Health Insurance Portability and Accountability Act (HIPAA)

HIPAA (the Health Insurance Portability and Accountability Act) addresses issues regarding the privacy and security of member confidential information.

Additional information can be found in the sections below:

The United States Department of Health and Human Services established the HIPAA Privacy Regulation in December 2000, which took effect on April 14, 2003. The Privacy Rule, as it is called, provides for the protection and privacy of individually identifiable health information. It also guards against the misuse of this information.

Requirements

The Privacy Rule sets forth administrative requirements, privacy and security requirements, and individual rights regarding the use and disclosure of protected health information. The rule also establishes penalties for the misuse or disclosure of protected health information.

Agency Privacy Officer

The HIPAA regulations require the AHCCCS Administration to assign an Agency Privacy Officer. The AHCCCS Administration's Assistant Director of the Office of Administrative Legal Services (OALS) is the Agency's Privacy Officer. Questions, concerns, and complaints about HIPAA Privacy matters can be sent to the following address:

AHCCCS Administration Attention: Privacy Officer
701 E. Jefferson, MD 6200
Phoenix, AZ 85034

Protected Health Information Privacy Notice (Notice of Privacy Practices)

The Notice of Privacy Practices is available in English and Spanish:

  • Authorization For AHCCCS To Disclose Protected Health Information
    This form is intended for use by members who want AHCCCS to disclose their protected health information to another person or entity.
  • Authorization for AHCCCS to Disclose Psychotherapy Notes
    This form is intended for use by members who want AHCCCS to disclose their psychotherapy notes to another person or entity.
  • Authorization To Disclose Protected Health Information to AHCCCS
    This form is intended for use by members and applicants who want a doctor or other entity to give AHCCCS their protected health information.
  • Authorization To Disclose Psychotherapy Notes To AHCCCS
    This form is intended for use by members and applicants who want a doctor or other entity to give AHCCCS their psychotherapy notes. This authorization remains in effect until the member's application for assistance through AHCCCS is withdrawn, denied, or when the member's AHCCCS eligibility ends.
  • Revocation of Authorization
    This form is intended for use by AHCCCS members who want to revoke (take back or cancel) their previously submitted authorization to release health information. This revocation does not apply to any information already released while the authorization form signed earlier was valid and in effect. The member may select one or several of the authorization forms to revoke or may select the ANY and ALL revocation option.

Creditable coverage is defined as coverage of the individual under any of the following types of plans:

  • A group health plan
  • Medicare Part A or B
  • AHCCCS Health Insurance (Medicaid)
  • KidsCare (Children's Health Insurance Program)
  • Military sponsored health insurance (CHAMPUS)
  • Medical care program of the Indian Health Service or tribal organizations
  • The federal employees health benefits program
  • A public health plan (a plan established or maintained by a State, county, or other political subdivision of a State that provides health insurance coverage to individuals)
  • A health benefit plan under the Peace Corps Act; or
  • A church plan

If there was a gap (or no coverage) in coverage of 63 days or more, the coverage before the gap can not be counted as creditable coverage.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that qualified individuals are provided continuous coverage for ongoing medical treatment. This may reduce how much or how long a health plan can keep a person from getting coverage due to pre-existing conditions.

What is a Certificate of Creditable Coverage?

A Certificate of Creditable Coverage is a document that proves an individual had health coverage under AHCCCS Health Insurance or KidsCare for the period of time noted on the certificate.

Why Is This Needed?

A certificate may be needed if an individual:

  • Becomes eligible under an employer's group health plan that excludes coverage for certain pre-existing medical conditions
  • Obtains coverage under a group health plan that is not affiliated with the employer
  • Is buying an individual policy
  • Receives medical advice, diagnosis, care or treatment for a condition within the 6-month period prior to enrollment in the new plan

Who Can Get a Certificate?

  • Any person who received full coverage under AHCCCS within the last 24 months is eligible to receive a Certificate of Creditable Coverage
  • A non-citizen, who received ONLY emergency services, can not get a certificate that certifies full coverage. To determine the level of coverage under AHCCCS, contact AHCCCS Member Services Unit:

    Call:

    • 1(855)HEA-PLUS (1-855-432-7587)
      • Calls Answered Monday through Friday 8 a.m. – 5 p.m.
    • AZ Relay Service for the hearing impared 1-800-367-8939

How to Get A Certificate?

To receive a Certificate of Creditable Coverage, a request must be made to AHCCCS Administration Member Services Unit:

Call:

  • 1(855)HEA-PLUS (1-855-432-7587)
    • Calls Answered Monday through Friday 8 a.m. – 5 p.m.
  • AZ Relay Service for the hearing impared 1-800-367-8939

The request must include the following:

  • Name of person for whom the certificate is requested
  • Social Security number or the person's AHCCCS ID number (this can be found on the member's AHCCCS ID Card)
  • Name and address to whom and where the certificate should be sent

Statement of HIPAA Portability Rights

Contact AHCCCS with a question, concern, or complaint related to HIPAA Privacy:

Email: Privacy@azahcccs.gov