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| Notice of Privacy Practices Molina
Healthcare of Nevada |
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| 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. |
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| Molina Healthcare of Nevada (“Molina”
or “we”) uses and shares protected health
information about you to provide your health benefits as a Molina Advantage member.
We use and share your information to carry out treatment,
payment and health care operations. We also use and
share your information for other reasons as allowed
and required by law. We have the duty to keep your health
information private. We have policies in place to obey
the law. The effective date of this notice is January
1, 2007. |
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| PHI stands for these
words, protected health information. PHI means health information that includes
your name, member number or other identifiers, and is
used or shared by Molina. |
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| Why does Molina use or share your
PHI? |
| We use or share your PHI to provide you with healthcare
benefits. Your PHI is used or shared for treatment,
payment, and health care operations. |
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| For Treatment. |
| Molina may use or share your PHI to give you,
or arrange for, your medical care. This treatment
also includes referrals between your doctors or
other health care providers. For example, we may
share information about your health condition
with a specialist. This helps the specialist talk
about your treatment with your doctor. |
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| For Payment. |
| Molina may use or share PHI to make decisions
on payment. This may include claims, approvals
for treatment, and decisions about medical need.
Your name, your condition, your treatment, and
supplies given may be written on the bill. For
example, we may let a doctor know that you have
our benefits. We would also tell the doctor the
amount of the bill that we would pay. |
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| For Health Care Operations. |
| Molina may use or share PHI about you to run
our health plan. For example, we may use information
from your claim to let you know about a health
program that could help you. We may also use or
share your PHI to solve member concerns. Your
PHI may also be used, to see that claims are paid
right. |
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| Health care operations involve many daily business
needs. It includes but is not limited to, the
following: |
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Improving quality |
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Actions in health programs to help members
with certain conditions
(such as asthma) |
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Conducting or arranging for medical review
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Legal services, including fraud and abuse
programs |
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Actions to help us obey laws. |
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Address member needs, including solving
complaints and grievances. |
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| We will share your PHI with other companies ("business associates")
that perform different kinds of activities for our health plans.
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| We may also use your PHI to give you reminders about
your appointments. We may use your PHI to give you information
about other treatment, or other health-related benefits
and services. |
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| When can Molina use or share your
PHI without getting written authorization (approval)
from you? |
| In addition to treatment, payment and health care operations, the
law allows or requires Molina to use and share your PHI for
the several other purposes, including the following: |
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| Disclosure of your PHI to family members, other relatives and
your close personal friends is allowed if:
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The information is directly relevant to the family or friend's
involvement with your care or payment for that care; and |
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You have either orally agreed to the disclosure or have been given
an opportunity to object and have not objected. |
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| Required by law. |
| We will use or share information about you as
required by law. We will share your PHI when required
by the Secretary of the Department of Health and
Human Services (HHS). |
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| Public Health. |
| Your PHI may be used or shared for public health
activities. This may include helping public health
agencies to prevent or control disease. |
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| Health Care Oversight. |
| Your PHI may be used or shared with government
agencies. They may need your PHI for audits. |
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| Research. |
| Your PHI may be used or shared for research
in certain cases, when approved by a privacy or institutional review board. |
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| Legal or Administrative Proceedings. |
| Your PHI may be used or shared for legal proceedings,
such as in response to a court order. |
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| Law Enforcement. |
| Your PHI may be used or shared with police to
help find a suspect, witness or missing person. |
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| Health and Safety. |
| PHI may be shared to prevent a serious threat
to public health or safety. |
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| Government Functions. |
| Your PHI may be shared with the government for
special functions, such as national security activities. |
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| Victims of Abuse, Neglect or Domestic
Violence. |
| Your PHI may be shared with legal authorities
if we believe that a person is a victim of abuse
or neglect. |
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| Workers Compensation. |
| Your PHI may be used or shared to obey Workers
Compensation laws. |
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| Other Disclosures. |
| PHI may be shared with funeral directors or
coroners to help them to do their jobs. |
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| When does Molina need your written
authorization (approval) to use or share your PHI? |
| Molina needs your written approval to use or
share your PHI for a purpose other than those
listed in this notice. You may cancel a written
approval that you have given us. Your cancellation
will not apply to actions already taken by us
because of the approval you already gave to us. |
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| What are your health information
rights? |
| You have the right to: |
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Request Restrictions
on PHI Uses or Disclosures
(Sharing of Your PHI)
You may ask us not to share your PHI to carry
out treatment, payment or health care operations.
You may also ask us to not to share your PHI with
family, friends or other persons you name who
are involved in your health care. However, we
are not required to agree to your request. You
will need to fill out a form to make your request. |
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Request Confidential
Communications of PHI
You may ask Molina to give you your PHI in a certain
way or at a certain place to help keep your PHI
private. We will follow reasonable requests, if
you tell us how sharing all or a part of that
PHI could put your life at risk. You will need
to fill out a form to make your request. |
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Review and Copy Your
PHI
You have a right to review and get a copy of your
PHI held by us. This may include records used
in making coverage, claims and other decisions
as a Molina member. You will need to fill out
a form to make your request. We may charge you
a reasonable fee for copying and mailing the records.
In certain cases we may deny the request. |
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Amend Your PHI
You may ask that we amend (change) your PHI. This
involves only those records kept by us about you
as a member. You will need to fill out a form
to make your request. You may file a letter disagreeing
with us if we deny the request. |
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Receive an Accounting
of PHI Disclosures (Sharing of your PHI)
You may ask that we give you a list of certain
parties that we shared
your PHI with during the six years prior to the
date of your request.
The list will not include PHI shared as follows: |
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for treatment, payment or health care
operations; |
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to persons about their own PHI; |
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sharing done with your authorization; |
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incident to a use or disclosure otherwise permitted or required under law; |
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as part of a limited data set for research or public health activities; |
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PHI released in the interest of national security or for intelligence purposes; |
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to correctional institutions having custody of an inmate; or |
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shared prior to April 14, 2003. |
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| We will charge a reasonable
fee for each list if you ask for this list more
than once in a 12-month period. You must fill
out a form to request a list of PHI disclosures. |
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| You may make any of the requests listed
above, or may get a paper copy of this Notice.
Please call Molina Member Services
at 1-800-665-3086. |
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| What can you do if your rights have
not been protected? |
| You may complain to Molina and to the Department of
Health and Human Services if you believe your privacy
rights have been violated. We will not do anything against
you for filing a complaint. Your care will not change
in any way. |
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| You may complain to us at the following: |
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| By Phone: |
| Molina Member Services 1-800-665-3086 |
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| In Writing: |
| Molina Healthcare of Nevada |
| Attention: Manager of Member Services |
| 7050 South Union Park Center, Suite 200 |
| Midvale, UT 84047 |
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| You may file a complaint with the Secretary of the
U.S. Department of Health and Human Services at: |
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| Office for Civil Rights |
| U.S. Department of Health & Human Services |
| 50 United Nations Plaza - Room 322 |
| San Francisco, CA 94102 |
| (415) 437-8310; (415) 437-8311 (TDD) |
| (415) 437-8329 FAX |
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| What are the duties of Molina? |
| Molina is required to: |
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Keep your PHI private. |
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Give you written information such as this on
our duties and privacy practices about your PHI. |
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Follow the terms of this Notice |
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This Notice is Subject to Change
Molina reserves the right to change its information
practices and terms of this notice at any time. If we
do, the new terms and practices will then apply to all
PHI we keep. If we make any material changes, a new
notice will be sent to you by US Mail. |
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| Contact Information |
| If you have any questions, please contact the following
office: |
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| By Phone: |
| Molina Member Services 1-800-665-3086 |
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| In Writing: |
| Molina Healthcare of Nevada |
| Attention: Manager of Member Services |
| 7050 South Union Park Center, Suite 200 |
| Midvale, UT 84047 |
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Please click
here ( )
to download a printable copy of the Notice of Privacy
Practices. |
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