NOTICE OF PRIVACY PRACTICES FOR LIFEPlan CCO NY, LLC

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.

Uses and Disclosures of Health Information

By law, LIFEPlan CCO NY, LLC (“Company”) is required to:

· Maintain the privacy and security of your Protected Health Information (including Medicaid Confidential Data)

· Provide you with notice of our legal duties and privacy practices with respect to Protected Health Information

· Notify you following a breach of your Protected Health Information and

· Follow the terms of the Notice that is currently in effect.

With your consent, we may use and disclose your Protected Health Information for the purposes of treatment, payment and health care operations as described below.

· Treatment: We can use and share your information with other professionals who are treating you. Example: Our care coordinator may speak to a nurse about your medications.

· Payment: We can use and share your health information to bill for services and receive payment. Example: We may include your health information when we bill Medicaid for our services.

· Health Care Operations: We may use and disclose your information to others for our business operations. Example: We may use your health information to improve the quality of our services.

LIFEPlan CCO may also use and disclose your Protected Health Information for other specific purposes that are required or permitted by law. These include for the purposes of:

1. Promoting public health and safety (e.g., preventing disease, adverse reactions to medications, reporting suspected abuse)

2. complying with the law (e.g., if state or federal law requires it)

3. assisting coroners, medical examiners, funeral directors, organ procurement agencies (e.g., assisting in autopsies or organ donations)

4. complying with government requests (e.g., for workers compensation claims, law enforcement purposes, health oversight agencies).

Authorization

We may use and disclose your Protected Health Information for purposes other than as described in this Notice or required by law only with your written authorization. You may revoke your authorization to use or disclose Protected Health Information in writing at any time.

Rights

You have certain rights concerning the use and disclosure of your Protected Health Information. The law describes them in more detail, but generally they are:

· The right to request restrictions on certain uses and disclosures of your Protected Health Information (although we do not have to agree with them)

· The right to request confidential communications (such as designating a certain telephone number or email address) if your request is reasonable

· The right to inspect or obtain an electronic or paper copy of your Protected Health Information. We may charge a reasonable, cost-based fee

· The right to amend your Protected Health Information under limited circumstances specified by law

· The right to receive an accounting of disclosures of Protected Health Information for six years prior to the date you ask for all disclosures except those made for purposes of treatment, payment, or health care operations

· The right to receive a paper copy of this Notice at any time.

· If you have designated someone as your Health Care Proxy or if someone is your legal guardian or surrogate, that person can exercise your rights and make choices about your health information, if the person has the required authority.

Complaints

You may complain if you feel we have violated your rights by contacting us using the contact information listed in this Notice. You may also file a complaint with the Secretary of the United States Department of Health and Human if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

Amendments

We reserve the right to amend this Notice and to make the new Notice provisions effective for all your Protected Health Information maintained by us.

Contact Information

For more information about Provider’s privacy practices, please contact:

Glenda Criss, Privacy Officer
315-737-6113 or glenda.criss@lifeplanccony.com

Effective Date of this Notice: July 1, 2018