Notice of Adult Cystic Fibrosis Assistance Program Privacy Practices

By law, the New York State Department of Health Adult Cystic Fibrosis Assistance Program (ACFAP) is required to protect the privacy of your personal health related information. ACFAP is also required to give you this notice to tell you how ACFAP may use and disclose (give out) your personal health related information held by ACFAP. We are required to notify you should a breach of your information occur.

ACFAP

  • To you or someone who has the legal right to act for you (your personal representative or caregiver),
  • To the Secretary of the federal Department of Health and Human Services, if necessary, to make sure your privacy is protected, and
  • Where required by law.

ACFAP

  • ACFAP may share your personal health related information with providers to make sure the providers are paid for the services they provide to you.
  • ACFAP may use your personal health related information to make sure you and other ACFAP beneficiaries get quality health care, to provide customer services to you, or to resolve any complaints you have.

ACFAP

  • For public health activities (such as reporting disease outbreaks),
  • For government healthcare oversight activities (such as fraud and abuse investigations),
  • For judicial and administrative proceedings (such as in response to a court order),
  • For law enforcement purposes (such as providing limited information to locate a missing person),
  • For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability),
  • To avoid a serious and imminent threat to health or safety,
  • To contact you about new or changed benefits under ACFAP, and
  • To create a collection of information that can no longer be traced back to you.

By law, ACFAP must have your written authorization to use or disclose your personal health related information for any purpose that is not set out in this notice. You may revoke (take back) your written authorization at any time, except if ACFAP has already acted based on your authorization.

By law, you have the right to:

  • See and get a copy of your personal health related information held by ACFAP for a reasonable fee.
  • Have your personal health related information amended if you believe that it is wrong or if information is missing, and ACFAP agrees. If ACFAP disagrees, you may have a statement of your disagreement added to your personal health related information.
  • Get a listing of those getting your personal health related information from ACFAP. The listing will not cover your personal health related information that was disclosed to you or your personal representative, that was disclosed to pay for your healthcare or for ACFAP operations, or that was disclosed for law enforcement purposes.
  • Ask ACFAP to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. Box instead of your home address).
  • Ask ACFAP to limit how your personal health related information is used and disclosed to pay your claims and run ACFAP. Please note that ACFAP may not be able to agree to your request.
  • Get a separate paper copy of this notice.

If you believe ACFAP has violated your privacy rights set out in this notice, you may file a complaint with ACFAP by sending a written request to the following address:

Privacy Complaints
Adult Cystic Fibrosis Assistance Program
New York State Department of Health
Riverview Center
150 Broadway, 3rd Floor West
Albany, NY 12204-0678

You also may file a complaint with the Secretary of the Federal Department of Health and Human Services. Filing a complaint will not affect your benefits under ACFAP. For more information call (518) 474-1222.

By law, ACFAP is required to follow the terms in this notice. ACFAP has the right to change the way your personal health related information is used and given out. If ACFAP makes any changes, you will get a new notice by mail within 60 days of the change.

The privacy practices in this notice will be effective April 14, 2006.