Sleep Apnea Connection L.L.C. (DBA) Choices Home Health Store Online Policies - Rights - Standards - Conditions* - Procedures:

• Patient/Client Bill of Rights
• Notice of Privacy Practices
• Detailed Privacy Notice
• Medicare Supplier Standards

Patient/Client Bill of Rights: 

As an individual receiving home care services, let it be known and understood that you have the following rights: 

1.   To select those who provide your home care services.

2.   To be provided with legitimate identification by any person or persons who enter your residence to provide home care services for you.

3.   To receive the appropriate or prescribed service in a professional manner without discrimination relative to your age, race, sex, religion, ethnic origin, sexual preference or physical/mental handicap.

4.   To be dealt with and treated with friendliness, courtesy, and respect by each and every individual representing the company who provides treatment or services for you and be free from neglect or abuse, be it physical or mental.

5.   To assist in the development and planning of your home care program so that it is designed to satisfy, as best as possible to your current needs.

6.   To be provided with adequate information from which you can give your informed consent for the commencement of service, the continuation of service, the transfer of service to another home care provider, or the termination of service.

7.   To express concerns or grievances or recommend modifications to your home care service without fear of discrimination or reprisal.  The Medicare hotline number is 1-866-238-9650.

8.   To request and receive complete and up-to-date information relative to your condition, treatment, alternative treatments and risks of treatment.

9.   To receive treatment and services within the scope of your home care plan, promptly and professionally, while being fully informed as to company policies, procedures and charges.

10.  To refuse treatment and services within the boundaries set by law, and to receive professional information relative to the ramifications or consequences that will or may result due to such refusal.

11.    To request and receive the opportunity to examine or review your medical records.

Sleep Apnea Connection L.L.C.(DBA) Choices Home Health Store

Acknowledgement of Receipt of Notice of Privacy Practices

I certify that I have received a copy of Notice of Privacy Practices. The Notice of Privacy Practices describes the types of uses and disclosures of my protected health information that might occur in my treatment, payment of my bills or in the performance of Sleep Apnea Connection L.L.C.’s health care operations.  The Notice of Privacy Practices also describes my rights and Sleep Apnea Connection L.L.C.’s duties with respect to my protected health information. The Notice of Privacy Practices is posted in the office of the Sleep Apnea Connection L.L.C. and on their website at www.sleepcpap.com. 

Sleep Apnea Connection L.L.C. reserves the right to change the privacy practices that are described in the Notice of Privacy Practices.  I may obtain a revised Notice of Privacy Practices by calling the office and requesting a revised copy be sent in the mail, asking for one at the time of my next appointment, or accessing Sleep Apnea Connection L.L.C.’s website.  

______________________________________
Signature of Patient or Personal Representative

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Name of Patient or Personal Representative

___________________________
Date

Description of Personal Representative’s Authority:_________________________________________

___________________________________________________________________________________.

SLEEP APNEA CONNECTION L.L.C. (DBA) Choices Home Health Store

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. 

If you have any questions about this Notice please contact: our Privacy Officer who is Kevin Barrow, RRT, NPS. 

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. 

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by viewing our website at www.choices111.com, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment. 

Understanding Your Health Record/Information: 

Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a: 

·          basis for planning your care and treatment

·          means of communication among the many health professionals who contribute to your care

·          legal document describing the care you received

·          means by which you or a third-party payer can verify that services billed were actually provided a tool in educating heath professionals

·          source of data for medical research

·          source of information for public health officials charged with improving the health of the nation

·          source of data for facility planning and marketing

·          a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve  

Understanding what is in your record and how your health information is used helps you to: 

·          ensure its accuracy

·          better understand who, what, when, where, and why others may access your health information

·          make more informed decisions when authorizing disclosure to others  

Your Health Information Rights 

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to: 

·          request a restriction on certain uses and disclosures of your information

·          obtain a paper copy of the notice of information practices upon request

·          inspect and obtain a copy of your health record

·          amend your health record

·          obtain an accounting of disclosures of your health information

·          request communications of your health information by alternative means or at alternative

·          locations revoke your authorization to use or disclose health information except to the extent that action has already been taken  

Our Responsibilities 

This organization is required to: 

·          maintain the privacy of your health information

·          provide you with a notice as to our legal duties and privacy practices with respect to

·          information we collect and maintain about you

·          abide by the terms of this notice

·          notify you if we are unable to agree to a requested restriction

·          accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.  

We will not use or disclose your health information without your authorization, except as described in this notice.

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Contact or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact our Privacy Contact, Kevin Barrow, RRT, NPS  at (360) 354.8282 or kbarrow@choices111.com for further information about the complaint process. 

Disclosures for Treatment, Payment and Health Operations 

We will use your health information for treatment. 

For example: Information obtained by a therapist or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. We may provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you. 

We will use your health information for payment. 

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. 

We will use your health information for regular health operations. 

For example: Members of our quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide. 

Business associates: There are some services provided in our organization through contacts with business associates. Examples include our billing service and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. 

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. 

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. 

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fund raising: We may contact you as part of a fund-raising effort. 

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement. 

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law. 

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. 

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals. 

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. 

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public. 

This notice was published and becomes effective on April 14, 2003.

25 Supplier Standards

Resource: Medicare Enrollment Application, DMEPOS, Form CMS-855S, http://www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf [PDF]

Note: This list is an abbreviated version of the application certification standards that every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. pt. 424, sec 424.57(c) and were effective on December 11, 2000.

1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.
4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or nonprocurement programs.
5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare-covered items that are under warranty.
7. A supplier must maintain a physical facility on an appropriate site.
8. A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier's compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.
9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, or cell phone is prohibited.
10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier's place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations. Failure to maintain required insurance at all times will result in revocation of the supplier's billing privileges retroactive to the date the insurance lapsed.
11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from calling beneficiaries in order to solicit new business.
12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare-covered items, and maintain proof of delivery.
13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.
17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
18. A supplier must not convey or reassign a supplier number; i.e. the supplier may not sell or allow another entity to use its Medicare Supplier Billing Number.
19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.
22. All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals).
23. All suppliers must notify their accreditation organization when a new DMEPOS location is opened.
24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.
25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation