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MISSISSIPPI METHODIST SENIOR SERVICES, INC. NOTICE OF PRIVACY PRACTICE

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY

This Notice of Privacy Practice (or “Notice”) describes how Mississippi Methodist Senior Services, Inc. (“MMSS”) will use and disclose protected information and data that we receive or create related to your healthcare.  We understand that your health information is personal to you, and we are committed to protecting the information about you.  MMSS is an organization with a variety of services available to our residents and others.  There are many departments and business associates that have access to your health information for the performance of those services.  These departments/business associates include but are not limited to:  Admissions, Nursing, Medical Records, Physical Therapy, Hospice, and Accounting.  All MMSS facilities follow the terms of this Notice and may share health information with each other for treatment, payment or health care operations described in this Notice. 

The project is being delivered using the design/build method. Each Green House® consists of 6,040 sq. ft. The houses meet regulatory guidelines and fall within Mississippi Medicaid reimbursement levels.

MMSS is required to:

  • Maintain the privacy of your protected health information as required by law;

  • Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
  • Abide by the terms of the Notice currently in effect. 

How We Will Use or Disclose Your Health Information

We will not use or disclose your health information without your authorization, except in the following situations:

  • Treatment:  We will use and disclose your health information while providing, coordinating, or managing your healthcare, including emergency treatment situations.   For example:  Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you.  Your physician will document in your record his/her expectations for the members of your healthcare team (in the form of orders).  Members of your healthcare team will then record the actions they took and their observations.  In that way, the physician will know how you are responding to treatment.  We will also provide your physician or subsequent healthcare provider with copies of various reports that should assist him/her in treating you once you are discharge from treatment. 
  • In addition, we may disclose your protected health information from time-to-time to another physician or healthcare provider (e.g. a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment. 
  • Payment:  We will use and disclose your medical information to obtain or provide compensation or reimbursement for providing your healthcare.  For example:  Your protected health information will be used, as needed, to obtain payment for your healthcare services.  This may include certain activities that your health payor may undertake before it approves or pays for healthcare services, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities (e.g. obtaining approval for a stay may require that your relevant protected health information be disclosed to obtain approval for that stay). 
  • Health Care Operations:  We will use and disclose your health information to deal with certain administrative aspects of your healthcare, to provide services and to manage our business more efficiently.  For example:  We may use or disclose, as needed, your protected health information in order to support the business activities of MMSS.  These activities include, but are not limited to:  quality improvement activities, training of healthcare students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.  Members involved with quality improvement may use information in your health/medical record to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide. 
  • Business Associates:  There are some services provided in our organization through contracts with business associates.  Examples include temporary staffing agencies, therapists, consultants and information technology vendors.  When these services are contracted, we may disclose your health information to our business associate so that it can perform the job we have requested and then bill for services rendered.  To protect your health information, however, we required the business associate to appropriately safeguard your information. 
  • Marketing Treatment Alternatives and Health-related Benefits and Services:  We may use and disclose health information to tell you about or recommend possible treatment options or alternatives or other health-related benefits and services that may be of interest to you. 
  • Fundraising:  We may use certain information and may contact you for the purposes of raising funds.  You have the right to request not to receive subsequent fundraising materials or “opt-out”. 
  • Others Involved In Your Healthcare:  Unless you notify us that you object, we may disclose to a family member, other relative, a close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.  If you are unable to agree to such a disclosure, we may disclose such information, as necessary, if we determine that it is in your best interest based on professional judgment.  We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location and general condition.  Finally we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare. 
  • Facility Directories:  Unless you notify us that you object and wish to “Opt-out”, we will use and disclose in our facility directory your name, location in the facility and religious affiliation for directory purposes.  This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. 
  • Required By Law:  We may use or disclose your protected health information to the extent required by law.  The use and disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.  You will be notified, when required by law, of any such uses or disclosures. 
  • Public Health:  We 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 purpose of controlling disease, injury or disability. 
    • Public Health Authority:  We may disclose your protected health information to a public health authority that is authorized by law to received reports.  We 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. 

    • Communicable Disease:  We may disclose your protected health information to a public health authority that is authorized by law to receive reports regarding communicable disease.  We may also 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. 
  • Victims of Abuse, Neglect or Domestic Violence:  We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect.  In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence or to assist an investigation of abuse, neglect or domestic violence, to the governmental entity or agency authorized to receive such information.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. 
  • Food and Drug Administration:  We 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, biologic product deviations, track products, to enable product recalls, to make repairs or replacements, or to conduct post-marketing surveillance, as required. 
  • Health Oversight:  We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections.  Oversight activities seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws. 
  • Judicial and Administrative (Legal) Proceedings:  We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process. 
  • Law Enforcement and Criminal Activity:  We may disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.  These law enforcement purposes include (1) legal processes and other processes required by law, (2) limited information required for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of a criminal conduct, (5) in the event that a crime occurs on the premises of a MMSS facility, and (6) medical emergency (not on a MMSS facility premises) and it is likely that a crime has occurred. 
  • Avert Serious Threat to Health or Security:  Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe 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.  We may also disclose protected health information if it is necessary for law enforcement to identify or apprehend an individual. 
  • Coroners, Medical Examiners and Funeral Directors:  We 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.  We 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.
  • Organ Donation:  Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant. 
  • Research:  We may also disclose your protected health information to researchers when the appropriate MMSS authority, after reviewing the research proposal and established protocols to ensure the privacy of your protected health information, has approved the research. 
  • Worker’s Compensation:  We may disclose protected health information to the extent authorized by and to the extent necessary to comply with the laws relating to worker’s compensation or other similar programs established by law. 
  • Military Activity and National Security:  When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service.  We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized. 

Prohibition on Other Uses or Disclosures

Other uses and disclosures of your protected health information will be made only with your valid written authorization, unless otherwise permitted or required by law.  Once given, you may revoke that authorization at any time, in writing.  If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your authorization.  Understandably, we are unable to rescind any disclosure we have already made with your authorization. 

Understand Your Health Information Record

Each time you visit (or are visited by) a long-term care facility, home health provider, hospital, physician, or other healthcare provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment.  This information, often referred to as your health record or medical record, serves as a: 

  • Basis for planning your care and treatment.
  • Means of communication among the many health professionals who contribute to your care. 
  • Legal document describing the care you received. 
  • Means by which you or a third-party payer can verify that services billed were actually provided. 
  • A tool in educating health professionals.
  • A source of data for medical research.
  • A source of information for public health officials charged with improving the health of the nation. 
  • A source of data for facility planning and marketing.
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: 

  • Ensure its accuracy
  • Better understand who, what, when, where and why others may access your Health Information.
  • Make more informed decisions when authorizing disclosures to others. 

Your Health Information Rights

You have many rights concerning the confidentially of your health information:

  • Right to inspect and copy your protected health information:  This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information.  A “designated record set” contains medical and billing information and is comprised of two (2) separate records; the medical record and the billing record.  If you request a copy of your health information, we may charge you a fee for the cost of copying and mailing the records.  In certain circumstances, we may deny your request to inspect or copy your health information.  If you are denied access to your health information, you may request that the denial be reviewed.  Another licensed healthcare professional will then review your request and the denial.  The person conducting the review will not be the person who denied your request.  Please contact our Privacy Officer if you have questions about access to your protected health information. 
  • Right to request a restriction on certain uses and disclosures of your information:  You have the right to request restrictions on the health information we may use and disclose for treatment, payment and health care operations.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment of your care.  Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.  MMSS is not required to agree to a restriction that you may request.  If the facility staff/caregivers or physicians agree to the requested restriction, we will comply with your request, unless the information is needed to provide you emergency treatment.  To request restrictions, you must make your request in writing to MMSS’ Privacy Officer.  In your request, you must tell us:  (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. 
  • Right to request to receive confidential communications from us by alternative means or at an alternative location:  We will accommodate reasonable requests.  Please make this request in writing to MMSS’ Privacy Officer.  Your request must specify how or where you wish to be contacted. 
  • Right to amend your protected health information:  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 maintained by MMSS.  To request an amendment, your request must be made in writing and submitted to the Privacy Officer.  In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a valid reason to support the request.  In addition, we may deny your request if:
  • We did not create the information, unless the person that created the information is no longer available to make the amendment;

  • The information is not part of the health information kept by or for us;

Is not part of the information you would be permitted to inspect or copy; OR

  • Is accurate and complete.
  • Right to receive an accounting of certain disclosures we have made, if any, of your protected health information:  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practice.  Not all health information is subject to this request.  For example, it excludes disclosures we may have made for a facility directory, to family members or friends involved in your care, disclosures authorized by you or for notification purposes.  You must submit a request in writing to the Privacy Officer.  Your request must state a time period, no longer than six (6) years and may not include dates before April 14, 2003.  Your request must state how you would like to receive the report (e.g., by paper or electronically).  The first account you request within a 12-month period is free.  For additional accountings, we may charge you the cost of providing the accounting.  We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred. 
  • Right to obtain a paper copy of this notice from us:  Upon request, even if you have agreed to accept this notice electronically, you have the right to obtain a paper copy of this notice.  Please get in touch with your MMSS contact person or the Privacy Officer for your request. 

Contact Information
Our contact information for all questions, requests, or for further information related to the privacy of your health information is:

Privacy Officer
109 South Broadway St.
P. O. Box 1567
Tupelo, MS 38802-1567
(662) 844-8977

Complaints
If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer of MMSS at the above address and/or with the Secretary, Department of Health and Human Services (200 Independence Avenue SW, Washington, DC 20201).  There will be no retaliation for filing a complaint.  A complaint form is available for completion for complaints filed directly with MMSS.  Contact the Privacy Officer, at (662) 844-8977, for a copy of this form.

Changes to This Notice
We reserve the right to change our practices and Notice, and to make the new provisions effective for all protected health information we maintain.  Any revision to our privacy practices will be described in a revised Notice that will be distributed and posted prominently at various locations in our organization (including our web site). 

A copy of the current Notice in effect is always available upon request.  Requests are to be made to the Privacy Officer at (662) 844-8977. 

Effective Date
This version’s effective date is June 20, 2007.

 
 

Mississippi Methodist Senior Services, Inc. • 109 South Broadway • Post Office Box 1567
Tupelo, Mississippi 38802-1567 • 662/844-8977 • Fax: 662/844-9053
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