Absolut Care Nursing Home Disclosure Information
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: 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 (716) 650-7750.
- 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 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: 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
$617 per day for residency and/or services.
Absolut Care of Allegany
BCBS
Skilled Level 1 – 236.9
Subacute Level 2 – 329.6
Subacute Level 3 – 432.6
Amerigroup ST
Level 1 – 236.9
Level 2 – 329.6
Level 3 – 432.6
Centers Plan MLTC
3810 – 210.09
3839 – 208.36
Fallon MLTC
3810 – 210.09
3839 – 208.38
Fidelis MLTC
3810 – 210.09
3839 – 208.36
Fidelis Managed Care
Level 1 – 225
Level 2 – 300
Level 3 – 375
Level 4 – 475
Custodial – 210.09
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 640
Level 4 – 740
iCircle MLTC
Level 1 – 350
Level 2 – 400
Level 3 – 450
Respite – 295
3810 – 210.09
3839 -208.36
Kalos MLTC
3810 – 210.09
3839 – 208.36
IHA
Managed Medicaid:
Level 1 – 319
Level 2 – 386
3810 – 210.09
3839 – 208.36
United Healthcare
Medicare/Commercial – 395
Dual Complete (Medicare) – 395
Dual Complete (Mcd – Americhoice) – 268
Medicaid (Rehab) – 268
Optum (Capitated Rate $400) – 0.01
Univera/RMSCO
Skilled – 250
Subacute Therapy – 340
Subacute Care – 375
Subacute Rehab – 375
Veterans
PDPM
VNA MLTC
3810 – 210.09
3839 – 208.36
Wellcare
3810 – 210.09
3839 – 208.36
Level 1 – 300
Level 2 – 355
Level 3 – 395
Level 4 – 475
Level 5 – 600
YourCare/Molina
3810 – 201.09
3839 – 208.36
Level 1 – 250
Level 2 – 350
Level 3 – 400
Absolut Care of Aurora Park
BCBS
Skilled Level 1 – 236.9
Subacute Level 2 – 329.6
Subacute Level 3 – 432.6
Amerigroup ST
Level 1 – 236.9
Level 2 – 329.6
Level 3 – 432.6
Centers Plan MLTC
Custodial – 210.09
Level 1 – 300
Level 2 390
Level 3 – 450
Level 4 – 600
Fallon MLTC
3810 – 251.58
3839 – 249.71
Fidelis MLTC
3810 – 251.58
3839 – 249.71
Fidelis Managed Care
Level 1 – 275
Level 2 – 350
Level 3 – 425
Custodial – 251.58
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 640
Level 4 – 740
iCircle MLTC
Level 1 – 350
Level 2 – 400
Level 3 – 450
Respite – 295
3810 – 251.58
3839 -249.71
Kalos MLTC
3810 – 251.58
3839 – 249.71
IHA Family Choice
Level 1 – 302
Level 2 – 363
IHA
Managed Medicaid:
Level 1 – 310
Level 2 – 375
3810 – 251.58
3839 – 249.71
MVP
Commercial/Medicaid – 275
United Healthcare
Medicare/Commercial – 450
Dual Complete (Medicare) – 450
Dual Complete (Mcd – Americhoice) – 283
Medicaid (Rehab) – 283
Optum (Capitated Rate $400) – 0.01
Univera/RMSCO
Skilled – 235
Subacute – 325
Subacute Rehab – 375
VNA MLTC
3810 – 251.58
3839 – 249.71
VNS MLTC
3810 – 251.58
3839 – 249.71
Wellcare
3810 – 251.58
3839 – 249.71
Level 1 – 300
Level 2 – 355
Level 3 – 395
Level 4 – 475
Level 5 – 600
YourCare/Molina
3810 – 251.58
3839 – 249.71
Level 1 – 250
Level 2 – 350
Level 3 – 400
Absolut Care of Gasport
BCBS
Medicaid HMO (Custodial)
Skilled (Level 1) – 236.90
Subacute (Level 2) – 329.60
Subacute (Level 3) – 432.60
Aetna
Level 1 – 199
Level 2 – 398
Level 3 – 592
Amerigroup
Level 1 – 236.90
Level 2 -329.60
Level 3 -432.60
Centers Plan MLTC
Custodial -220.90
Level 1 – 300
Level 2 – 390
Level 3 – 450
Level 4 – 600
Complete Senior Care LT
3810 – 222.82
3839 – 220.90
Subacute – 370
Respite – 225
Elderwood MLTC
3810 – 222.82
3839 – 220.90
Fallon MLTC
3810 – 222.82
3839 – 220.90
Fidelis MLTC
3810 – 222.82
3839 – 220.90
Fidelis Managed Care
Level 1 – 225
Level 2 – 300
Level 3 – 375
Level 4 – 475
Custodial – 222.82
iCircle MLTC
Level 1 – PDPM
Level 2 – PDPM
Level 3 -PDPM
Respite – N/A
3810 – 222.82
3839 – 220.90
Kalos MLTC
3810 – 222.82
3839 – 220.90
IHA Family Choice
Level 1 – 302
Level 2 – 363
ISP Stop Loss
ALF Stop Loss
IHA
Level 1 – 381
Level 2 – 474
Medicare 222.82
3839 – 220.90
United Healthcare
Medicare/Commercial – 425
Dual Complete (Medicare)
Dual Complete (Mcd – Americhoice)
Medicaid (Rehab) – 283
Optum (Capitated Rate N/A) – 0.01
Univera/RMSCO
Med Adv & Commercial:
Skilled – 250
Subacute Therapy – 340
Subacute-Care – 375
Subacute Rehab – 375
VNA MLTC
3810 – 222.82
3839 – 220.90
Veterans
PDPM
Wellcare
3810 – 222.82
3839 – 220.90
Level 1 – 300
Level 2 – 355
Level 3 – 395
Level 4 – 475
Level 5 – 600
YourCare/Molina
3810 – 222.82
3839 – 220.90
Level 1 – 250
Level 2 – 350
Level 3 – 400
Absolut Care of Three Rivers
BCBS
Skilled Level 1 – 244.49
Subacute Level 2 – 338.13
Subacute Level 3 – 387.27
Vent – 675
Aetna
Level 1 – 199
Level 2 – 398
Level 3 – 592
Amerigroup ST
Level 1 – 236.9
Level 2 – 329.6
Level 3 – 432.6
Fidelis MLTC
3810 – 221.92
3839 – 220.04
Fidelis Managed Care
Level 1 – 225
Level 2 – 300
Level 3 – 375
Level 4 – 475
Custodial – 221.92
iCircle
Level 1 – 350
Level 2 – 400
Level 3 – 450
Respite – 295
3810 – 221.92
3839 – 220.04
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 640
Level 4 – 740
Molina
Level 1 – 250
Level 2 – 350
Level 3 – 400
MVP
Commercial/Medicaid – 291
Commercial/Medicaid – 351
Commercial/Medicaid – 456
Commercial/Medicaid – 501
Commercial/Medicaid Benchmark – 220.04
Medicare – PDPM
United Healthcare
Medicare/Commercial – 370
Dual Complete (Medicare) – 370
Dual Complete (Mcd – Americhoice) – 220.04
Medicaid (Rehab) – 243
Optum (Capitated Rate)
VNA MLTC
3838 – 221.92
3839 – 220.04
Wellcare
3838 – 227.25
3839 – 233.53
Level 1 – 300
Level 2 – 355
Level 3 – 395
Level 4 – 475
Level 5 – 600
YourCare/Molina
3810 – 221.92
3839 – 220.04
Level 1 -250
Level 2 – 350
Level 3 -400
Absolut Care of Westfield
BCBS
Medicaid HMO (Custodial)
Skilled Level 1 – 236.9
Subacute Level 2 – 329.6
Subacute Level 3 – 432.6
Aetna
Level 1 – 199
Level 2 – 398
Level 3 – 592
Amerigroup ST
Level 1 – 236.9
Level 2 – 329.6
Level 3 – 432.6
Fidelis MLTC
3810 – 216.28
3839 – 214.50
Fidelis Managed Care
Level 1 – 225
Level 2 – 300
Level 3 – 375
Level 4 – 475
Custodial – 216.28
iCircle MLTC
Level 1 – 350
Level 2 – 400
Level 3 – 450
Respite – 295
3810 – 216.28
3839 – 214.50
Humana
Level 1 – 395
Level 2 -465
Level 3 – 640
Level 4 – 740
IHA
Level 1 – 310
Level 2 – 375
3810 – 216.28
3839 – 214.50
Kalos MLTC
3810 – 216.28
3839 – 214.50
United Healthcare
Medicare/Commercial – 425
Dual Complete (Medicare) – 425
Dual Complete (Mcd – Americhoice) – 244
Medicaid (Rehab) – 244
Optum (Capitated Rate $475) – 0.01
Univera/RMSCO
Skilled – 250
Subacute Therapy – 340
Subacute Care – 375
Subacute Rehab – 650
VNA MLTC
3810 – 216.28
3839 – 214.50
Wellcare
3810 – 216.28
3839 – 214.50
Level 1 – 300
Level 2 – 355
Level 3 – 395
Level 4 – 475
Level 5 – 600
YourCare/Molina
3810 – 216.28
3839 – 214.50
Level 1 -250
Level 2 – 350
Level 3 -400
Facility
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ALLEGANY, LLC
Owners
Israel Sherman, Samuel Sherman
Landlord
2178 N. Fifth Street, LLC
Landlord Address
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT AURORA PARK, LLC
Israel Sherman, Samuel Sherman
292 Main Street, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT GASPORT, LLC
Israel Sherman, Samuel Sherman
4540 Lincoln Drive, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT THREE RIVERS, LLC
Israel Sherman, Samuel Sherman
101 Creekside Drive, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT WESTFIELD, LLC
Israel Sherman, Samuel Sherman
26 Cass Street, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
Summary of all contracts for the provision of goods and services for which the facility pays with any portion of Medicaid or Medicare funds or other agreements entered by the facility within 30-days of execution:
| 255 Greenwich Medical Services, PC | Dermatology |
| 255 Greenwich Medical Services, PC | Optometry |
| 292 Main Street, LLC | Lease – Operating |
| Advantage Funding Commercial Capital | Transport – Mini Bus |
| ADVO Waste | Medical Waste Disposal |
| All State Fire and Security | PM – Fire Alarm System Testing and Inspection: Hand Portable, Kitchen Fire Systems, Fire Alarm, Sprinkler |
| American HealthTech | Software Agreement |
| Busy Beaver | Landscaping Services |
| Catholic Health | Lab – Covid |
| CHE | Psychological Services |
| Danforth | HVAC/Plumbing Services |
| Dentserv | Dental Services |
| Dialyze Direct | Dialysis |
| Ecolab | Dish machine Rental |
| Ferguson Electric | Electrical Service |
| FFAE | Architectural Services |
| Forefront Behavioral | Psychological Services |
| General Physicians, PC | Medical Director/Physician Services |
| H&R Healthcare | Billing |
| Health System Services | Part B Supplier |
| Hudson Energy | Energy Supply |
| Lehigh Construction | Building Services |
| Liberty RC, Inc | Dialysis |
| M and M Asphalt | Snow Plowing |
| Medline | Supplies |
| Mobile Dysphagia Diagnostics Speech Language Swallowing Services | FEES |
| Modern Disposal | Waste Disposal |
| Nova Healthcare Solutions | |
| Otis | PM – Elevators |
| PDI | Portable X-ray |
| Penn Power | PM – Generators |
| Pitney Bowes | Postage Meter |
| Procare | Pharmacy |
| Pure Life Renal | Dialysis |
| SRX | Pharmacy |
| The Browne Company | Roof Consulting Services |
| Tri R Mechanical | Refrigeration Services |
| US Foods | Food |
| US Foods | Food |
| Vital Healthcare Solutions | Diabetic Services |
| Allegany | Aurora Park | Gasport | Three Rivers | Westfield |
| EMPIRE BCBS AMERIGROUP | BCBS OF WESTERN NY | CENTERS PLAN FOR HEALTHY LIVING | FIDELIS CARE | FIDELIS |
| FIDELIS CARE NY | CATHOLIC HEALTH/ LIFE | COMPLETE SENIOR CARE | ICIRCLE FINGER LAKES | iCIRCLE FINGERLAKES |
| iCIRCLE FINGERLAKES | CENTERS PLAN FOR HEALTHY LIVING | FIDELIS CARE | MVP HEALTH PLAN | INDEPENDENT HEALTH |
| INDEPENDENT HEALTH | FIDELIS CARE NY | ICIRCLE OF FINGER LAKES | NASCENTIA HEALTH | MVP HEALTH PLAN |
| NASCENTRIA HEALTH OPTIONS | ICIRCLE SERVICES FINGER LAKES | INDEPENDENT HEALTH | UNITED HEALTHCARE | NASCENTIA HEALTH |
| UNITED HEALTHCARE | INDEPENDENT HEALTH | MVP HEALTH PLAN | UNIVERA COMM HEALTH | UNITED HEALTH |
| UNIVERA EXCELLUS | NASCENTRIA HEALTH OPTIONS | NASCENTRIA HEALTH | WELLCARE | EXCELLUS HEALTH |
| FIDELIS CARE | ||||
| VNS CHOICE | UNIVERA HEALTHCARE (EXELLUS) | UNITED HEALTH | WELLCARE | |
| WELLCARE | UNITED HEALTH | UNIVERA HEALTHCARE | ||
| VNS CHOICE | VETERAN’S AFFAIRS | |||
| WELLCARE | VNS CHOICE | |||
| YOURCARE HEALTH PLAN, INC | WELLCARE | |||
| FIDELIS CARE | YOURCARE HEALTH PLAN | |||
| BCBS OF WESTERN NY |
Facility
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ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ALLEGANY, LLC
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