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.

Texas Children’s Health Plan has developed this Notice of Privacy Practices (“Notice”) to comply with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  HIPAA was enacted by Congress to establish standards for protecting the confidentiality and security of your health information.

Texas Children’s Health Plan (TCHP) and its employees follow the privacy practices described in this Notice. This Notice describes the general ways your protected health information may be used and disclosed in order for TCHP to administer your benefits, and to facilitate TCHP health care operations. Protected health information, as defined by HIPAA, means your personal health information which is found in your medical and billing records and which relates to your past, present, or future physical or mental health conditions or the provision of payment for services related to those health conditions. During the course of treatment, payment and health care operations activities, this may include information created or received by health care providers, benefit plan sponsors, and insurance companies.

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Your Health Information Rights
As a member receiving benefits from TCHP, you have the following rights regarding your protected health information. To exercise any of the following rights, you must submit a written request on a form provided by TCHP. The forms can be found on the TCHP Web site, http://www.texaschildrenshealthplan.org, or by contacting the TCHP Privacy Office at 832-824-2091.

• Right to a copy of this Notice. You may obtain a paper copy of this Notice at any time, even if you have been provided with an electronic copy, by contacting TCHP at 1-800-990-8247.  You may obtain an electronic copy of this Notice on the TCHP Web site, http://www.texaschildrenshealthplan.org.  You do not have to submit a written request to obtain the Notice.

• Right to inspect and copy. You have the right to inspect and/or receive a copy of your protected health information maintained by TCHP. TCHP may charge you a reasonable fee for copying your information.

• Right to request amendment. If you believe your protected health information maintained by TCHP is incorrect or incomplete, you may request an amendment to your information. TCHP is not required to agree to your request.

• Right to request restriction. You may request limitations on how TCHP uses and/or discloses your protected health information. For example, you may ask TCHP to not disclose that you have had a particular surgery. TCHP is not required to agree to your request. If TCHP agrees to your request, TCHP will comply with your request unless the use or disclosure is necessary in order to provide you with emergency treatment or is otherwise required by law.

• Right to receive confidential communications.  You may request that communications from TCHP regarding your protected health information be provided to you in an alternative way or at an alternative location if you state that the disclosure of all or part of your protected health information could endanger you. For example, you may prefer to get mail regarding your protected health information at an address other than your usual mailing address. You must specify in writing how or where you wish to be contacted.

• Right to accounting of disclosures. You may request a list of TCHP’s disclosures of your protected health information that have been made to persons or entities other than for the purposes of health care treatment, payment or operations, or pursuant to your specific authorization.  This list will contain each disclosure TCHP has made for the past six (6) years, but not prior to April 14, 2003.  If you make more than one request in a 12 month period, TCHP may charge you a reasonable fee.

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Our responsibilities
TCHP is required by law to:

• Ensure your protected health information that identifies you is kept private in accordance with federal and state law; and

• Provide you with this Notice of TCHP’s legal duties and privacy practices with respect to your protected health information; and

• Follow the terms of this Notice as long as it is in effect.  If TCHP revises this Notice, TCHP will follow the terms of the revised Notice as long as it is in effect.

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Use and Disclosure of Your Protected Health Information 
The following is a list of ways TCHP may use and disclose your protected health information. Each bold-faced section provides you with examples of how your information will be used and/or disclosed. Not every possible use or disclosure in any given section is listed. However, all of the ways TCHP is permitted to use and disclose information will fall within one of the bold-faced print sections below.

• Treatment. TCHP may disclose your protected health information to doctors, dentists, pharmacies, hospitals and other health care providers who provide medical treatment or services to you. For example, doctors may request protected health information from TCHP to supplement their own records to ensure they are fully informed about your medical condition and treatment needs.

• Payment. TCHP may use and disclose your protected health information to help pay for your covered services in a number of ways, including but not limited to: conducting utilization and medical necessity reviews; coordinating care; determining eligibility; determining formulary compliance; collecting premiums; calculating cost-sharing amounts; coordinating of benefits with other insurers; claims adjudication and settling subrogation claims; and responding to complaints, appeals and requests for external review. For example, TCHP may use your protected health information to decide whether a particular treatment is medically necessary and may disclose this information to your provider.

• Health Care Operations. TCHP may use and disclose your protected health information for routine health care operations. Health care operations at TCHP include quality improvement, credentialing of providers, outcomes assessment, preventive health, disease management, case management, care coordination, administration of reinsurance and stop loss; underwriting and rating; detection and investigation of fraud; administration of pharmaceutical programs and payments, and other general administrative activities, including data and information systems management and customer service. For example, TCHP may use your protected health information when assessing how a particular treatment affected your medical outcome. TCHP may also disclose your protected health information to your health care providers to assist them in their health care operations.

• Appointments and Alternatives. TCHP may use and disclose your health care information to contact you to provide appointment reminders or information about disease management, wellness programs, prescription refill reminders, and other communications regarding your case management or health care coordination.

• Business Associates. TCHP may disclose your protected health information to TCHP business associates in order to carry out treatment, payment, or health care operations. For example, TCHP may disclose your protected health information to a company who prepares TCHP documents for mailing to its members, such as member ID cards or member handbooks.

• Correctional Institutions. If you are an inmate of a correctional institution or under the custody of a law enforcement official, TCHP may disclose your protected health information to the correctional institution or law enforcement official. This disclosure may be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

• Health Oversight Activities. TCHP may disclose your protected health information to a health oversight or regulatory agency or entity for activities authorized by law, such as audits, investigations, inspections, and licensure.

• Health-Related Benefits and Services. TCHP may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

• Individuals Involved in Your Care or Payment for Your Care. TCHP may disclose your protected health information to a family member, other relative, or close personal friend who is involved in your medical care or in the payment for your medical if the protected health information disclosed is directly relevant to such person’s involvement, unless you tell TCHP otherwise. For example, if a family member or caregiver calls TCHP with prior knowledge of a claim, TCHP may confirm whether or not the claim has been received and paid.

• Law Enforcement. TCHP may disclose your protected health information for law enforcement purposes, as required by law or in response to a valid subpoena.

• Lawsuits and Disputes. TCHP may disclose your protected health information in response to a court or administrative order. In addition, TCHP may disclose your protected health information in response to a valid subpoena, discovery request, or other lawful process provided that efforts have been made to tell you about the request or to obtain an order protecting the information requested, as required by law.

• Medical Examiners. TCHP may disclose protected health information to a medical examiner in coordination with your physician to identify a deceased person or to determine the cause of death, or as otherwise permitted by law.

• Public Health Activities. As required by law, TCHP may disclose your protected health information for public health activities, including, but not limited to, reporting child abuse or neglect; notifying government authorities of suspected abuse, neglect or domestic violence.

• Research. TCHP may disclose your protected health information to researchers when the research has been legally approved and protocols have been established to ensure the privacy of your protected health information.

• Serious Threat to Health or Safety. TCHP may use and disclose your protected health information when TCHP deems it necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. 

• Workers' Compensation. TCHP may disclose your protected health information to workers' compensation or similar programs to the extent necessary to comply with laws relating to worker’s compensation or similar programs.

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Written Authorization
Except as described above, TCHP will not use or disclose your protected health information unless you authorize such use or disclosure to TCHP in writing, on the form provided by TCHP. You may revoke such authorization by providing a completed revocation of authorization form to TCHP.

A written revocation will not apply to any previous use or disclosure of protected health information made in good faith under a prior authorization. TCHP has an authorization form and a revocation of authorization form available for your use at http://www.texaschildrenshealthplan.org or from the TCHP Privacy Office at 832-824-2091.

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Changes to this notice
TCHP reserves the right to change this Notice from time to time. TCHP reserves the right to make the revised Notice effective for protected health information TCHP already has about you as well as any information TCHP receives in the future. The revised Notice will be provided to you in writing within 60 days of the changes.  Additionally, a copy of the current Notice or a summary of the current Notice will be posted on the TCHP Web site at http://www.texaschildrenshealthplan.org. The effective date of the Notice will appear on the first page of the Notice or summary. In addition, you may request a copy of the current Notice in effect at any time from TCHP.

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Complaints
If you believe your privacy rights have been violated, you may file a complaint with TCHP or with the Secretary of the United States Department of Health and Human Services.  You will not be penalized or retaliated against in any way for making a complaint to TCHP or the United States Department of Health and Human Services.

If you wish to file a complaint with TCHP, you may contact the TCHP Privacy Office at 832-824-2091.

If you wish to file a complaint with the Secretary of the United States Department of Health and Human Services, you may write to:

Region VI
Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX  75202

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Contact
If you have any questions about this Notice or your privacy rights, or wish to obtain a form to exercise your rights as described above, you may contact the TCHP Privacy Office at 832-824-2091 or write to:

Privacy Office
Texas Children’s Hospital
6621 Fannin, MC 3-4221
Houston, TX  77030

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