Notice of Privacy Practices Molina Medicare

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.

Contract Number H8176-002
Molina Healthcare of South Carolina, Inc., dba "Molina Medicare of Ohio", ("Molina", "we" or "our") uses and shares protected health information about you to provide your health benefits as a Molina Medicare Complete Care HMO DSNP 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 and to follow the terms of this Notice. The effective date of this Notice is October 1, 2019. 

Contract Number H9955-001
Molina Healthcare of Ohio (“Molina”, “we” or “our”) uses and shares protected health information about you to provide your health benefits as a Molina Medicare 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 and to follow the terms of this Notice. The effective date of this Notice is September 23, 2013.

PHI means protected health information. PHI is health information that includes your name, member number or other identifiers, and is used or shared by Molina.

Why does Molina use or share your PHI?

We use or share your PHI to provide you with health care benefits. Your PHI is used or shared for treatment, payment, and health care operations.

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.

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.

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.

Health care operations involve many daily business needs. It includes but is not limited to the following:

  • Improving quality;
  • Actions in health programs to help members with certain conditions (such as asthma);
  • Conducting or arranging for medical review;
  • Legal services, including fraud and abuse detection and prosecution programs;
  • Actions to help us obey laws;
  • Address member needs, including solving complaints and grievances.

We will share your PHI with other companies (“business associates”) that perform different kinds of activities for our health plan. 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.

 

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 several other purposes, including the following:

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). This may be for a court case, other legal review, or when required for law enforcement purposes.

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.

Health Care Oversight
Your PHI may be used or shared with government agencies. They may need your PHI for audits.

Research
Your PHI may be used or shared for research in certain cases, such as when approved by a privacy or institutional review board.

Legal or Administrative Proceedings
Your PHI may be used or shared for legal proceedings, such as in response to a court order.

Law Enforcement
Your PHI may be used or shared with police for law enforcement purposes, such as to help find a suspect, witness or missing person.

Health and Safety
PHI may be shared to prevent a serious threat to public health or safety.

Government Functions
Your PHI may be shared with the government for special functions, such as national security activities.

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.

Workers Compensation
Your PHI may be used or shared to obey Workers Compensation laws.

Other Disclosures
PHI may be shared with funeral directors or coroners to help them to do their jobs.

 

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. Molina needs your authorization before we disclose your PHI for the following: (1) most uses and disclosures of psychotherapy notes; (2) uses and disclosures for marketing purposes; and (3) uses and disclosures that involve the sale of PHI. 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.

 

What are your health information rights?

You have the right to:

  • 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 make your request in writing. You may use Molina’s form to make your request.

  • 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 make your request in writing. You may use Molina’s form to make your request.

  • 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 make your request in writing. You may use Molina’s 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. Important Note: We do not have complete copies of your medical records. If you want to look at, get a copy of, or change your medical records, please contact your doctor or clinic.

  • 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 make your request in writing. You may use Molina’s form to make your request. You may file a letter disagreeing with us if we deny the request.

  • 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:

    • for treatment, payment or health care operations;
    • to persons about their own PHI;
    • sharing done with your authorization;
    • incident to a use or disclosure otherwise permitted or required under applicable law;
    • as part of a limited data set in accordance with applicable law; or
    • PHI released in the interest of national security or for intelligence purposes.

We will charge a reasonable fee for each list if you ask for this list more than once in a 12-month period. You will need to make your request in writing. You may use Molina’s form to request.

You may make any of the requests listed above, or may get a paper copy of this Notice. Please call Molina Member Services at (866) 472-4584, 7 days a week, 8 a.m. to 8 p.m. local time. TTY/ TDD users, please call 711.

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 and benefits will not change in any way.

You may complain to us at the following:

By Phone:
Molina Member Services (866) 472-4584 
Monday -Friday, 8a.m. - 8p.m., local time. 
TTY users, please call 711

In Writing:
Molina Healthcare of Ohio
Attention: Manager of Member Services
7050 Union Park Center,
Suite 200 Midvale, UT 84047

You may file a complaint with the Secretary of the U.S. Department of Health and Human Services at:

Office of the Civil Rights 
U.S. Department of Health and Human Services 
200 Independence Avenue, SW 
Room 509F, HHH Building 
Washington, D.C. 20201 
Phone: (800) 368-1019, TTY: (800) 537-7697, Fax: (202) 619-3818

 

What are the duties of Molina?

Molina is required to:

  • Keep your PHI private;
  • Give you written information such as this on our duties and privacy practices about your PHI;
  • Provide you with a notice in the event of any breach of your unsecured PHI:
  • Not use or disclose your genetic information for underwriting purposes;
  • Follow the terms of this Notice

This Notice is Subject to Change
We reserve 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, we will post the revised Notice on our website and send the revised Notice, or information about the material change and how to obtain the revised Notice, in our next annual mailing to our members then covered by us. This Notice is available on our website at www.molinahealthcare.com.

Contact Information

If you have any questions, please contact the following office:

By Phone:
Molina Member Services (866) 472-4584, 7 days a week, 8 a.m. to 8 p.m. local time. TTY/TDD users, please call 711.

In Writing:
Molina Healthcare of Ohio
Attention: Manager of Member Services
7050 Union Park Center, Suite 200
Midvale, UT 84047

Molina Medicare is a Health Plan with a Medicare Contract and a contract with the state Medicaid program. Enrollment in Molina Medicare depends on contract renewal. 
This information is available in other formats, such as Braille, large print, and audio.

Molina Healthcare (Molina) complies with all Federal civil rights laws that relate to healthcare services. Molina offers healthcare services to all members without regard to race, color, national origin, age, disability, or sex. Molina does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. This includes gender identity, pregnancy and sex stereotyping. 

To help you talk with us, Molina provides services free of charge: 
• Aids and services to people with disabilities 
o Skilled sign language interpreters 
o Written material in other formats (large print, audio, accessible electronic formats, 
Braille) 
• Language services to people who speak another language or have limited English skills 
o Skilled interpreters 
o Written material translated in your language 
o Material that is simply written in plain language 
If you need these services, contact Molina Member Services at (800) 665-3086; 
TTY 711, 7 days a week, 8 a.m. - 8 p.m., local time. 

 

If you think that Molina failed to provide these services or treated you differently based on your race, color, national origin, age, disability, or sex, you can file a complaint. You can file a complaint in person, by mail, fax, or email. If you need help writing your complaint, we will help you. Call our Civil Rights Coordinator at (866) 606-3889, or TTY, 711. Mail your complaint to: 

Civil Rights Coordinator 
200 Oceangate 
Long Beach, CA 90802 
You can also email your complaint to civil.rights@molinahealthcare.com. Or, fax your complaint to (562) 499-0610. 
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

You can mail it to: 

U.S. Department of Health and Human Services 
200 Independence Avenue, SW 
Room 509F, HHH Building 
Washington, D.C. 20201 
You can also send it to a website through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. 
If you need help, call 1-800-368-1019; TTY 800-537-7697.

 

English ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-665-3086 (TTY: 711).

Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-665-3086 (TTY: 711).

Chinese 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-665-3086（TTY：711).

Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-665-3086 (TTY: 711).

French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-665-3086 (ATS : 711).

Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-665-3086 (TTY: 711).

German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-665-3086 (TTY: 711).

Korean 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-665 3086 (TTY: 711) 번으로 전화해 주십시오. ­

Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-665-3086 (телетайп: 711).

Arabic صمϟ΍ فΗΎه رقم *1-800-665-3086 رقمΑ ϞصΗ΍ ϥΎجϤϟΎΑ كϟ قر΍ىΘΗ ΔϳغىϠϟ΍ ΓعدΎشϤϟ΍ ΕΎخدن ϥ قئ ،ΔغϠϟ΍ ذلر ΍ΙحدΘΗ Ζلن΍ إذ :ΔحىظϠن و΍ϜΒϟم: 7

Hindi ध्यान दें: यदद आप द दिं ी बोलते ैंतो आपकेललए मुफ्त मेंभाषा स ायता सेवाएिंउपलब्ध ैं। 1-800-665-3086 (TTY: 711) पर कॉल करें।

Italian ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-800-665-3086 (TTY: 711).

Portugués ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-665-3086 (TTY: 711).

French Creole ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-665-3086 (TTY: 711).

Polish UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-800-665-3086 (TTY: 711).

Japanese 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-665-3086（TTY: 711 ）まで、お電話にてご連絡ください。

Hmong LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-800 665-3086 (TTY: 711). ­

Farsi توجه : اگر به زببن فبرسڲ گقتڰϭ مڲ کنید، تسϬیالت زببنڲ بصϭرت رایڰبن براڱ شمب فراوم مڲ ببشد. بب :TTY (1-800-665-3086 (711 تمبس بڰیرید .

Armenian ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-800-665-3086 (TTY (հեռատիպ)՝ 711)

Cambodian Ś ូ ś ើ ូ ធ លរយ័ត្៖Ś បរើសិřជាអ្កřិយាយ Ś ភាសាផមរ, បសវាជំřយផនកភាសា Ś បោយមិřគិត្ឈ្ល គឺអាចមាřសំរារ់រំបរអ្ក។ ចរ ទរស័ព្ 1-800-665-3086 (TTY: 711)។ យ

Albanian KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-800-665-3086 (TTY: 711). 

Amharic ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1- 800-665-3086 (መስማት ለተሳናቸው: 711).

Bengali েক্ষ্য করুনঃ ΐিΆ আ঩িন ΋া৯ো, ক΅া ΋েৣ΄ ঩াৣΑন, ΄াোৣে িনঃখΑচায় Ύা৉া ৊োায়΄া ঩িΑৣ৉΋া উ঩েব্ধ আৣছ। ৤পান করুন 1-800-665-3086 (TTY: 711)।

Cushite (Oromo language) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-665-3086 (TTY: 711).

Dutch AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-800 665-3086 (TTY: 711). ­

Greek ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέφονται δωρεάν. Καλέστε 1-800-665-3086 (TTY: 711).

Gujarati સચk ના: જો તમે ગજk રાતj બોલતા હો, તો િન:શલ્k ક ભાષા સહાય સવાઓ તમારા માટે ઉપલબ્ધ છ. ફોન કરો 1­ 800-665-3086 (TTY: 711). 

Kru(Bassa language) Dè ɖɛ nìà kɛ dyéɖé gbo: Ɔ jǔ ké m [Ɓâsɔɔ-wùɖù-po-nyɔ] jǔ ní, nîí, â wuɖu kà kò ɖò po-poɔ ɓɛîn m gbo kpáa. Ɖá 1-800-665-3086 (TTY:711) ̀ 

Ibo Ige nti: O buru na asu Ibo asusu, enyemaka diri gi site na call 1-800-665-3086 (TTY: 711).

Yoruba AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-800-665-3086 (TTY: 711).

Laotian ໂ࢝ຌຊາ࢜: ້࢘າລ່າ ່࢚າ࢛ເລົ້າພາࢧາ ຤າລ, ກາ࢛࢜ໍ຤ິກາ࢛ຊ່ລ຋ເࢨຼືອຌ້າ࢛ພາࢧາ, ໂຌຌ຋࢜ໍ່ ເࢧັຽຄ່າ, ແມ່࢛ມີພ້ອມໃࢨ້່࢚າ࢛. ໂ࢚ຣ 1-800-665-3086 (TTY: 711).

Nepali ध्यान दिनहोस: तपार्इंल नेपाली बोल्नहधॎछ भनेतपार्इंको ननऩतत भाषा सहायता सेवाहरू ननिःशल्क रूपमा उपलब्ध छ । फोन गनहोस 1-800-665-3086 (दिदिवार्इ: 711) ।

Panjabi ਿੀਆੁ ਿਿਓ: ਜਾ ਤ਼ਸਾਃ SਜਾU਻ Uੋਲਿਾ ਹੋ, ਤਾਂ Vਾਸ਼ਾ ਿਵਚ ਸਹਾਇਤਾ ਸਾਵਾ ਤ਼ਹਾਡਾ ਲਈ YTਤ ਉSਲUੀ ਹ। 1-800-665-3086 (TTY: 711) 'ਤਾ ਕਾਲ ਕ

Pennsylvania Dutch Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-800-665-3086 (TTY: 711).

Romanian ATENȚIE: Dacă vorbiți limba romãnă, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-800-665-3086 (TTY: 711).

Serbo-Croatian OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-800-665-3086 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 711).

Syriac (Assyrian language) ܵ ܲ ܲ ܵ ܵ ܼ ܵ ܼ ܸ ܵ ܵ ܙܘܗܪܓ : ܐܢ ܐܚܬܘܢ ܟܑ ܗâܙâܞܬܘܢ ܠܫܢܑ ܐܬܘܪܝ،ܑ âܨܝܬܘܢ ܕܩܕܡܞܬܘܢ ܚܡܡܬܒ ܕܗܝܪܬܒ ܔܡܫܢܑ ܼâܓܢܐܝܬ . ܩܪܘܢ ܥá ܵ ܲ ܲ ܲ ܲ ܲ ܵ ܼ ܲ ܲ ܵ ܲ ܵ ܲ ܲ ܲ ܲ ܵ ܵ ܵ ܵ 1-800-665-3086 (TTY: 711) ܑܢܞܢâ

Thai เรยนี : ถาคณพดภาษาไทยคณสามารถใชบรการชวยเหลอทางภาษาไดฟร ้ ุ ู ุ ้ ิ ่ ื ้ ี โทร 1-800-665-3086 (TTY: 711).

Tongan FAKATOKANGA¶I: Kapau µoku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea µoku nau fai atu ha tokoni ta¶etotongi, pea teke lava µo ma¶u ia. Telefoni mai 1-800-665-3086 (TTY: 711).

Ukrainian УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-800-665-3086 (телетайп: 711).

Urdu ܼ ܼܼ ܹ ܸܼ ܼ ܼ ܸ ܼ ܸ ܼ ܹ ܼ ܵ ܸ ܸ خΒرد΍ر: ΍گر آپ ΍ردو ΑىΘϟے ہϴں، Ηى آپ کى زϥΎΑ کی ندد کی خدنΕΎ نكΖ نϴں دس ΏΎϴΘ ہϴں ۔ کΎ ϝ کرϳں (TTY: 711) 3866658