Effective: August 2017

Updated: October 2024

 

Innovative Integrated Health, Inc. (IIH) offers you access to health care through the Program of All-Inclusive Care for the Elderly (PACE). By law, IIH is required to protect your health information. After you enroll in IIH as your health plan, Medicare and/or Medi-Cal sends IIH your information. IIH also receives health information from health care individuals and institutions from which you receive care to approve and pay for your health care.

 

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.

 

YOUR RIGHTS

 

Below are your rights regarding your health information including claims records. Each of these may have rules, limits, and/or exceptions.

 

Getting a Copy of Your Health Information

• You may request a copy of any of your health information. To do so, your request must be made in writing and you must present a valid form of identification. IIH may charge a nominal fee for its costs to copy and mail records over to you. 

• You can expect to receive a copy of your health information within 30 days of your request.
• IIH may omit parts of certain health records as authorized by law.

 

Asking for Health Information Corrections

• You may submit a written request to have any incomplete or incorrect information that IIH has about you corrected. 

• IIH may deny your request if the information is not originally created by IIH or if IIH believes the information is complete and correct. IIH will notify you within 60 days with reason(s) for its decision. If your request is denied, you may ask IIH to reconsider its decision. You may also submit a statement that explains your disagreement along with your request for reconsideration, which IIH will keep with your records.

 

Requesting Confidential Means of Communication

• You may request that IIH contact you using your preferred method of communication. Examples include your cell phone, home phone, work phone, or even an alternative address where to send you mail.

• IIH will consider all reasonable requests, but IIH is required to agree if you inform IIH that not doing so may put you in danger.

 

Asking IIH to Limit What is Used or Shared

• You may ask that IIH not use or share certain health information for treatment, payment, or its operations.

• IIH may decline your request if it potentially impacts your care negatively.

 

Getting a List of Those with Whom IIH Has Shared Your Health Information With

• You may ask for a list of the times when IIH has shared your health information up to 6 years before your request date.

• You may ask for a list of the type of information shared, who IIH has shared your information with, when, and why.

• IIH will provide you with all disclosures except for those related to treatment, payment, its operations, and certain other cases (such as specific disclosures you have requested IIH not to make).

 

Getting a Copy of this Notice

• You may ask for a paper copy of this Notice at any time.

• You may find a copy of this Notice on IIH’s website.

 

Choosing Someone to Act for on Your Behalf

• If you have given a person power of attorney or if this person is your legal guardian, this person has the rights and can make choices about your health information. 
• IIH will make sure this person has the authority and can act on your behalf before taking any action.

 

Filing a Complaint if You Feel Your Rights Have Been Violated

• If you feel IIH has violated your rights, you can contact IIH using the information in this Notice.
• If file a complaint, IIH will not retaliate against you.

 

Using a Self-Pay Restriction

• If you pay for a service in whole, you may ask your doctor not to share the information about this service with IIH. If you or your provider submits a claim to IIH, IIH is not obligated to agree to a restriction. If disclosure if required by law, IIH does not have to agree to a restriction.

 

Telling IIH Your Preferences Regarding what Health Information is Shared 

• If you have a specific preference for how IIH shares your information, please contact IIH. In most cases, if IIH uses or shares your Protected Health Information (PHI) for reasons other than treatment, payment, or its operations, IIH must first seek your written permission. Even after you grant IIH permission to share or disclose your health information:
  • You may revoke it by submitting a request in writing at any time. Although IIH cannot reverse any prior use or disclosure of your information that has occurred with your permission, IIH will stop using or disclosing your health information going forward.
  • You have both the right and option to tell IIH to share information with your family, close friends, or others involved in the payment for your care.
  • You may also tell IIH to share information in a disaster relief situation.
• IIH will never share your information without your written consent in the following situations:

• IIH must obtain your authorization for any use or disclosure of psychotherapy notes, except to carry out certain treatment, payment, or its operations.
• For marketing purposes.
• To sell your information.

 

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

 

Your information may be used or disclosed by IIH only for treatment, payment, and its operations related to the PACE program in which you are enrolled. IIH may use and disclose your information via health information exchanges with providers involved in your care. The information IIH uses and discloses includes, but is not limited to, your name, your address, the history of your care and treatment, and any cost or payment for your care. Below are some examples of how IIH shares your information with those involved with your care:

 

Helping to Manage the Your Health Care Treatment

• IIH may use and disclose your health information with professionals who are treating you. 

• For example: A doctor sends IIH information about your diagnosis and treatment plan so IIH can arrange for additional services. IIH will share information with doctors, hospitals, and others to get you the care you need.

 

Managing IIH’s Health Care Operations

• IIH may use and disclose your health information to run its  operations and contact you when necessary.

• For Example: IIH uses your health information to develop better services for you, which may include reviewing the quality of care and services you receive. IIH may also use this information in audits and fraud investigations.

• IIH is not allowed to use genetic information to make decisions on your benefits coverage and cost of that coverage.

 

Paying for Your Health Services

• IIH may use and disclose your health information as it pays for the goods and services associated with your care.

• For Example: IIH shares information with health care providers who bill us for your care. IIH may also forward bills to other health plans and/or organizations for payment.

 

Administering Your Health Plan

• IIH may share your health information with the Department of Health Care Services (DHCS) and/or the Centers for Medicare & Medicaid Services (CMS) for plan administration.

• For Example: DHCS contracts with IIH in providing a health plan and IIH provides DHCS with certain statistics.

 

HOW ELSE IS YOUR HEALTH INFORMATION USED OR DISCLOSED?

 

IIH is permitted or even required to disclose your information in other cases, typically for purposes that benefit public health and research. IIH must meet many conditions with the law before IIH discloses your health information for these purposes. These include: 

 

• Help with Public Health and Safety Issues – IIH may disclose your health information for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medicines, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety.

 

• Compliance with the Law – IIH will disclose your health information if required by law. 

 

• Responding to Organ and Tissue Donation Requests and Work with a Medical Examiner or Funeral Director – IIH may disclose your health information with organ procurement organizations. IIH may also disclose this information with a coroner, medical examiner, or funeral director when an individual dies.

 

• Addressing Workers’ Compensation, Law Enforcement, and Other Governments Request –  IIH may use or disclose your health information for workers’ compensation claims, for law enforcement purposes, with health oversight agencies for activities as authorized by law, and for special government functions, such as military, national security, and presidential protective services.

 

• Responding to Lawsuits and Legal Actions – IIH may disclose your health information in response to a court or administrative order, or in response to a subpoena.

 

• Complying with Special Laws – There are special laws that protect some types of health

information, such as mental health services, treatment for substance use disorders, and HIV/AIDS testing and treatment. IIH will abide by these laws when they are more restrictive than this Notice. There are also laws that limit IIH’s use and disclosure to reasons directly connected to the administration of our programs.

RESPONSIBILITIES OF IIH

 

IIH’s responsibilities include the following:

• IIH is required by law to maintain the privacy and security of your PHI.

• IIH will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• IIH must follow the duties and privacy practices described in this Notice and give you a copy of it.

• IIH will not use or disclose your information other than as described here unless you tell IIH it can in writing. Even if you tell IIH it can, you may change your mind at any time. Let IIH know in writing if you change your mind.

 

CHANGES TO THE TERMS OF THIS NOTICE

 

IIH reserves the right to change this Notice. Any updated Notice will be posted on IIH’s website.

 

HOW YOU MAY CONTACT IIH

 

To exercise any rights as explained in this Notice, please send your written correspondence to:

 

Innovative Integrated Health, Inc.

Compliance Department
1200 Newport Center Drive, Suite 230

Newport Beach, CA 92660
Phone: +1 (714) 798-9044

 

If you believe that IIH has not protected your privacy and wish to file a complaint or grievance, you may write or call IIH at the address and phone number above. Alternatively, you may contact the agencies below:

 

California Department of Health Care Services

Privacy Officer

C/O: Office of HIPAA Compliance

Department of Health Care Services

P.O. Box 997413, MS 0010

Sacramento, CA 95899-7413 

Email: [email protected] 

Phone: +1 (916) 445-4646

Fax: +1 (916) 440-7680

 

U.S. Department of Health and Human Services

Office for Civil Rights Regional Manager

90 Seventh St. Suite 4-100 San Francisco CA 94103

Email: [email protected] 

Phone: +1 (800) 368-1019

Fax: +1 (415) 437-8329

TDD: +1 (800) 537-7697

 

USE YOUR RIGHTS WITHOUT HESITATION

 

IIH cannot revoke your healthcare benefits or retaliate against you in any way if you file a complaint or exercise any of the privacy rights as outlined in this Notice.