New York State Notice of Important Document.

• Opt-Out Letter is also available in Portable Document Format (PDF, 749KB)

There is NO CHANGE to your MEDICAID.

This letter is about a new program that New York State has started for our Medicaid members.

We know getting the health care you need is sometimes difficult. We want that to change. You should have a primary health care provider. When you do not feel well, you should have a place to go besides an emergency room. We want you to know what health care you need and where to get it, so that you feel confident you can manage your health.

New York State Delivery System Reform Incentive Payment Program (DSRIP)

What is DSRIP?

The new program, the New York State "Delivery System Reform Incentive Payment Program" (DSRIP) will help you, your doctors and other health care providers work together better to serve your healthcare needs. DSRIP is a program in which doctors, clinics, hospitals, medical and community services in your area work together to build a better health care system. This will help you get better health care. These groups of providers are forming what is called a "Performing Provider System" (PPS). PPS providers have worked to understand what your community needs to improve health care. They are now planning how to meet those needs To see the full list of PPS in your region and throughout the state, please visit the following website: (https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/providers_professionals.htm) and look for "PPS Contact List"within the Introductory Information box.

How may DSRIP and the PPS help me?

• You may find that there are new community health services that are easier to use and that meet your needs better.
• You may find that you will need to have fewer tests done since your doctors and hospitals will be communicating better.
• You may receive help from community health workers or care managers. This will help you manage your health and get the care you need.
• People who work for the PPS may reach out to you about special health care services, such as help for your sugar diabetes or high blood pressure.

Can I become part of DSRIP and be in a PPS?

Because you are receiving Medicaid, you are already a part of this new program. Medicaid would like to help each PPS by sharing health information about persons with Medicaid who are in the PPS. This is health information about the medical services you have received through Medicaid.

Does the PPS become my insurance plan?

No, the PPS will not replace your Medicaid, your HMO or your insurance. A PPS is not an insurance company. The PPS will work with your Medicaid to help you get services you need. You will continue to have the right to the Medicaid services. This includes access to care and privacy. However, you will also need to follow any rules for these services.

What types of information will be shared?

You will have the same rights as you already have with Medicaid regarding privacy and getting care. To help the PPS assist you, NYS Medicaid, in compliance with state and federal laws, will share certain information with the PPS about your medical care. This includes your medical conditions, prescription drugs and visits to doctors. This may be the same information that you have already agreed in your Medicaid application can be maintained and used by NYS, your providers and your Health Plan to help you get care easier, pay for your health care and for health care operations. This information may include HIV/AIDS or mental health diagnoses and treatment information about yourself to the extent permitted by law, until you do not want it shared. Any alcohol and substance abuse patient identifying information cannot be released unless you specifically consent to such release.

If Medicaid shares my information, what rights do I have as part of the PPS?

The PPSs will need to follow all state and federal laws protecting the privacy of this information. The PPS cannot further share your information with persons or organizations unless this sharing is allowed under state and federal law. These laws and regulations include New York Mental Hygiene Law Section 33.13, New York Public Health Law Article 27-F, and federal confidentiality rules, including 42 CFR Part 2 (which specifies the conditions under which the disclosure of alcohol and substance abuse information is permissible) and 45 CFR Parts 160 and 164 (which are the rules referred to as "HIPAA").

The information may be used to help you achieve better health. It will be easier for your providers to be up to date on the care you have received. This means you may not have to repeat tests. There may be less confusion about your medications. The PPS may use it to help you become aware of the new services being offered in your community. These services may help you with your health.

You do not need to have Medicaid share your information as part of the DSRIP program. However, we believe there are many benefits for you to have this information shared with providers as part of DSRIP.

What happens if I do not want Medicaid to share my information with my PPS?

If you decide you do not want Medicaid to share your information, you do not lose any of your Medicaid benefits. You can still see your own doctors. But, you may not be able to get the special services the PPS will offer.

What should I do if I don´t want this information shared?

If you do not want Medicaid to share your information, you will need to notify us. This is called "opting out." Opting out means your protected health information from Medicaid will not be shared with a PPS within the DSRIP program. You will need to call the Medicaid Call Center at (1-855-329-8850). Or, you may sign and mail back the enclosed "Form to Opt Out of Medicaid Information Sharing." You can do this now or at any time. If you want Medicaid to share this information to help improve how you get health care, you don´t need to do anything. You are in! We look forward to helping you become healthier!

Thank You.

New York State Medicaid Program

Si usted quisiera ver esta carta en español, por favor visite el siguiente sitio web:

http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/consumers.htm

If you would like to view this letter in 18 point Font, please visit the following website:

http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/consumers.htm

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