessary benefit or service
related activities. For example, these activities may include quality
and cost improvement functions such as conducting or arranging for
medical review, quality improvement studies, audit services,
management, or general administration.
Other ways your medical information may be used or disclosed
without written permission include:
Informing You – Your information may be used in order to
let you know about health and wellbeing services. Examples of this may
include contacting you for appointment reminders, telling you about
treatment alternatives or giving you information about health related
benefits or services.
Public Health – Information may be reported to a public
health authority or other appropriate government authority authorized
by law to collect or receive information to help prevent or control
disease, injury, disability, infection exposure, and child abuse or
family violence. The authorities could include local, state or federal
governmental agencies. For example, your medical information may be
shared if you are exposed to a communicable disease or may otherwise
be at risk of contracting or spreading a disease.
Health Oversight Activities – Information may be shared
with other government agencies to provide oversight of the health care
system. Examples of this include licensing and inspecting of medical
facilities, audits or other proceedings related to oversight of the
health care system.
Coroners, Medical Examiners, or Funeral Directors – Your
medical information may be released to a medical examiner, coroner, or
funeral director as needed to carry out duties authorized by law. For
example, this may be necessary to identify a deceased person.
For Organ Donations – If you are an organ donor,
information may be given to the organization that finds or transplants
organs for the purpose of an organ transplantation or donation.
Worker’s Compensation – Your information may be
disclosed to comply with Worker’s Compensation or similar laws.
Public Safety – Your information may be disclosed to
prevent or lessen a serious threat to your health or safety, to
another person, or the general public.
Specialized Government Functions – Your information may be
used or disclosed to the government for specialized government
functions. For example, your information may be disclosed to the
appropriate military authorities if you are or have been a member of
the U.S. armed forces.
Law Enforcement – Your information may be disclosed to
fulfill a requirement by law or law enforcement agencies. As an
example, medical information may be used to identify or locate a
missing person.
Court or Other Hearings – Your information may be
disclosed to comply with a court order.
Required by Law – In addition to the ways listed above in
which your medical information may be disclosed, Medicaid may share
your information when required by law.
YOUR MEDICAL INFORMATION PRIVACY RIGHTS
You have the right to:
See or Copy Your Medical Information – To see or copy
enrollment, claim, or other records used to make decisions about your
health plan services, send in a completed request form to the address
listed in the "To Use Your Rights" section of this document.
Medicaid will not include information prepared for legal actions or
proceedings. A fee may be charged to cover the processing cost of your
request.
Correct Information You Believe to be Incorrect or Incomplete
– To ask for a correction to enrollment, claim, or other records
used to make decisions about your health plan services, send in a
completed request form, to the address listed in the "To Use Your
Rights" section of this document. Your request will be reviewed.
If the change is not allowed, you will be told in writing why and how
you can disagree.
Request a List of Who Was Given Your Information and Why –
Such a list will not include information used for payment of your
treatment, for our health care operations, or for any information
already provided on a previous list, national security, law
enforcement/corrections, or certain health oversight activities.
Information given to you will include the release date, the name of
the person or organization, a brief description, and the reason for
the disclosure. The list will not include dates before April 14, 2003,
or go back more than six years. Medicaid will provide one list per
year free of charge. There may be a charge for additional lists. To
obtain such a list, send a completed request form to the address
listed in the "To Use Your Rights" section of this document.
Request Restrictions on Using or Sharing Your Medical
Information For Treatment, Payment or Health Care Operations –
You have the right to request restrictions on how your information is
used or disclosed. Medicaid is not required to agree to your requested
restrictions. After sending a completed request form to the address
listed below, your request will be evaluated. We will let you know if
we can comply with the restriction or not.
Request That You Be Informed About Your Health in a Way or at a
Location That Will Help Keep Your Information Private – You have
the right to request how and where Medicaid contacts you about your
medical information. After sending a completed request form to the
address listed in the "To Use Your Rights" section of this
document, your request will be evaluated and Medicaid will let you
know if it can be done.
Receive a Paper Copy of This Notice – If you received this
notice on the DHFS Internet site or by electronic mail (e-mail), you
have the right to ask for and receive a paper copy of this notice by
calling Recipient Services at (800) 362-3002.
TO USE YOUR RIGHTS
To use any of these rights or to obtain a copy of the correct
privacy request form for inspecting, copying, amending, making
restrictions, or obtaining an accounting of your health information,
call Recipient Services at (800) 362-3002. Send your completed privacy
request form to the DHCF Privacy Officer, Wisconsin Medicaid and
BadgerCare Recipient Services, P.O. Box 6678, Madison, WI 53716-0678.
CHANGES TO THIS NOTICE
This notice may be changed or amended at any time. The changes are
effective for all medical information including what is on file. A new
notice will be sent to you when policy changes are made. Wisconsin
Medicaid will also post the new notice on the Recipient page of the
Internet at http://dhfs.wisconsin.gov/medicaid/.
Until a change happens, Medicaid will comply with the current version
of this Notice.
FOR MORE INFORMATION
If you have questions about any part of this notice or would like
additional information about our privacy practices, please write to
Wisconsin Medicaid and BadgerCare Recipient Services, P.O. Box 6678,
Madison, WI 53716-0678, or telephone (800) 362-3002 (V/TTY).
COMPLAINTS
You will not lose benefits or eligibility or otherwise be
retaliated against for filing a complaint. Please send written
complaints about this notice, about how Medicaid handles your medical
information, or if you believe your privacy rights have been violated
to the DHCF Privacy Officer at Wisconsin Medicaid and BadgerCare
Recipient Services, P.O. Box 6678, Madison, WI 53716-0678.
You may also file a complaint directly with the Secretary of the
U.S. Department of Health and Human Services by writing to the Privacy
Officer, Office of Civil Rights, Department of Health and Human
Services, 200 Independence Avenue SW, Washington, D.C. 20201. For
additional information, call (866) 627-7748.
If you have no questions about this notice, you do not have to
do anything. Remember this notice has no effect on your health care
benefits or eligibility.
Wisconsin.gov |
