| Last Updated: June 11, 2007 |
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA)
of 1996 requires significant changes by health plans. Many of these
changes are related to HIPAA's Privacy Standards, which are effective
April 14, 2003.
Care Choices has involved all employees in ongoing HIPAA training
sessions to ensure that all of our staff members are well educated
about HIPAA and to ensure that HIPAA Privacy Standards are maintained
at all times.
Q. What are the HIPAA Privacy Standards?
Q. How has Care Choices changed processes
to comply with HIPAA?
Q. What is considered protected health information
under HIPAA?
Q. How will Care Choices handle inquiries
that include protected health information?
Q. How does Care Choices safeguard
the privacy of your protected health information?
Q. How have the HIPAA Privacy
Standards been communicated to Care Choices members?
Q. When will a Care Choices Authorization
Form be required?
Q. How can you obtain a copy
of the Care Choices Authorization Form?
Q. How can you obtain a copy of the
Care Choices "Notice of Privacy Practices"?
Q. How can you receive additional
HIPAA information from Care Choices?
Q. What are the HIPAA Privacy Standards?
A. The federal HIPAA Act requires health plans to protect
the privacy of each member's individually identifiable health care
information.
Specific privacy requirements of HIPAA include the following:
- Defines Protected Health Information (PHI) as health-related
information which identifies an individual member or provides
a reasonable basis to believe that the information could be used
to identify a member.
- Provides health plans with the ability to use PHI for treatment,
payment and health care operations (TPO) purposes without member
authorizations.
- Requires health plans and providers to make reasonable efforts
to limit the use and disclosure of PHI to the minimum necessary
in required circumstances.
- Requires member authorization for certain non-TPO uses and
disclosures of PHI.
- Permits a health plan to disclose PHI to its business associates
to perform services on behalf of the health plan.
- Provides members with the right to access their PHI.
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Q. How has Care Choices changed processes
to comply with HIPAA?
A. Care Choices has adopted policies for both internal and external operations,
including those involving external clients, vendors, etc. These policies restrict
Care Choices from disclosing PHI without a signed member authorization except
in specific circumstances.
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Q. What is considered protected health information
(PHI) under HIPAA?
A. PHI includes such information as a member's name, address, phone number,
Social Security number, other demographic information, and any information
related to their health condition or diagnosis.
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Q. How will Care Choices handle inquiries
that include protected health information?
A. To help ensure compliance with the new Privacy Standards, Care Choices
requires that all member issues are coordinated exclusively through our Customer
Service department. In most situations, Care Choices' employees, other than
those in our Customer Service department, will no longer be able to discuss
member issues that involve PHI including claim issues, eligibility issues,
benefit issues, etc.
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Q. How does Care Choices safeguard
the privacy of your protected health information?
A. Care Choices HMO has the following safeguards in place within the
organization to internally protect members' personal health information that
is provided to us orally, in writing and electronically:
- After five minutes of inactivity, computers automatically time
out. A screensaver appears and a password is required to unlock
the screensaver. Each user has his or her own password that expires
every 90 days. Sharing of passwords is strictly prohibited.
- Shredding bins are located throughout the company to hold confidential
documents that need to be destroyed. Bins are picked up weekly
for disposal.
- All employees are required to sign a confidentiality agreement
annually, acknowledging they understand and will follow all company
security policies.
- Antivirus protection software is installed on all computer
systems, networks, and firewalls. All information is backed-up
daily and securely maintained, therefore information can be restored
with minimum loss.
- Unique user identifiers and passwords are required for email
and voicemail messages.
- Employees must wear a photo ID key card, ensuring that only
employees have access to the 24-hour locked offices.
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Q. How have the HIPAA Privacy Standards
been communicated to Care Choices members?
A. Care Choices is required by the HIPAA standards to provide all members
with a copy of our "Notice of Privacy Practices." This written notice
has been mailed to all subscriber households and provides an explanation of
how Care Choices will ensure the protection of member health information.
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Q. When will a Care Choices Authorization
Form be required?
A. An Authorization Form (PDF
Document) will be required in many circumstances involving disclosures
of PHI to someone other than the member. For example, an authorization will
usually be required if the member wishes to authorize another party to discuss
an issue involving their PHI.
 Authorization Form en Español
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Q. How can you obtain a copy of
the Care Choices Authorization Form?
A.  Download the
Care Choices Authorization Form which you can print, complete and mail to Care
Choices HMO. You may also request a copy from our Customer Service department
by calling (800) 852-9780.
Authorization Form en Español
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Q. How can you obtain a copy of the Care
Choices "Notice of Privacy Practices"?
A. Download the
Notice of Privacy Practices.
PDF documents require Adobe Acrobat Reader to view. If you do
not have Acrobat Reader installed on your PC, click
here to download.
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Q. How can you receive additional
HIPAA information?
A. First, check the Notice of Privacy Practices referenced in the question
above. For more information on the HIPAA standards, please visit www.hhs.gov/ocr/hipaa/
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