New Horizons Rehabilitation Services, Inc.
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.
New Horizons Rehabilitation Services, Inc. (“New
Horizons”) abides by all Health Insurance Portability and Accountability
Act regulations, otherwise known as HIPAA.
New Horizons is committed to confidentiality as required
by HIPAA and state law. New Horizons is
required by law to maintain the privacy of protected health information and to
provide individuals with notice of its legal duties and privacy practices with
regard to protected health information.
New Horizons is required to abide by the terms of its notice, but
reserves the right to change the terms of this notice and make new notice
provisions effective for all protected health information that is
maintained. If New Horizons revises its
notice, it will post the revised notice at all of its locations and provide a
copy upon request.
Protected Health Information is information about you,
including demographic information, that:
is created or received by a health care provider, health plan,
health care clearinghouse or an employer;
identifies you or from which there is a reasonable belief that
you could be identified; and
relates to your past, present or future physical or mental
health or condition or the provisions of health care or the past, present or
future payment for the provision of health care services.
New Horizons and its business associates may use your
protected health information without your consent, authorization or opportunity
to agree or object for treatment, payment and health care operations as
TREATMENT is the provision, coordination or management of
health care and related services. It
also includes, but is not limited to, consultation and referrals between one or
more of your providers. For example, if
your treating doctor is not aware of the prescription medications that you are
taking, New Horizons may disclose a list of such medications and the diagnosis
or condition for which you are taking each medication.
PAYMENT is activities undertaken to obtain or provide
reimbursement for the provision of health care. It includes activities to determine eligibility or coverage for
insurance benefits, reviewing services provided to you for medical necessity
and appropriateness, undertaking utilization reviews, billings, claims
management, collection activities and related health care data processing. For example, New Horizons may provide
protected health information to your health care plan or insurer to determine
whether you are eligible for coverage for a certain service or to determine
what percentage of your bill your health care plan or insurer will pay.
HEALTH CARE OPERATIONS include those activities undertaken to
conduct quality assessment and improvements activities, population-based
activities related to improving health or decreasing the cost of health care,
protocol development, case management and care coordination, reviewing the
quality and performance of health care professionals, training non-health care
professionals, conducting or arranging medical review, legal services or
auditing, business planning and development, business management and general
administrative activities. For example,
New Horizons may use protected health information to determine what additional
services New Horizons should offer and whether certain services are effective.
New Horizons may also contact you to provide appointment
reminders or information about treatment alternatives or other health-related
benefits and services that may be of interest to you. New Horizons may contact you to raise funds for the organization.
New Horizons may make certain uses and disclosures of your
protected health information after giving you an opportunity to agree or
object. If you are incapacitated, in an
emergency situation or unavailable, New Horizons may use or disclosure your
protected health information for these certain purposes if, in New Horizons’
professional judgment, the use or disclosure is in your best interest. These purposes include the following:
If you do not object, New Horizons may use your protected
health information to list your name, general condition, religious affiliation
and location in New Horizons’ facility in a facility directory. New Horizons may disclose this information
to anyone asking for you by name and to members of the clergy.
If you do not object, New Horizons may disclose your protected
health information to your family, relatives, friends, and other persons whom
you identify if the protected health information is directly relevant to that
person’s involvement in your care or payment for care. Similarly, if you do not object, New
Horizons may use and disclose your protected health information for the purpose
of notifying, identifying and locating family members, personal representatives
and others responsible for your care of your location, general condition or
If you do not object, New Horizons may use your protected
health information for or disclose it to entities authorized to assist in
disaster relief efforts.
New Horizons may use or disclose your protected health
information in the following situations without your consent, authorization or
agreement and without giving you an opportunity to object:
Horizons may use or disclose your protected health information to the extent
that the use or disclosure is required by law.
The use or disclosure will be made in compliance with the law and will
be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or
disclosures. Under the law, New
Horizons must make disclosures when required by the Secretary of the Department
of Health and Human Services to investigate or determine compliance with the
requirements of 45 CFR 160, 164 et seq.
New Horizons may
disclose your protected health information for public health activities and
purposes to a public health authority that is permitted by law to collect or
receive the information. The disclosure
will be made for the purposes of controlling disease, injury or
disability. New Horizons may also
disclose your protected health information, if directed by the public health
authority, to a foreign government agency that is collaborating with the public
health authority. New Horizons may
disclose your protected health information, if authorized by law, to a person
who may have been exposed to a communicable disease or may otherwise be at risk
of contracting or spreading the disease or condition.
New Horizons may disclose protected health information
to a health oversight agency for oversight activities authorized by law such as
audits, investigations, inspections, and civil, criminal, administrative, and
disciplinary proceedings. Oversight
agencies seeking this information include government agencies that oversee the
healthcare system, government benefit programs, other government regulatory
programs and civil rights laws.
Horizons may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse or
neglect. In addition, New Horizons may
disclose to a governmental entity or agency authorized to receive such
information your protected health information if it believes that you have been
the victim of abuse, neglect or domestic violence. In such cases, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Horizons may disclose your protected health information to a person or company
required by the Food and Drug Administration to report adverse events, product
defects or problems, biological product deviations, to track products, to make
sure repairs or replacements, or to conduct post marketing surveillance.
Horizons may use and disclose protected health information in the course of any
judicial or administrative proceedings, in response to an order of a court or
administrative tribunal, in response to certain subpoenas, discovery requests
and other lawful processes. New
Horizons may also disclose protected health information, so long as applicable
legal requirements are met, for law enforcement purposes.
Horizons may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for the
coroner or medical examiner to perform other duties authorized by law. New Horizons may also disclose protected
health information to a funeral director, as authorized by law, in order to
permit the funeral director to carry out his/her duties. We may disclose such information in
reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric,
organ, eye or tissue donation purposes.
certain circumstances, New Horizons may disclose your protected health
information to researchers for approved research that has established protocols
to ensure the privacy of your protected health information.
with applicable federal and state laws, New Horizons may disclose your
protected health information, if New Horizons believes that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or the public. New Horizons may also disclose protected health information if it
is necessary for law enforcement authorities to identify or apprehend an
with applicable law, New Horizons may use or disclose protected health
information of individuals who are Armed Forces personnel for: activities deemed necessary by appropriate
military command authorities to assure proper execution of a mission and
disclosures to a foreign military authority if you are a member of that foreign
military service. New Horizons may also
disclose your protected health information to authorized federal officials for
conducting national security and intelligence activities.
Horizons may disclose your protected health information as authorized to comply
with workers’ compensation laws and other similar legally established programs.
Horizons may disclose your protected health information to a correctional
institution or law enforcement official having lawful custody of you if you are
an inmate of a correctional facility and if the correctional facility or
official makes certain representations regarding the need for the information.
New Horizons will not use or disclose protected health
information for purposes other than those described in the sections above
without a written authorization from you or a person authorized to act on your
behalf. You or the person authorized to
act on your behalf may revoke such an authorization in writing.
You have the following rights:
A right to request restrictions on certain uses and disclosures
of protected health information. New
Horizons is not required to agree to your request to restrict New Horizons’ use
or disclosure of your protected health information. To request restrictions you must make your request in writing to
Ronald N. Storing.
In your written request, you must tell New Horizons what
information you want to limit and to whom you want the limits to apply.
A right to receive confidential communications of your
protected health information. You have
the right to request that New Horizons communicate your protected health
information to you in alternate locations and by alternate means. For example, you can ask that New Horizons
contact you by mail at an address other than your home address. To request communications by alternate means
or at an alternate location, you must make your request in writing to the
Privacy Officer. New Horizons will not
ask you the reason for your request and will accommodate reasonable requests. You must also specify how and where you wish
to be contacted. You must also provide
information on how payment will be handled.
A right to inspect and copy protected health information. You have the right to inspect and obtain a
copy of your protected health information that New Horizons may use to make
decisions about your care. During an
inspection of your information, a professional staff person may be in
attendance to assist you. To inspect or
obtain a copy of your information that may be used to make decisions about you,
you must submit your request in writing to the Privacy Leader. If you request a copy of the information,
New Horizons may charge you a fee for copying and mailing incurred with your
request. New Horizons may deny your
request under very limited circumstances.
If you are denied access to your information, you may request that the
denial be reviewed. Another licensed
health care professional chosen by New Horizons will review your request and
the denial. The person conducting the
review will not be the person who originally denied your request. New Horizons will comply with results of the
A right to amend your protected health information. This means you may request an amendment of
your protected health information maintained in a designated record set for as
long as New Horizons maintains it. Your
request must be in writing and submitted to the Vice President of
Rehabilitation at 1814 Pond Run, Auburn Hills, MI 48326. This writing must provide a reason that
supports your request. In certain
cases, New Horizons may deny your request for an amendment. If New Horizons denies your request for an
amendment, you will receive a written denial and you will have the right to
file a statement of disagreement with New Horizons, which may prepare a
rebuttal to your statement and will provide you with a copy of such
rebuttal. Please contact the Vice
President of Rehabilitation at 1814 Pond Run, Auburn Hills, MI 48326 if you
have any question about amending your records.
A right to receive an accounting of disclosures of your protected
health information. You have the right
to a written account of disclosures of your protected health information which
New Horizons and its business associates made in the six years prior to the
date of your request or for a shorter period of time. Certain disclosures are exempt from the
written accounting. You must submit
your request in writing to the Privacy Leader.
Your request must indicate the time period for which you want the
accounting. New Horizons will provide,
free of charge, the first accounting you request in a twelve month period. New Horizons may impose a reasonable charge
for subsequent accountings requested in a twelve month period provided that New
Horizons informs you of the fee and provides you with an opportunity to
withdraw or modify the request.
A right to obtain a paper copy of this notice from New
Horizons upon request.
If you believe that your privacy rights have been
violated, you may complain to New Horizons or the Secretary of Health and Human
Services. New Horizons will not
retaliate against any individual filing a complaint. New Horizons’ complaint process is as follows:
Contact the Privacy Leader at the location(s) where you
received services. He/She will attempt
to resolve the complaint.
If your complaint is not resolved by the Privacy Leader, you
may submit your written complaint to the Primary Privacy Leader or the Vice
President of Rehabilitation. The
Primary Privacy leader will respond in writing to you, or your guardian/advocate
with copies to the Privacy Leader and your Employment Coordinator.
If your complaint is not resolved by the Primary Privacy
Leader, you should direct your complaint in writing to the President/CEO.
If you still do not feel your complaint has been resolved, you
can contact the Department of Health and Human Services for further resolution.
If you want further information regarding New Horizons’
privacy policies and procedures you should contact Ronald N. Storing at
248-340-0559. The effective date of
this notice is April 14, 2003.