Notice of Family Planning Extension Program Privacy Practices

Effective 4/14/03

NOTICE OF PRIVACY PRACTICES

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.

Effective April 14, 2003, new federal privacy law requires the Family Planning Extension Program to tell you how we use and share your medical information. We also must tell you about your rights concerning this information.

The New York State Department of Health, with assistance from family planning program providers, operates the Family Planning Extension Program. The Department of Health has issued a combined privacy notice for Medicaid, Family Health Plus and the Child Health Plus Program. Because your information is handled differently for the Family Planning Extension Program we are issuing a separate notice.

What Kinds of Health Information Do We Have?

The Department of Health's Family Planning Extension Program currently does not directly maintain any health information about you. Instead, the health care provider who determined your eligibility for this program is required to maintain this information. The provider used information about your previous Medicaid status and the date your last pregnancy ended to confirm your eligibility for the Family Planning Extension Program.

After qualifying you for the program, the provider forwards very limited information, which allows the Department to reimburse them for your visit. The Department does not disclose the information received or make any decisions that affect your eligibility. Consequently, although you could seek to exercise directly with this program the rights stated under the new federal privacy laws discussed below, we cannot fulfill many of these requests because of the limited information we have. You may wish to approach your family planning provider regarding health information and rights under the federal privacy law since providers maintain your medical record.

Your Health Information Rights:

DOH must maintain any information we have confidentially. We must follow this notice. If we change our practices regarding the health information we keep, we must provide you with a new notice. This notice will be posted on the DOH website: http://www.health.state.ny.us and in our office. You, or a person legally authorized to act for you (e.g., parents of a minor who does not consent for their own care, a guardian, a health care proxy), have a right to:

  • get a paper copy of this notice of privacy practices upon request;
  • see or get a copy of your health information for a reasonable fee; if denied, you have the right to seek a review of the denial;
  • request amendments to your health information;
  • request limits on certain uses and disclosures of your information;
  • get a list of disclosures of your health information;
  • request communications of your health information by alternative means or at alternative locations;
  • revoke any special authorizations to use or disclose health information, except to the extent that disclosure has already been taken.

Under certain circumstances, minors can independently consent for medical services relating to family planning and reproductive health under state and federal law. A minor's right to confidentiality in such situations is recognized in the federal law, including the privacy regulations, and in state law.

What Are Our Responsibilities to You?

The Department is required to notify you of any breach of unsecured protected health information. The Department does not disclose any patient identifiable information or make any decisions that affect your eligibility; as previously discussed, these matters are handled by the provider. Consequently, although you could seek to exercise the rights stated under the new federal privacy law, we cannot fulfill many of these requests because of the limited information we have. You may wish to approach your family planning provider regarding health information and rights under the federal privacy law since providers maintain your medical record.

How Does the Family Planning Extension Program Use or Disclose Your Health Information?

For Payment: Providers submit limited information to the Department to receive payment for services rendered and auditing requirements.

For Program Health Care Operations: For example, we may give information to contracted organizations to help operate our program.

In certain other situations, the Department can use and disclose information without your authorization:

For Health Oversight and Public Health Reasons: Information may be disclosed when required to monitor the level and quality of care you receive.

As Required by Law: For example, to federal officials to ensure compliance with the privacy regulations.

For More Information or to Report a Problem:

If you have privacy questions, need more information or believe your privacy rights have been violated and you wish to complain, you may contact:

Privacy Contact
Family Planning Extension Program
NYSDOH
859 Corning Tower ESP,
Albany, NY 12237

Phone: 518-474-1911

e-mail: bwh@health.state.ny.us

If you wish to complain, a complaint form will be sent to you. In that instance, you may also complain to the Office for Civil Rights, Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, New York 10278, telephone number (212) 264-3313, fax number (212) 264-3039, TDD (212) 264-2355. You will not be retaliated against for filing a complaint or assisting an investigation.