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Effective July 15th, Health Services for Children with Special Needs (HSCSN) will implement Optum Financial/Optum Pay as the check payment vendor for provider electronic funds transfer (EFT). The details to the provider letter can be found in this document.

Notice of Privacy Practices

This Notice tells you how personal or medical information about you may be used and shared. It also tells how you can get access to this information. Please review it carefully.

Health Services for Children with Special Needs, Inc. (HSCSN) knows how important it is to keep your health information private. 

We will keep your personal information safe and only use it exactly how we said it will be used.

We only use your personal information according to the law and as we say in this notice. We have the right to change this notice at any time. The notice can be found in the enrollee guide. You may ask for a copy at any time.

Different laws say different things about health information

  • Health information means information about you or your child’s health care.
  • Personal information means health information and any other information that we have gotten while giving benefits to you or your child. This may be your address and Social Security number.
  • The law says we must give you this notice. It will tell you about:
    • The ways we may use health information about you and your child
    • Your rights
    • Our responsibilities in how we use and tell other people about this information

Health Information

We may get health information from you or others to give health services. We also get information from:

  • Health care claims and encounters
  • Medical history
  • Service requests
  • Complaints and appeals

How We Protect the Privacy of Personal Information

We protect your health information by:

  • Giving personal information about you or your child only to people at HSCSN who need to know. This helps us get you products or services.
  • Keeping all personal information safe and secure.
  • Asking permission each time before we send information about you or your child.
  • Others are not allowed to tell anyone else about the information we give them about you or your child. This is the law.

How We May Use and Release Health Information

The law says that we can use health information without your permission for:

  • Treatment—We may give information to people who provide treatment.
    • Doctors
    • Nurses
    • Technicians
    • Office staff
    • Other personnel
  • Payment—We may use and give others health information about the enrollee when we need to decide:
    • If the service or item is covered
    • To set up care
    • To review if the service is medically necessary
    • To pay or review claims
    • To answer complaints
  • Health care operations—We may use and give others your personal information or your child’s personal information to help with health care operations. This may include:
    • Quality improvement activities
    • Accreditation
    • Answering inquiries
    • Appeals and review programs
    • Health promotion
    • Case management and care
    • General office activities

Sometimes it may be used for:

  • Auditing
  • Reviewing pharmacy programs and payments
  • Helping the sale, transfer, or merger of all or a part of The HSC System with another organization

This list does not include every reason that information can be given. You are asked to sign an authorization form, and it includes information about these activities.

Other Allowed or Required Uses

The law allows us to use or give health information about you or your child without permission for the following reasons:

  • To obey the federal or state agencies who oversee health care.
  • To meet our promises with our sister companies as your health care insurer.
  • To let health plan sponsors perform plan administration.
  • To researchers who are following all laws required to protect your. privacy.
  • To comply with a court order or other lawful process.
  • To anyone providing services to us. They have to make sure that they will keep all information safe and secure.
  • To let you know about treatment alternatives or health-related benefits or services.
  • Sometimes, we are allowed by federal and state law to give agencies health information about you or your child without authorization. For example to:
    • Protect victims of abuse or neglect
    • Avoid a serious threat to health or safety
    • Track diseases or medical devices
  • We may also inform military or veteran authorities if you are an armed forces enrollee.
  • We may give information:
    • To coroners
    • For worker’s compensation
    • For national security
    • To anyone the law says we must give it to
  • We will give health information to organizations that handle organ, eye, or tissue transplantation or to an organ donation bank. This helps make organ transplants and organ donations easier.
  • We are allowed to use health information that does not identify you or your child.
  • We may give health information about you to your family members or friends if you agree to it in writing.

If you ask, we will tell you what information was released. We will also tell you who got it and why.

Other Uses of Health Information

  • We will not use or tell anyone about your health information or your child’s health information for any reason. The only time we share information is for the reasons listed above or if we have your written approval.
  • We must get a separate approval from any consent we have received from you in the past.
  • If we are given approval to use or release health information, the approval may be stopped at any time. You need to notify us in writing.
  • If the approval is stopped, we will no longer use or give anyone else information about you or your child. 
  • We cannot take back any uses or releases already made if you already gave permission.

There are special rules for HIV or substance abuse information about you or your child.

  • We cannot give that information without a special written and signed approval. 
  • This is different from the approval and consent we talked about above.
  • The law states that we have both a signed consent and a special written approval.

There are special laws for HIV or substance abuse records. You or your child’s legal caregiver must give all consents and approvals.

Rights Regarding Health Information

You, your child, and your child’s caregiver have the following rights regarding their health information.

Right to Look at and Copy Health Information

The only exception is for psychotherapy notes or other limited reasons. You need to send a written request to us before you may look at and/or copy the health information. A fee may be charged for the costs of copying, mailing or other supplies.

Right to Change the Record

You may ask us to change information if the health information is not right. If we do not let you change the information, we will tell you why in writing.

Right to an Accounting of Disclosures

This is a list of who we gave medical information to about you or your child. This is information about you or your child that is not part of treatment, payment, and health care operations. To get this list:

  • You must ask for it in writing.
  • You need to tell us what time period you want.
  • It may not be longer than 6 years ago.
  • It cannot include dates before April 14, 2003.

We will give you the list free of charge. We will not give you the list free of charge if we have already given you a list within the same 12-month period.

We may temporarily suspend your right to receive an accounting of disclosures in certain circumstances, as defined by law.

Right to Request Restrictions (Limits)

You have the right to ask for a limit on the health information we use or give someone else. This includes information about:

  • Treatment
  • Payment
  • Health care operations

You also have the right to ask for a limit on the health information we give about you or your child to someone who is involved in the care or payment of it. We do not have to agree to a requested restriction.

Right to Confidential Communications

You have the right to ask for health information to be talked about in a particular place or in a certain way. We will agree to all reasonable requests.

Right to a Paper Copy of This Notice

At any time, you have the right to ask at any time for a paper copy of this notice.

Changes to This Notice

We can:

  • Change this notice.
  • Make the changed notice effective for medical information we already have about the enrollee.
  • Change it for any information we receive in the future.

We will keep a summary of the current notice with the effective date in the top right-hand corner. You can always get a copy of the notice currently in effect.

For More Information or to Report a Complaint

You may file a complaint if you believe that your privacy has been violated. You can contact our office or the Secretary of the Department of Health and Human Services.

To file a complaint with the Secretary:

  • Send a letter to 200 Independence Avenue, SE, Washington, D.C. 20201.
  • Call 1(877) 696-6775.

To file a complaint with our office, contact the:

  • HSCSN Customer Care / Compliance & Privacy Officer Jason Pounds at 202-467-2737.
  • HSCSN 1101 Vermont Avenue NW, Suite 1200, Washington, D.C. 20005. 

You will not be penalized for filing a complaint.