HIPAA Information

• member name
• member ID number
• member date of birth
• member address
• member phone number

• provider tax id number (if a provider is calling)

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.

As your health plan, the Children’s Medical Security Plan sees information about your health and finances. It is important that you know that MassHealth takes great care to protect your privacy and will continue to do so. By law, we are required to maintain the privacy of your information, give you this notice and follow the terms of this notice.

MassHealth and UniCare, our plan administrator, want you to know some of the things we do to protect your information.

• We limit the number of people we show it to.
• We ask those people to protect it.
• We let you check the information we have about you to make sure it is correct.

• From you when you fill out the application forms
• From doctors, hospitals and labs that must be paid for the services they provide
• From other companies we do business with, like our dental and mental health provider networks
• From agencies who keep track of your credit rating

• Our employees at MassHealth and UniCare, so we can pay your health care providers for services you get, and so we can check on your eligibility for different health benefits
• Our doctors and other providers
• Other companies we do business with
• People who have a legal right to see it, like:
• the U.S. Department of Health & Human Services when it needs to make sure your privacy is protected
• government agencies that give you benefits and services, or for licensure, audit or other proceedings
• Agencies who oversee how we run our business, like those that evaluate the quality of health care services you get

• Our employees and providers sign an agreement to keep it private.
• Other companies we do business with have written agreements with us to keep it private.
• We follow state and federal privacy laws.

• To pay your health care providers for services you get.
• To make sure that your health care is covered by your benefit plan.
• For example, we want to be sure that a service offered by a provider will be paid for by your plan so you know if you will be charged for that service.
• To make sure your health care is medically necessary.
• With health care providers to coordinate treatment and services that you get.
• To demonstrate to government agencies that oversee our work that we are handling your information correctly.
• To meet legal requirements.
• To the U.S. Department of Health & Human Services, to make sure your privacy is protected.
• To operate our programs.
• For example, to make sure you are receiving quality health care, or to study ways to reduce costs.
• For research projects that meet privacy requirements and help us evaluate and improve our programs.
• With other government agencies that give you benefits or services.
• To prevent or respond to an immediate health emergency.

Unless you give us permission, we cannot use this information for any other reason. If you do not give us your written consent, we cannot use it. You may cancel your permission at any time, as long as you do it in writing. Note: we cannot take back any health information we used or shared when we had your permission.

You have the right to:

• Write to us to get a copy of information we have about you. We have the right to charge you to cover certain costs.
• Ask us to change your health information if you think it is wrong or incomplete. You must tell us in writing which health information you want us to change, and why. We may not be able to change the information in certain circumstances. Information we didn’t create cannot be changed by us.
• Ask us in writing to limit the information we share or limit how we use it. We may not be able to grant this request.
• Ask us to get in touch with you in some other way, if contacting you at the address or telephone number we have for you would put you in danger. You must tell us in writing that you are in danger and exactly where and how we should contact you.
• Request a list of when and with whom we shared your information (on or after April 14, 2003), with limited exceptions. You must ask for this in writing.

You have the right to receive a paper copy of this notice. You can receive another copy of it at any time.

We can make changes to this policy on your right to privacy. Any changes made will apply to information that we already hold and that we receive in the future. We will let you know about the changes through a note mailed to your address or a note posted on our website.

You can call CMSP Customer Service at 1-800-909-2677.

If you think we have not protected your privacy, you can file a complaint with UniCare, MassHealth or the federal government:

Office for Civil Rights
U.S. Department of Health & Human Services
Government Center
J.F.K. Federal Building
Room 1875
Boston, MA 02203
(OCRComplaints@hhs.gov)

If you want to file a complaint or request any of the rights in this policy, write to:

Children’s Medical Security Plan
PO Box 519
Andover, MA 01810-0009
Attention: HIPAA Lead

If you are not satisfied with the response you receive from UniCare, or if you wish to contact MassHealth, write to:

MassHealth
Privacy Office
600 Washington Street
Boston, MA 02111

Filing a complaint will not affect your benefits.