Smoking Cessation Trust

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IMPORTANT CHANGES TO PHARMACY BENEFITS

Effective July 1, 2017

Effective 7/1/2017 – Chantix (Varenicline) and Nicotrol (Inhaler & Spray) will no longer be covered under the Smoking Cessation Trust program Pharmacy Benefit.

             If you have questions concerning this new pharmacy benefit change please call our Customer Service Center at

1-855-259-6346


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PRIVACY NOTICE

Summary

At SCT Management Services (SCTMS), our policy is to always safeguard your privacy by keeping your personal and medical information in the strictest confidence.

SCT Management Services Pledge Regarding Your Medical Information

Your medical information is personal and SCT Management Services is committed to keeping this information confidential. Maintaining access to a record of the care and services you receive at any hospital and clinic enables those who provide you treatment to provide you with quality care and comply with certain legal requirements. This notice applies to the use and disclosure of your medical records maintained in the SCT Management Services system.

Medical Records

Your medical records are important documents needed in order to administer the Smoking Cessation program in which you enrolled. We will insure the confidentiality of those records and how records are used to administer the smoking cessation program.

Consent for Use and Disclosure of Medical Records

We may receive from any physician and health care professional of smoking cessation services “protected health information” (PHI) about you to the extent permitted by applicable law, for any permitted purpose, including but not limited to, our quality assurance, utilization review, processing of claims, financial audits or other purposes related to the payment and certain smoking cessation program operation activities.

By participation in the smoking cessation program and availing yourself of the smoking cessation program options offered, you give consent to each physician and health care professional rendering smoking cessation services hereunder to disclose to us all information (to the extent permitted by applicable law) pertaining to you for any permitted purpose specified in the law. This consent shall not permit a use or disclosure of PHI when a separate specific authorization is required by law or when another condition must be met for such use or disclosure to be permitted under applicable law. Although the Smoking Cessation Trust is not an insurance company, it will comply with applicable Health Insurance Portability and Accountability Act (HIPAA) rules and regulations, including those relating to privacy and security of your PHI.

Professional Review

We are permitted by law to use your records to conduct professional/regulatory review programs for smoking cessation services without your consent/authorization. Such review programs include, but are not limited to; the National Committee for Quality Assurance (NCQA), Health Plan Employer Data and Information Set (HEDIS), and the Court monitored programs.

In addition, there may be instances where SCT Management Services may share your protected health information with members of other health care organizations, TPA’s, quality improvement organizations, accreditation organizations, judicial officials, and Quit-lines as allowed under HIPAA regulations and as necessary to carry out treatment, payment or health care operations, or the operations of the smoking cessation program. These members include patient care settings contracted by SCT Management Services, and all contracted medical staff, employees, volunteers, trainees, students and other personnel providing services as employed by other facilities.

SCT Management Services may elect to participate in secure statewide or regional health information networks designed and developed to promote smoking cessation and general healthcare continuity. Your healthcare information may be included in this network and accessed only by healthcare personnel involved in your healthcare.

How SCT Management Services May Use and Disclose Your Medical Information

SCT Management Services may use or disclose your medical information for the following reasons:

  • Treatment: SCT Management Services may use your medical information to provide treatment or services. SCT Management Services may disclose your medical information to doctors, nurses, technicians, medical students or other hospital/clinic personnel who are involved in taking care of you. SCT Management Services may disclose your medical information to individuals outside our organization who may be involved in your care.
  • Payment: SCT Management Services may use and disclose your medical information to pay for the treatment and services you receive at other facilities.
  • Treatment Alternatives: SCT Management Services may use and disclose your medical information to tell you about or recommend possible smoking cessation treatment options or alternatives that may be of interest to you.
  • Health-related Benefits and Service: SCT Management Services may use and disclose your medical information to tell you about health-related benefits or services that may be of interest to you.
  • Individuals Involved in Your Care: SCT Management Services may discuss medical information about you with a friend or family member who is involved in your medical care.
  • Research: Under certain circumstances, SCT Management Services may use and disclose your medical information for research purposes.
  • Required By Law: SCT Management Services will disclose medical information about you when required to do so by federal, state or local law or court order, including the court with oversight of the smoking cessation program.
  • Health Oversight Activities: SCT Management Services may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the healthcare system, government programs and compliance with civil rights laws.
  • Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, SCT Management Services may disclose your medical information in response to a court or administrative order, response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute.
  • Coroner, Medical Examiners and Funeral Directors: SCT Management Services may release medical information to a coroner or medical examiner.
  • Law Enforcement: SCT Management Services may release your medical information if asked by a law enforcement official for the following reasons:


    1. In response to a court order, subpoena, warrant, summons or similar process.
    2. Limited information to identify or locate a suspect, fugitive, material witness or missing person.
    3. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.
    4. About a death we believe may be the result of criminal conduct.
    5. About criminal conduct at the hospital or clinic.
    6. In emergency circumstances to report a crime, the location of the crime or victims or the identity, description or location of the person who committed the crime.


  • National Security and Intelligence Activities: SCT Management Services may release your medical information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
  • Protective Services for the President and Others: SCT Management Services may disclose your medical information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or conduct special investigations.
  • Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, SCT Management Services may release your medical information to the correctional institution or law enforcement official. This information would be released for the following uses: (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) to ensure the safety and security of the correctional institution.

What is PHI?

PHI is any health information about you that SCTMS sends, receives, or keeps as part of our smoking cessation program activities. This includes information sent, received, and kept by electronic, written, and oral means. Health information that clearly identifies you or that could reasonably be used to identify you and your health needs is called PHI. Medical records and claims are two common examples of PHI.

We undertake efforts required by law to keep your PHI secure. Unless otherwise permitted or required by law, we do not disclose confidential information without your consent/authorization. As a Member, you (or your legal guardian/Personal Representative) have the right to:

  1. Request restrictions on certain uses and disclosures of PHI, although SCTMS is not required to agree to a requested restriction.
  2. Receive confidential communications of PHI from SCTMS.
  3. With certain exceptions, inspect and receive a copy of PHI.
  4. Request an amendment to PHI you believe to be incorrect or incomplete.
  5. Receive an accounting of certain disclosures of PHI.
  6. Obtain a paper copy of the Notice of Privacy Practices from SCTMS upon request (even if you previously agreed to receive the Notice electronically).

Access to PHI

All confidential documents are kept in a physically secure location with access limited to authorized SCTMS personnel only, and with those who have entered into a Business Associate Agreement with SCTMS. You (or your legal guardian/Personal Representative) have the right, with certain exceptions, to request access to inspect and obtain a copy of your PHI.

You do not have the right to inspect or obtain a copy of PHI that consists of:

  1. Psychotherapy Notes; or
  2. Information gathered in reasonable expectation of, or for use in, a civil, criminal, or administrative action or proceeding; or
  3. PHI maintained by SCTMS that is subject to the Clinical Laboratory Improvement Amendments of 1988 (CLIA) 42 U.S.C. 263a, to the extent the provision of access to you would be prohibited by law; or exempt from the Clinical Laboratory Improvements Amendments of 1988 (CLIA), pursuant to 42 CFR 493.3(a)(2).

Your Rights Regarding Medical Information About You

You have the following rights regarding medical information that SCT Management maintains about you:

  • Right to Inspect and Copy: You have the right to inspect and request copies of medical information that may be used to make decisions about you. Usually, this includes medical and billing records. To inspect and receive copies of medical information that may be used to make decisions about you, you must submit your request in writing to:

    SCT Management Services, L3C
    P.O. Box 2430
    New Orleans, LA 70176

    If you request a copy of the information, SCT Management Services may charge a fee for the costs of copying, mailing or other supplies associated with your request. SCT Management Services may deny your request to inspect and copy in certain circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another Smoking Cessation Program Professional chosen by SCT Management Services will review your request and the denial. The person conducting the review will not be the person who denied your request and SCT Management Services will comply with the outcome of the review.

  • Consents/Authorizations: Although consent from you (or your legal guardian/Personal Representative) is not required to use or disclose PHI for certain purposes specified in the law, physicians and providers will generally request that you (or your legal guardian/personal representative) sign a consent form permitting disclosure of medical records (to the extent permitted by law) to SCTMS at the time of your first visit to the physician, provider or facility.

    In the event that the physician, provider or facility fails to obtain such consent for disclosure to SCTMS, or you refuse to sign such consent for disclosure to SCTMS, WE shall use OUR best efforts to obtain such written consent from you (or your legal guardian/personal representative) prior to the physician, provider of facility release of PHI (i.e. health records) to use for purposes permitted by law.

    When you sign the documents to become a class beneficiary, you are giving consent (to the extent permitted by applicable law) to the use or the release of your PHI by any person or entity including without limitation, physicians, providers, facilities and to SCTMS or its designees (including its authorized agents, business associates, regulatory agencies and affiliates) for any permitted purpose, including but not limited to, quality assurance, utilization review, processing of claims for payment from providers for smoking cessation services rendered to you, financial audits or other purposes related to the payment or certain healthcare operations activities of the Smoking Cessation Trust program. This consent does not permit a use or disclosure of PHI when a separate specific authorization is required by law.

    We will not release PHI about you without your permission/authorization unless permitted or required by law (including a court order).

    We require all smoking cessation program service providers to maintain confidential patient information in accordance with federal and state laws including, HIV/AIDS status, mental health, sexually transmitted diseases or alcohol/drug abuse. State and federal law prohibits further disclosure of HIV/AIDS, other sexually transmitted disease, mental health and alcohol abuse and drug abuse information to any person or agency without obtaining specific valid written authorization for that purpose from the patient (or legal guardian/personal Representative), or as otherwise permitted by state or federal law.

    To request an Authorization Form you must submit your request in writing to:

    SCT Management Services, L3C
    P.O. Box 2430
    New Orleans, LA 70176

    Authorization Forms will be kept in your file.

  • Members Who Are Unable to Give Consent/Authorization: Sometimes courts or doctors decide that certain people are unable to understand enough to make decisions for themselves. Usually, a person with legal authority to make health care decisions for another person (for example, a legal guardian) can exercise the health information rights described herein for the person, but not always. Unless otherwise required or permitted by law, when we need an authorization form signed for a person who cannot make healthcare decisions for themselves, we will have it signed by their legal guardian/personal representative.

  • Right to Request Amendments (Changes) to PHI: SCT Management Services recognizes your right to request amendment of PHI or a record containing PHI for as long as the PHI is maintained in our records. SCTMS will accept properly completed written requests to amend PHI. We must approve or deny your request to amend the disputed PHI no later than 60 days after receipt of the request. If we are unable to take an action within the required timeframe, we may take up to 30 additional days, provided that, no later than 60 days after receiving your request, we provide you with a written statement of the reason for the delay and date by which we will complete its action on your request and notify you, in writing, of the determination no later than 60-90 days after receipt of such a request.

    To request an amendment, your must submit your request in writing to:

    SCT-Management Services, L3C
    P.O. Box 2430
    New Orleans, LA 70176

    In addition, you must provide a written reason that supports your request. SCT Management Services may deny your request for an amendment if it is not in writing or does not include a reason to support the request. Furthermore, SCTMS may deny your request if you ask to amend information:

    1. Not created by SCT Management Services;
    2. Not part of your personal or medical information kept by or for the SCT Management Services;
    3. Not part of the information which you would be permitted to inspect and copy; or
    4. That is accurate and complete.

Use of Measurement Data

It is important for us to know about tobacco-related illnesses of the Scott class beneficiaries to help improve the quality of smoking cessation services and products that physicians, providers and facilities provide. We sometime use medical data (laboratory results, diagnoses, etc.) which does not identify individual class beneficiaries for this purpose.

Internal Protection of Oral, Written and Electronic PHI Across SCTMS

To ensure internal protection of oral, written, and electronic PHI across SCTMS, the following rules are strictly adhered to:

  1. PHI is accessed by SCTMS personnel and business associates only if such information is necessary to the performance of job related tasks.
  2. PHI is not discussed inside or outside our facility, unless the data is necessary to the performance of job related tasks.
  3. PHI, reports and other written materials are reasonably safeguarded throughout our facility against unauthorized access by SCTMS personnel or public viewing.
  4. All employees, volunteers, and any external entity with a business relationship with us that involves health information will be held responsible for the proper handling of our data and business communications and are required to sign a confidentiality statement or business associate agreement, respectively.

Website Internet Information

Changes To This Notice

SCT Management Services reserves the right to change this notice. SCT Management Services reserves the right to make the revised or changed notice effective for medical information SCT Management Services already has about you as well as any information SCT Management Services receives in the future.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us. To file a complaint with SCT Management Services, contact SCT Management Services via the contact information below.

SCT Management Services, L3C
P.O. Box 2430
New Orleans, LA 70176

You will not be penalized for filing a complaint.

Other Uses of Medical Information

Other uses and disclosures of personal and medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide SCT Management Services permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, SCT Management will no longer use or disclose your personal or medical information for the reasons covered by your written authorization. You understand that SCT Management Services is unable to take back any disclosures SCT Management Services already made with your permission and that SCT Management Services is required to retain.

Protection of Information Disclosed to Plan Sponsors, Employers or Government Agencies.

Our policies and procedures prohibit sharing your PHI with any fully insured employer group’s plan sponsor without your authorization (or your legal guardian/personal representative). We are careful not to release PHI to your employer as part of routine financial and operating reports. Information may be disclosed for permissible reasons, such as coordination of benefits and subrogation.

We may disclose summary health information that does not identify you or any individual class beneficiaries to plan sponsors for allowable purposes. We may disclose information to judicial officials, government agencies or accreditation organizations that monitor our compliance with the Scott court decision, applicable laws and standards as permitted by law.

If you have any questions about this notice, please contact:
SCT-Management Services, L3C
P.O. Box 2430
New Orleans, LA 70176

This Privacy Notice may be updated, revised and amended in the future, due to a change in law or otherwise. You will be notified of new or updated Privacy Policies as required by law.

THE SMOKING CESSATION TRUST IS A COURT-ORDERED SMOKING CESSATION PROGRAM WITH LIMITATIONS ON ELIGIBILITY AND PROGRAM CONTENT. IT IS NOT AN INSURANCE PLAN, AND THE PROGRAM BENEFITS ARE NOT INSURANCE BENEFITS.