HIPAA Notice of Privacy Practices

01Our commitment to your privacy

Bloom Home Care Services (“Bloom,” “we,” “us,” or “our”) is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (“PHI”), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

“Protected health information” means information about you — including demographic information — that may identify you and that relates to your past, present, or future physical or mental health, the care we provide, or payment for that care.

02Who follows this notice

This notice applies to all of the care and services you receive from Bloom Home Care Services. It is followed by every member of our workforce, including:

• All Bloom caregivers, aides, and direct care staff
• Our office, scheduling, billing, and administrative team
• Employees, contractors, and volunteers acting on our behalf
• Business associates who perform services for us and are bound by written agreements to protect your PHI

03How we may use and disclose your health information

The following describes the ways we may use and disclose your PHI without a separate written authorization. Not every use or disclosure is listed, but every use we make will fall within one of these categories.

For treatment

We use and share your PHI to provide, coordinate, and manage your home care. For example, our caregivers may share information about your needs, routines, and care plan with one another, with your ALTCS case manager, and with your physicians, home health agencies, therapists, or other providers involved in your care.

For payment

We use and disclose your PHI to obtain payment for the services we provide. This includes submitting claims and supporting documentation to AHCCCS, the Arizona Long Term Care System (ALTCS), and their contracted health plans (such as Mercy Care, UnitedHealthcare Community Plan, and Arizona Complete Health), verifying eligibility and benefits, obtaining prior authorization for services, and coordinating billing with any other responsible payer.

For health care operations

We use and disclose your PHI to run our agency and make sure you receive quality care. Examples include quality assessment and improvement, caregiver training and evaluation, care coordination and case management, licensing and accreditation activities, and general business and administrative functions.

Appointment reminders & care-related communications

We may contact you or your authorized representative to schedule or confirm visits, discuss your care, or share information about services that may benefit you.

Individuals involved in your care

Unless you object, we may share PHI with a family member, friend, or other person you identify who is involved in your care or helps pay for it, to the extent relevant to their involvement.

04ALTCS & AHCCCS coordination

Bloom Home Care Services is a contracted provider within the Arizona Long Term Care System (ALTCS), administered by the Arizona Health Care Cost Containment System (AHCCCS) — Arizona’s Medicaid agency. Because we serve ALTCS members, we may use and disclose your PHI as necessary to:

• Coordinate your care with your AHCCCS/ALTCS health plan and your assigned case manager
• Develop, update, and carry out your person-centered service plan
• Verify eligibility and obtain authorization for covered services
• Submit claims, encounter data, and supporting records to AHCCCS and its contracted plans
• Participate in AHCCCS quality, compliance, monitoring, and oversight activities, including audits and reviews
• Comply with the AHCCCS Medical Policy Manual (AMPM), our provider agreement, and applicable state and federal Medicaid requirements

These uses and disclosures are made in accordance with HIPAA and applicable AHCCCS policies. As an ALTCS member, you also have rights and protections under your AHCCCS health plan; your case manager can explain those member rights and the plan’s own privacy practices.

05Other uses and disclosures permitted or required by law

We may use or disclose your PHI without your authorization in the following circumstances, subject to the limits set by law:

• As required by law — when federal, state, or local law requires the disclosure.
• Public health activities — to prevent or control disease, injury, or disability, and to report to public health authorities.
• Victims of abuse, neglect, or exploitation — to report suspected abuse, neglect, or exploitation of a vulnerable or incapacitated adult to Arizona Adult Protective Services or other authorities, as permitted or required by law.
• Health oversight activities — to agencies such as AHCCCS and licensing bodies for audits, investigations, inspections, and licensure or certification.
• Lawsuits and legal proceedings — in response to a court or administrative order, subpoena, or other lawful process.
• Law enforcement — for limited law-enforcement purposes as permitted by law.
• Coroners, medical examiners, and funeral directors — as necessary for them to carry out their duties.
• To avert a serious threat — to prevent a serious and imminent threat to your health and safety or the health and safety of the public.
• Workers’ compensation — as authorized by and to the extent necessary to comply with workers’ compensation laws.
• Organ & tissue donation, research, military, and national security — in the limited circumstances permitted by law.

06Uses and disclosures that require your written authorization

Other than the uses and disclosures described above, we will not use or disclose your PHI without your written authorization. This always includes:

• Most uses and disclosures for marketing purposes
• Any sale of your protected health information
• Most disclosures of psychotherapy notes, where applicable

If you give us written authorization, you may revoke it at any time in writing, except to the extent we have already relied on it. Once revoked, we will no longer use or disclose your PHI for the reasons covered by that authorization.

07Your rights regarding your health information

You have the following rights with respect to the PHI we maintain about you. To exercise any of these rights, please contact our Privacy Officer using the information at the end of this notice.

08Our responsibilities

• We are required by law to maintain the privacy and security of your PHI.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing.

09Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as any information we receive in the future. The current notice will be posted at our office and on this website, and will show the effective date. You may request a copy of the most recent version at any time.

10Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. government. You will not be penalized or retaliated against for filing a complaint.

With Bloom Home Care Services

Contact our Privacy Officer using the information below. We will investigate every complaint we receive.

With the U.S. Department of Health and Human Services

You may file a complaint with the Office for Civil Rights (OCR):

• U.S. Department of Health and Human Services, Office for Civil Rights
• 200 Independence Avenue, S.W., Washington, D.C. 20201
• Toll-free: 1-877-696-6775
• www.hhs.gov/ocr

ALTCS members may also raise privacy concerns with their AHCCCS health plan or ALTCS case manager, or with AHCCCS at www.azahcccs.gov.