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HIPAA Notice of Privacy Practices

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Your Privacy Rights As a MaineCare Member

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

MaineCare is required by law to protect your health information and to provide you with notice of its legal responsibilities for your health information. You may request this notice in paper copy or electronic copy at any time.

You have the right to know what MaineCare knows about your health.

MaineCare knows things about your health, like:

  • what is wrong with you if you are sick or injured
  • if you are taking medicine and what kinds
  • if you use anything else to help you, like a wheelchair or a hospital bed
  • your x-rays, lab tests or other tests that have been done for you

MaineCare knows some things about who you are, like:

  • your name, address, birth date and phone number
  • your Social Security number
  • your MaineCare ID number

You have the right to see what is in your MaineCare records.

  • You can access and get copies of your health information in your MaineCare file.

You have the right to ask us to correct any errors on file at MaineCare in your MaineCare records.

You have the right to know whom MaineCare shares your health information with.

  • MaineCare talks to people that give you medical care or pay for your medical care.

You have the right to receive a list of those with whom MaineCare shares your health information.

  • You can request a list of people we have shared your health information with, that is not part of your medical treatment or payment for the services you get.

You have the right to ask us to limit who we share your health information with.

You have the right to ask MaineCare to get in touch with you only in certain ways.

  • You may ask us to call you only at a certain phone number, or ask us to send your mail only to a certain address. You must give us a phone number or mailing address to use, if you make this request.

You have the right to complain if you believe MaineCare is not protecting your health information properly.

  • If you have a complaint or concern about how we are handling your health information, you may call:

MaineCare Privacy Official
Bureau of Medical Services
11 State House Station
Augusta, Maine 04333-0011

287-2674 or 1-800-321-5557
TTY: 287-1828 or 1-800-423-4331

MaineCare does not retaliate against anyone who complains about MaineCare or a Member of our staff.

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Notice of Privacy Practices

MaineCare is required by law to protect the individually identifiable health information of all MaineCare Members. As a MaineCare Member, you have the right to expect that only those individuals, organizations and/or agencies that have a need to know will be allowed access to your health information, unless otherwise allowed by law.

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

MaineCare reserves the right to change our Privacy Practices at any time. If we change our Privacy Practices, we will provide you with a revised notice as soon as practical.

These Privacy Practices are affective on April 14, 2003.

Disclosure of Protected Health Information

MaineCare may use your health information for treatment, payment, or health care operations. This means we may use your health information when we:

  • discuss your medical treatment plan with your health care provider, or refer you to another health care provider or specialist;
  • submit claims to your insurance carrier or to another party that makes payments on your behalf; or
  • review our quality control, evaluation, training, or audit practices

When MaineCare shares your health information, the information we share:

  • will not exceed what is requested; and
  • will not exceed what is reasonably required for the purpose for which it was disclosed, based on the professional judgment of MaineCare staff. MaineCare reserves the right to determine whether or not the information requested exceeds minimum necessary requirements and to limit, as appropriate, the information disclosed.

Restricting Disclosure of Your Protected Health Information

You may request that MaineCare restrict the use or disclosure of your health information. MaineCare is not required to agree to these restrictions; however, if we do agree, we will maintain a record of those restrictions. Additionally,

  • if MaineCare ends the restriction, we will first notify you writing
  • if you end the restriction, then your health information will be used and disclosed as permitted by law
  • in an emergency situation, we may release information to the appropriate health care providers if it pertains to the administration of the MaineCare Program

Request for Confidential Communication

All reasonable requests for confidential communication of Protected Health Information will be honored provided that:

  • you clearly state that you could be endangered by the disclosure of all or part of the Protected Health Information;
  • the request is submitted in writing to the MaineCare Privacy Officer Liaison; and
  • you provide us with an alternative address or method of contact; otherwise, we may refuse to accommodate your request.

Your Right to Inspect and Copy Your MaineCare File

You have the right to inspect and obtain a copy of certain health information maintained in your MaineCare file. Generally, MaineCare files contain the following material, although your file may not include all this material:

  • Prior Authorization files
  • medical eligibility assessments

Amending Your MaineCare File

You have the right to amend the health information or other records in your MaineCare file for as long as that material is maintained in your file. Your request to amend your MaineCare file may be denied if the information you want to change:

  • was not created by MaineCare, unless the original source of the information is no longer available to make the requested corrections
  • is not part of the file available for your review
  • is currently accurate and complete

Accounting of Disclosures

You have the right to request that MaineCare provide you with a list of everyone with whom we shared your health information. This Accounting of Disclosures will not include:

  • disclosures you agreed to in writing
  • records of routine medical treatment or medical payments
  • information used for our own internal reviews and normal business operations
  • disclosures for Worker Compensation claims or
  • disclosures required by law and not covered under HIPAA

Uses and Disclosures of Health Information Requiring You to Agree or Object

Before your heath information is made available to the following groups, MaineCare will give you the opportunity to object:

  • family members, close friends, or other persons assisting in your health care or for notification purposes

Uses and Disclosures of Health Information Regarding Deceased Individuals

MaineCare safeguards health information about deceased individuals for as long as the information is maintained in MaineCare files. A deceased individual’s health information will be protected in the same manner and to the same extent as that of other individuals.

Denial of Access

In some limited circumstances, you may be denied access to your MaineCare file. If you are denied access, and believe you should be allowed access to this information, you may file a complaint with either MaineCare or the Secretary of Health and Human Services.

Complaint Process

If you believe your privacy rights have been violated, or that you have been wrongly denied access to your MaineCare file, you have the right to file a complaint either directly with the MaineCare Privacy Official or with the Secretary of Health and Human Services.

If you file a complaint, you must:

  1. File your complaint in writing, either on paper or electronically;
  2. Name MaineCare as the subject of the complaint and describe what occurred; and
  3. File your complaint within 180 days of when you knew the problem occurred.

MaineCare documents all complaints. While we are not obligated to respond to all complaints, we do retain a copy in our files for 6 years.

Contact information:

MaineCare Privacy Officer Liaison
Office of Medical Services
11 State House Station
Augusta, Maine 04333-0011

287-2674 or 1-800-321-5557
TTY: 287-1828 or 1-800-423-4331

It is the strict policy of MaineCare that there will be no retribution or retaliation against anyone filing a complaint against MaineCare or a Member of its staff.

The Secretary of the Department of Health and Human Services has delegated to the Office for Civil Rights (OCR) the authority to receive and investigate complaints.

For complaints involving the Office of Medical Services, Department of Health and Human Services:

Region I, Office for Civil Rights
U.S. Department of Health and Human Services
Government Center, J.F. Kennedy Federal Building
Room 1875
Boston, Massachusetts 02203

Toll free: 1-617-565-1340
Fax: 1-617-565-3809
TDD: 1-617-565-1343

Notice of Privacy Practices (.doc)

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