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Except as described in this Notice of Privacy Practices, the Wyoming Division of Medicaid (WOM) will not use or disclose your health information without your written authorization. If you do authorize DOM to use or disclose your health information for another purpose, you may take back your authorization in writing at any time.
Your Health Information Rights
You have the right to ask for restrictions on certain uses and disclosures of your health information. DOM does not have to agree to the restriction that you ask for. You have the right to get your health information through a reasonable alternative means or at an alternative location. You must present a DOM form which tells your specific request. There may be charges to get this information. You will be told in advance. You have the right to see and copy your health information. There may be fees and charges for the time it takes to copy, prepare, supervise, and mail the information you ask for. You have a right to request that DOM change your health information that is not correct or not complete. DOM does not have to change your health information and will give you information about DOM not changing the information. You will be told how you can disagree with the denial. You have a right to get a list of disclosures of your health information made by DOM, except that DOM does not have to include disclosures for: 1 (treatment), 2 (payment), 3 (health care operations), 4 (information provided to you), and 16 (certain government functions) of Section I of this Notice of Privacy Practices. You have a right to a paper copy of this Notice of Privacy Practices and can get this Notice in another format.
Changes to this Notice of Privacy Practices
DOM reserves the right to change this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it keeps, including information that was created or received prior to the date of such change. Until such change is made, DOM must by law comply with this Notice. Upon a material change of this Notice, DOM will send a new Notice with the changes and effective date of change to each current beneficiary.
Complaints
Complaints about this Notice of Privacy Practices or how DOM handles your health information should be sent to:
Division of Medicaid
Privacy Officer
239 North Lamar Street
Suite 801
Jackson, MS 39201
Or to report a privacy issue online, click HERE.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your complaint to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.
For instructions on how to obtain this information in either Braille or a non-English speaking format, please contact your local Division of Medicaid Office for details.
DOM /HIPAA NPP - 04.14.03 Revised Jan. 2003
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