Your Rights
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. For more information visit: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Your Rights As a Patient/Resident
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us at (585) 350-5551
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/ privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the saturations described below, talk to us. Tell us what you want us to do and we will follow your instructions.
You have the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety
In these cases, we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
In the case of fundraising:
• We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services
How else can we use or share your health information? We are allowed or required to share your
information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues
• We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
Do research
• We can use or share your information for health research.
Comply with the law
•We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal
privacy law.
Respond to organ and tissue donation requests
• We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
• We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
•For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know if a breach occurs that may have compromised the privacy or security of your information.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. Please inquire with our staff if you have any questions.
Anti-Discrimination Disclaimers
Our organization and its facilities do not discriminate in the admission, retention or care given to patients/residents in terms of age, race, creed, color, national origin, gender, gender identity, marital status, sexual preference, handicap, blindness, disability or sponsor.
Our organization is an Equal Opportunity Employer (EOE) and considers all candidates for employment regardless of race, color, age, sex, sexual orientation, genetic history, national origin, marital status, disability, Vietnam or disabled veteran status or arrest record.
Maximum rates for residency and services
In no event shall a resident be charged more than $1,000 per day for residency and/or services.
Bishop
Aetna
Skilled Level 1 – 280
Comprehensive Level 2 – 280
Complex Level 3 – 458
Level 4 – 570
Excellus
Medicare/Commercial:
Level 1 – 297.95
Level 2 – 361.21
Level 3 – 404
Level 4 - 675
Medicaid:
Level 1 – 235
Level 2 – 325
Level 3 – 375
Level 4 – 675
MLTC – 234.15
Fidelis
Medicare:
Level 1 – 235.97
Level 2 – 350
Level 3 – 425
MLTC – 234.15
Medicaid:
Level 1 – 235.97
Level 2 – 350
Level 3 – 425
Custodial – 235.97
Hospice
Non-core – 6.50
Humana
Level 1 – 345
Level 2 – 415
Level 3 – 590
Level 4 – 700
iCircle – 257.57
Molina
Custodial – 235.97
Medicaid only Level 1 – 235.97
Level 2 – 235.97
Level 3 – 235.97
Vent – 235.97
Tricare
United Healthcare – 234.15
Medicaid – 295
Medicare/Commercial – 400
Optum:
Part A – 385/mo
VA CCN - PDPM
VNA (Nascentia)
MLTC – 234.15
VNS
MLTC – 234.15
Wellcare/Today’s Opt
MLTC – 234.15
Medicare/Medicaid:
Level 1 – 228
Level 2 – 280
Level 3 – 350
Level 4 – 400
Level 5 – 600
Chautauqua
Aetna
Subacute Level 1 – 260
Comprehensive Level 2 – 345
Complex Level 3 – 385
Intensive Level 4 – 515
BCBS
Skilled Level 1 – 233.40
Subacute Level 2 – 302.36
Res Custodial – 198.97
Bedrest – 99.49
Humana
Level 1 – 345
Outpatient Level 4 – 700
iCircle
Skilled Nursing – 350
MCR & Managed MCD Subacute Therapy – 400
MCR & Managed MCD Subacute Rehab – 450
MCR & Managed MCD Respite Care – 295
MCR & Managed MCD Skilled Nursing – 350
MCR & Managed MCD Subacute Therapy – 400
MCR & Managed MCD Subacute Rehab – 450
MCR & Managed MCD Respite Care – 295
IHA
Nursing – 270
Kalos
MLTC – 234.56
MVP Health
Skilled Nursing – 210
Rehab Nursing – 300
Rehab Nursing – 350
Rehab Nursing – 450
Nascentia Health VNA
Skilled Nursing – 234.56
United Healthcare
Skilled – 355
UHC Commercial Skilled - 365
Skilled Nursing – 237
Univera
Skilled – 250
Med Adv & Commercial Subacute – 340
Subacute-Rehab – 375
UPMC Health – PDPM
Wellcare
MLTC – 234.56
Medicare Adv & Medicaid Level 1 – 290
Level 2 – 340
Level 3 – 395
Level 4 – 440
Level 5 – 600
Roscoe
ArchCare MLTC
Medicaid – 224.33
Managed Medicaid – 222.34
Custom – 234.32
Custom – 236.28
Fidelis
Medicaid Custodial – 236.28
Medicaid MLTC – 234.32
Medicaid/Medicare Skilled Level 1 – 225
Level 1 – 325
Level 3 – 425
Hamaspik
Medicaid Managed – 236.28
Medicaid MLTC – 234.32
Medicaid/Medicare Level 1 – 300
Level 2 – 375
Level 3 – 450
Level 4 – 600
iCircle MLTC – 259.91/257.75
Medicaid – 224.33/222.34
Medicaid Pending
Semi – 280.64
Private - 296.76
Medicare PDPM
MVP
Managed MCD/Respite Custodial – 224.33
Medicaid/Commercial Level 1 – 291
Medicaid/Commercial Level 2 – 351
Medicaid/Commercial Level 3 – 456
Medicaid/Commercial Level 4 – 501
Medicare MCR – PDPM
No Fault & WC PDPM
Private Pay
Semi – 280.64
Private – 296.76
United Healthcare (no Optum)
Medicaid Custodial – 275
Medicare/Commercial Skilled – 352
Medicare/Commercial Trach – 450
VA CCN – PDPM
VNS MLTC – 236.28/234.32
Sunset
Aetna Level 1 – 275
Level 2 – 350
Level 3 – 450
Level 4 – 550
Level 5 – 625
CDPHP
Excellus
Level 1 – 175
Medicare/Commercial Level 2 – 215
Level 3 – 285
Level 4 – 198
Fidelis
MLTC – 171.92
All Types Custodial – 160
Level 1 – 250
Level 2 – 300
Level 3 – 350
GHI
Level 1 – 275
PPO Level 1 – 375
Level 2 – 500
Level 3 – 550
HMO
Level 1 – 250
Level 1 – 350
Level 2 – 450
Level 3 – 500
Medicaid
Level 1 – 240
Level 1 – 330
Level 2 – 425
Level 3 – 475
No Fault & WC PDPM
MVP
Level A – 260
Medicare/Medicaid Level B – 275
Level C – 300
Level D – 350
NYSCHP
Private Pay
Semi – 304.31
Private – 327.72
SNH – 171.92
Tricare
United Health Care
Medicare/Commercial Skilled – 336
Medicaid Skilled – 250
Medicaid Custodial – 156.62
Optum Skilled – 214/246/327/475
Wellcare
Level 1 – 275
Medicare/Medicaid Level 2 – 300
Level 3 – 350
Level 4 – 400
Level 5 – 575
LT/Custodia. – 171.92
Susquehanna
Aetna
Commercial:
Level 1 – 200
Level 2 – 260
Level 3 – 350
Medicare:
Level 1 – 210
Level 2 – 270
Level 3 – 360
CDPHP
MLTC – 204
Skilled MC – 233
Medicare – 265
Gov – 324
Excellus
Skilled – 287.95
Medicare/Commercial Subacute – 361.21
Subacute Rehab – 404
Vent/TBI – 675
Medicaid/Special:
Skilled – 235
Subacute 325
Subacute Rehab – 375
Vent/TBI – 675
Custodial – 219.03
Respite – MCD Rate
MVP
Level 1 – 260
Level 2 – 325
Level 3 – 420
Level 4 – 490
Fidelis
Medicaid Custodial MLTC – 219.03
Medicaid custodial MLTC – 220.84
MCD/MCR Skilled Level 1 – 235
Level 2 – 300
Level 3 – 350
Level 4 – 450
Humana
Level 1 – 345
Choice Care Level 2 – 415
Level 3 – 590
Level 4 – 700
iCircle MLTC
Custodial – 240.93
MLTC & Managed MCD Custodial – 242.92
MLTC & Managed MCD Skilled – 350
MLTC & Managed MCD Subacute Therapy – 400
MLTC & Managed MCD Subacute Rehab – 450
Medicare Skilled – PDPM
Medicaid – 233/212.10
Medicaid Pending
Semi - 233
Private – 212.10
Medicare – PDPM
No Fault & WC – PDPM
Private Pay
Semi – 350
Private 360
United Healthcare
Optum – 365
Medicaid – 233
MCR/Commercial Skilled – 342
MCR/Commercial Bariatric – 382
MCR/Commercial Trach – 410
VA CNN – PDPM
Veterans
Bed Hold – 221.61
Rehab + Extensive – 469
Rehab – 381
Extensive – 422
Special Care – High – 350
Special Care – Low – 330
Clinically Complex 288
Psychosocial – 253
Reduced Physical Functions – 253