Oakland Schools School Based Services Medicaid Program - 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. Please review the Following Carefully.

The purpose of this notice is to inform you of how your school district and Oakland Schools may use and disclose a student's "Protected Health Information" (PHI) for treatment, payment or health care operations under the Medicaid School Based Services (SBS) Program. Oakland Schools is required by law to maintain the privacy of PHI and to provide notice of its legal duties and privacy practices with respect to PHI. Oakland Schools will abide by the terms set forth in this notice. This notice takes effect April 14, 2003 and will remain in effect until Oakland School's replaces or modifies it. Your school district and Oakland Schools may use or disclose a student's PHI without the student's or parent's consent for the following uses and disclosures:

To You or Your Personal Representative: We may disclose a child's PHI to you as the child's parent or legal guardian or to the child if the child is 18 years of age or older.

For Treatment: We may use and disclose a child's PHI to health care providers who request it in connection with the child's treatment.

For Payment: We may use and disclose a child's PHI for payment-related activities including determining eligibility for the Medicaid SBS Program and submitting claims for Medicaid reimbursement.

When Allowed or Required by Law: We will use and disclose a child's PHI if allowed to or required to do so by law. For example, we will use and disclose a child's PHI in compliance with the Family Educational Rights and Privacy (FERPA), in responding to court and administrative orders and subpoenas, or when required by federal or state regulatory authorities.

For any other use or disclosure of PHI, we must obtain your written authorization. You have the following rights and to exercise these rights, you must make a written request:

Access: You have the right to look at or receive a copy of your child's PHI that Oakland Schools maintains. We may charge a fee for the costs associated with your requests. If we deny your request, you will be told the basis for the decision and whether you have a right to further review.

Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your child's PHI, such as disclosures allowed or required by law. This accounting will not include disclosures made to you or with your authorization. This accounting applies to disclosures to or made by Oakland Schools on or after April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a fee to cover the cost of responding to these additional requests.

Restrictions: You have the right to request that Oakland Schools place restrictions on the way it uses or discloses your child's PHI for treatment, payment, or health care operations. We are not required to comply with your request.

Amendment: You have the right to request that Oakland Schools amend your child's PHI that we maintain. If we deny your request, we will provide you a written explanation. If you disagree, you may have a statement of your disagreement placed in our records.

Communication: You have the right to request that Oakland Schools communicate with you in a specified manner.

If you believe Oakland Schools has violated these privacy rights, contact Oakland Schools or the US Department of Health and Human Services. You will not be retaliated against for reporting a privacy rights violation. For further information or to report a violation, please write to:

Oakland Schools

Attn: HIPAA Privacy Officer - Medicaid Program
2111 Pontiac Lake Road
Waterford, Michigan 48328
(248) 209-2345