Effective Date: August 4, 2022
Commonwealth Care Alliance, Inc. is required by law (i) to protect the privacy of your Medical Information (which includes behavioral health information); (ii) to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to Medical Information; and (iii) to notify you if your unencrypted Medical Information is affected by a breach.
We reserve the right to change this Notice and to make the changes effective for all Medical Information we maintain. If we make a material change to the Notice, we will (i) post the updated Notice on our website; (ii) post the updated Notice in each of Our Health Care Providers’ service locations; and (iii) make copies of the updated Notice available upon request. We will also send Our Health Plan Members information about the updated Notice and how to obtain the updated Notice (or a copy of the Notice) in the next annual mailing to Members. We are required to abide by the terms of the Notice that is currently in effect.
Contact Information: If you have questions about the information in this Notice, would like to exercise your rights, or file a complaint, please contact:
Commonwealth Care Alliance, Inc.
Attention: Privacy and Security Officer
30 Winter Street
Boston, MA 02108
Toll Free: 866-457-4953 (TTY 711)
SECTION 1: Companies to Which This Notice Applies
This Notice applies to Commonwealth Care Alliance, Inc. and its subsidiaries that are subject to the HIPAA Privacy Rule as “covered entities.” Some of these subsidiaries are “Our Health Plans”—companies that provide or pay for Medicare Advantage benefits, Medicaid benefits, or other health care benefits, such a health insurer or HMO. Other subsidiaries are Our Health Care Providers (“Our Providers”) that furnish treatment to patients, such as primary care clinics.
This Notice describes how all of these entities use and disclose your Medical Information and your rights with respect to that information. In most cases, Our Health Plans use and disclose your Medical Information in the same ways as Our Providers and your rights to your Medical Information are the same. When there are differences, however, this Notice will explain those differences by describing how we treat Medical Information about a Health Plan’s Member differently than Medical Information about a Provider’s Patient.
The Health Plans and Providers to which this Notice applies include:
Our Health Plans
- Commonwealth Care Alliance Massachusetts, LLC
- Commonwealth Care Alliance Rhode Island, LLC
- CCA Health Michigan, Inc.
- Commonwealth Care Alliance Indiana, LLC
- CCA Health Plans of California, Inc.
Our Health Care Providers
- Commonwealth Clinical Alliance, Inc.
- Boston’s Community Medical Group, Inc. d/b/a CCA Primary Care
- Reliance PO of Michigan, Inc.
- Marie’s Place
SECTION 2: Information We Collect:
Individuals are responsible for providing correct and complete Medical Information for Commonwealth Care Alliance, Inc., and its subsidiaries (CCA) to provide quality services. CCA is committed to protecting the confidentiality of individuals’ Medical Information that is collected or created as part of our operations and provision of services. When you interact with us through our services, we may collect Medical Information and other information from you, as further described below.
Medical Information may include personal information, but it is all considered Medical Information when you provide it through or in connection with the services:
- We collect information, such as email addresses, personal, financial, or demographic information from you when you voluntarily provide us with such information, such as (but not limited to) when you contact us with inquiries, fill out on-line forms, respond to one of our surveys, respond to advertising or promotional material, register for access to our services or use certain services.
- Wherever CCA collects Medical Information, we make access to this notice available. By providing us with Medical Information, you are consenting to our use of it in accordance with this notice. If you provide information to CCA, you acknowledge and agree that such information may be transferred from your current location to the facilities and servers of CCA and the authorized third parties with whom CCA does business.
SECTION 3: How We Use and Disclose Your Medical Information
This section of our Notice explains how we may use and disclose your Medical Information to provide healthcare, pay for healthcare, obtain payment for healthcare, and operate our business efficiently. This section also describes other circumstances in which we may use or disclose your Medical Information.
Our model of care requires that Our Health Plans and Our Health Care Providers work together with other healthcare providers to provide medical services to you. Our professional staff, physicians, and other care providers (referred to as a “Care Team”) have access to your Medical Information and share your information with each other as needed to perform treatment, payment, and healthcare operations as permitted by law.
Treatment: Our Providers may use a Patient’s Medical Information and we may disclose Medical Information to provide, coordinate, or manage your healthcare and related services. This may include communicating with other healthcare providers regarding your treatment and coordinating and managing your healthcare with others.
Example: You are being discharged from a hospital. Our nurse practitioner may disclose your Medical Information to a home health agency to make sure you get the services you need after discharge from the hospital.
Payment: We may use and disclose your Medical Information to pay for healthcare services you have received and to obtain payment from others for those services.
Example: Your doctor may send Our Health Plan a claim for healthcare services furnished to you. The Health Plan may use that information to pay your doctor’s claim and it may disclose the Medical Information to Medicare or Medicaid when the Health Plan seeks payment for the services.
Healthcare Operations: We may use and disclose your Medical Information to perform a variety of business activities that allow us to administer the benefits you are entitled to under Our Health Plan and the treatment furnished by Our Providers. For example, we may use or disclose your Medical Information to:
- Review and evaluate the skills, qualifications, and performance of healthcare providers treating you.
- Cooperate with other organizations that assess the quality of the care of others.
- Determine whether you are entitled to benefits under our coverage; but we are prohibited by law from using your genetic information for underwriting purposes.
Joint Activities. Commonwealth Care Alliance, Inc. and its subsidiaries have an arrangement to work together to improve health and reduce costs. We may engage in similar arrangements with other health care providers and health plans. We may exchange your Medical Information with other participants in these arrangements for treatment, payment, and health care operations related to the joint activities of these “organized health care arrangements.”
Persons Involved in Your Care: We may disclose your Medical Information to a relative, close personal friend or any other person you identify as being involved in your care. For example, if you ask us to share your Medical Information with your spouse, we will disclose your Medical Information to your spouse. We may also disclose your Medical Information to these people if you are not available to agree and we determine it is in your best interests. In an emergency, we may use or disclose your Medical Information to a relative, another person involved in your care or a disaster relief organization (such as the Red Cross), if we need to notify someone about your location or condition.
Required by Law: We will use and disclose your Medical Information whenever we are required by law to do so. For example:
- We will disclose Medical Information in response to a court order or in response to a subpoena.
- We will use or disclose Medical Information to help with a product recall or to report adverse reactions to medications.
- We will disclose Medical Information to a health oversight agency, which is an agency responsible for overseeing health plans, health care providers, the healthcare system generally, or certain government programs (such as Medicare and Medicaid).
- We will disclose an individual’s Medical Information to a person who qualifies as the individual’s Personal Representative. A “Personal Representative” has legal authority to act on behalf of the individual, such as a child’s parent or guardian, a person with a health care power of attorney, or a disabled individual’s court-appointed guardian.
Threat to health or safety: We may use or disclose your Medical Information if we believe it is necessary to prevent or lessen a serious threat to health or safety.
Public health activities: We may use or disclose your Medical Information for public health activities, such as investigating diseases, reporting child or domestic abuse and neglect, and monitoring drugs or devices regulated by the Food and Drug Administration.
Law enforcement: We may disclose Medical Information to a law enforcement official for specific, limited law enforcement purposes, such as disclosures of Medical Information about the victim of a crime or in response to a grand jury subpoena. We may also disclose Medical Information about an inmate to a correctional institution.
Coroners and others: We may disclose Medical Information to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye, and tissue transplants.
Worker’s compensation: We may disclose Medical Information as authorized by and in compliance with workers’ compensation laws.
Research organizations: We may use or disclose your Medical Information for research that satisfies certain conditions about protecting the privacy of the Medical Information.
Certain government functions: We may use or disclose your Medical Information for certain government functions, including but not limited to military and veterans’ activities and national security and intelligence activities.
Business associates: We contract with vendors to perform functions on our behalf. We permit these “business associates” to collect, use, or disclose Medical Information on our behalf to perform these functions. We contractually obligate our business associates (and they are required by law) to provide the same privacy protections that we provide.
Fundraising Communications: We may use or disclose Medical Information for fundraising. If you receive a fundraising request from us (or on our behalf) you may opt out of future fundraising activities.
SECTION 4: Other Uses and Disclosures Require Your Prior Authorization
Except as described above, we will not use or disclose your Medical Information without your written permission (“authorization”). We may contact you to ask you to sign an authorization form for our uses and disclosures or you may contact us to disclose your Medical Information to another person and we will need to ask you to sign an authorization form.
If you sign a written authorization, you may later revoke (or cancel) your authorization. If you would like to revoke your authorization, you must do so in writing (send this to us using the Contact Information at the beginning of this Notice). If you revoke your authorization, we will stop using or disclosing your Medical Information based on the authorization except to the extent we have acted in reliance on the authorization. The following are uses or disclosures of your Medical Information for which we would need your written authorization:
- Use or disclosure for “marketing” purposes: We may only use or disclose your Medical Information for “marketing” purposes if we have your written authorization. We may, however, send you information about certain health-related products and services without your written authorization, as long as no one pays us to send the information.
- Sale of your Medical Information: Commonwealth Care Alliance, Inc. will not sell your Medical Information. If we did, we would need your written authorization.
- Use and disclosure of psychotherapy notes: Except for certain treatment, payment, and health care operations activities or as required by law, we may only use or disclose your psychotherapy notes if we have your written authorization.
SECTION 5: You Have Rights with Respect to Your Medical Information
You have certain rights with respect to your Medical Information. To exercise any of these rights, you may contact us using the Contact Information at the beginning of this Notice.
Right to a Copy of this Notice: You have a right to receive a paper copy of our Notice of Privacy Practices at any time, even if you agreed to receive the Notice electronically.
Right to Access to Inspect and Copy: You have the right to inspect (see or review) and receive a copy or summary of your Medical Information we maintain in a “designated record set.” If we maintain this information in electronic form, you may obtain an electronic copy of these records. You may also instruct Our Health Care Providers to send an electronic copy of information we maintain about you in an Electronic Medical Record to a third party. You must provide us with a request for this access in writing. We may charge you a reasonable, cost-based fee to cover the costs of a copy of your Medical Information. In accordance with the HIPAA Privacy Rule and in very limited circumstances, we may deny this request. We will provide a denial in writing to you no later than 30 calendar days after the request (or no more than 60 calendar days if we notified you of an extension).
Right to Request Medical Information be Amended: If you believe that Medical Information we have is either inaccurate or incomplete, you have the right to request that we amend, correct, or add to your Medical Information. Your request must be in writing and include an explanation of why our information needs to be changed. If we agree, we will change your information. If we do not agree, we will provide an explanation with future disclosures of the information.
Right to an Accounting of Disclosures: You have the right to receive a list of certain disclosures we make of your Medical Information (“disclosure accounting”). The list will not include disclosures for treatment, payment, and healthcare operations, disclosures made more than six years ago, or certain other disclosures. We will provide one accounting each year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months. You must make a request for disclosure accounting in writing.
Right to Request Restrictions on Uses and Disclosures: You have the right to request that we limit how we use and disclose your Medical Information (i) for treatment, payment, and healthcare operations or (ii) to persons involved in your care. Except as described below, we do not have to agree to your requested restriction. If we do agree to your request, we will comply with your restrictions, unless the information is necessary for emergency treatment.
Our Health Care Providers must agree to your request to restrict disclosures of Medical Information if (i) the disclosures are for payment or healthcare operations (and are not required by law) and (ii) the information pertains solely to healthcare items or services for which you, or another person on your behalf (other than Our Health Plans) has paid in full.
Right to Request an Alternative Method of Contact: You have the right to request in writing that we contact you at a different location or using a different method. For example, you may prefer to have all written information mailed to your work address rather than to your home address or e-mailed to you. Our Health Care Providers will agree to any reasonable request for alternative methods of contact.
SECTION 6: You May File a Complaint About Our Privacy Practices
If you believe your privacy rights have been violated, you may file a written complaint either with Commonwealth Care Alliance, Inc. or the U.S. Department of Health and Human Services.
Commonwealth Care Alliance, Inc. will not take any action against you or change the way we treat you in any way if you file a complaint.
To file a written complaint with or request more information from Commonwealth Care Alliance, Inc., contact us using the Contact Information at the beginning of this Notice.
SECTION 7: State-Specific Requirements
Massachusetts Immunization Information Systems: Our Providers are required to report vaccinations you receive to the Massachusetts Immunization Information System (MIIS). The MIIS is a statewide system to keep track of vaccination records and is managed by the Massachusetts Department of Public Health (MDPH). If you do not want your MIIS records shared with other healthcare providers, you must submit an Objection to Data Sharing Form to:
Massachusetts Immunization Information System (MIIS)
Massachusetts Department of Public Health
305 South Street
Jamaica Plain, MA 02130