Notice of Privacy Practices

MMD Community Care LLC is required by law to protect the privacy of your health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice that is currently in effect. We take that seriously.

Health information means information that identifies you and relates to your physical or mental health, the care you receive, or payment for that care. This notice tells you when we may share it, when we need your permission first, and what you can ask us to do.

For treatment. We share information with the people who provide your care. For example, a support coordinator or a direct support professional assigned to you may be told what support you need so that they can deliver it safely, and we may share information with your doctor or another provider involved in your care.

For payment. We use and share information to bill and receive payment from New Jersey Medicaid, the Division of Developmental Disabilities, or another payer, and to confirm that services you received are covered.

For health care operations. We use information to run the agency well. Examples include reviewing the quality of the support we deliver, training and supervising staff, and carrying out required audits and compliance reviews.

The law also permits or requires us to share health information in specific situations. Those include: when a law requires it; for public health activities; to report suspected abuse, neglect or exploitation; for health oversight activities such as state investigations and licensing reviews; in response to a court order, subpoena or other lawful process; for certain law enforcement purposes; to a coroner, medical examiner or funeral director; for organ and tissue donation; for approved research in limited circumstances; to prevent a serious and imminent threat to health or safety; for workers compensation claims; and for specialized government functions such as military and national security activities.

Unless you object, we may share relevant information with a family member, friend or other person you involve in your care or in payment for your care, and in a disaster relief situation.

Other uses and disclosures are made only with your written authorization. Your written authorization is always required before we:

• Use or share psychotherapy notes, apart from the limited exceptions the law allows.
• Use or share your information for marketing purposes.
• Sell your health information.

You may cancel an authorization in writing at any time. Canceling it stops any future use or sharing under that authorization. It cannot undo something we already did while the authorization was in effect.

You have the right to:

• See and get a copy of the health information we hold about you, including an electronic copy if we keep it electronically. We will respond within the time the law allows and may charge a reasonable cost based fee for copies.
• Ask us to correct information you believe is wrong or incomplete. If we decline, we will tell you why in writing and you may file a statement of disagreement.
• Get a list of certain disclosures we made of your information in the six years before your request, apart from the disclosures the law excludes, such as those for treatment, payment and operations.
• Ask us to limit what we use or share. We are not required to agree, except in one case: if you pay in full out of pocket for a service, you may tell us not to share information about that service with your health plan, and we must honor that.
• Ask us to contact you a certain way, for example at a different address or phone number. We will accommodate reasonable requests.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Be told if there is a breach that compromises the privacy or security of your health information.
• Choose someone to act for you. If you have a guardian or you have given someone medical power of attorney, that person can exercise these rights for you. We will confirm their authority first.

To exercise any of these rights, contact our Privacy Officer, [MMD to confirm the Privacy Officer name], at (732) 801-7683 or info@mmdcommunitycare.com.

We are required by law to keep your health information private and secure, to give you this notice, to follow the terms of the notice currently in effect, and to notify you if a breach compromises your information.

We may change this notice. A change applies to information we already hold as well as to information we receive afterwards. If we change it, we will post the new notice on this page with a new effective date and make paper copies available at our office.

If you believe your privacy rights have been violated, tell us. Contact our Privacy Officer at (732) 801-7683, or write to 2950 Hamilton Blvd, South Plainfield, NJ 07080.

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, by calling 1-800-368-1019 (TDD 1-800-537-7697), or online at hhs.gov/ocr/complaints.

You will not be penalized for filing a complaint. We will not retaliate against you, and filing a complaint will never affect the care you receive from us.

We will provide this notice in large print or another format you can use, and we will explain it to you in your language, free of charge. Ask any member of our staff or call (732) 801-7683.