The McGuire Group Notice of Privacy Practices
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) 826-2010.
- 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
$599 per day for residency and/or services.
$725 per day for residency and/or services at our East Patchogue, NY facility.
Autumn View Health Care Facility
BCBS
Medicaid HMO – 308.95
Skilled Level 1 – 339.58
Subacute Level 2 – 445.71
Subacute Level 3 – 551.83
Subacute Level 4 – 551.83
Amerigroup
Custodial – 236.24
Level 1 – 309.43
Level 2 – 365.25
CHS Pace
Respite – 260.10
Custodial – 235
Rehab – 425
Fallon
MLTC – 240.87
PACE – PDPM
Respite – 240.87
Humanna
Level 1 – 395
Level 2 – 465
Level 3 – 630
Level 4 – 740
iCircle
MLTC – 264.96
Kalos
MLTC – 240.87
Family Choice
Level 1 – 378
Level 2 – 467
ISP Stop Loss – 350
ALF Stop Loss – 400
IHA
Skilled – 389
Subacute – 481
Subacute – Rehab Pilot – 3,550
Custodial – 240.87
GHI
Level 1 Skilled – 396
Level 2 Rehab – 375
Level 3 Subacute Rehab – 425
Med Advantage:
Level 1 Skilled – 285
Level 2 Rehab – 375
Level 3 Subacute Rehab – 425
Magnacare
Level 1 Skilled Nursing or Restorative – 478
Level 2 Rehab Low – 478
Level 3 Rehab Medium – 478
Level 4 Rehab High – 478
United Healthcare
Medicare/Commercial – 480
Dual Complete (Medicare) – 480
Dual Complete (Medicaid – Americhoice) – 232.64
Medicaid – 338
Univera
Med Adv:
Skilled – PDPM
Subacute – PDPM
Subacute-Rehab – PDPM
Commercial/Special:
Skilled – 341/311
Subacute – 435/396
Subacute-Rehab – 495/451
VNA (Nascentria)
MLTC – 240.87
Wellcare
MLTC – 240.87
Level 1 – 300
Level 2 – 350
Level 3 – 400
Level 4 – 475
Level 5 – 600
Veterans
PDPM
Brookhaven
Aetna
Level 1 – 375
Level 2 – 375
Level 3 – 400
Level 4 – 520
Empire BC
Level 1 – 400
Level 2 – 575
Level 3 – 675
Complex Care – 775
GHI
Commercial:
Level 1 Skilled – 295
Level 2 Rehab – 375
Level 3 Subacute Rehab – 425
Med Advantage
Level 1 Skilled – 285
Level 2 Rehab – 375
Level 3 Subacute Rehab – 425
HealthFirst
Level 1 – 325
Level 2 – 425
Level 3 – 500
Level 4 – 700
Heritage HP
Level 1 – 265
Level 2 – 345
Level 3 – 375
HIP & VYTRA
Level 1 – 305
Level 2 – 375
Level 3 – 400
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 640
Level 4 – 740
Magnacare
Level 1 Skilled Nursing or Restorative – 478
Level 2 Rehab Low – 478
Level 3 Rehab Medium – 478
Level 4 Rehab High – 478
Optum (part A)
MLTC – 294.98
Level 1 – 300
Level 2 – 350
Level 3 – 400
Level 4 – 475
Level 5 – 600
Oxford
Level 1 – 275
Level 2- 325
United Healthcare
Level 1 – 300
Level 2 – 380
Vytra
Level 1- 325
Level 2 – 440
US Fam Health Plan
Level 1 – 248
Level 2 – 396
Level 3 – 396
Garden Gate Health Care Facility
BCBS
Medicaid HMO – 308.95
Skilled Level 1 – 339.58
Subacute Level 2 – 445.71
Subacute Level 3 – 551.83
Level 4 – 551.83
Amerigroup
Custodial – 236.24
Level 1 – 309.43
Level 2 – 365.25
CHS Pace
Respite – 235
Custodial 235
Rehab – 425
Fallon
MLTC – 235.60
PACE – PDPM
Respite – 235.60
iCircle
MLTC – 259.16
Kalos
MLTC – 235.60
Family Choice
Level 1 – 378
Level 2 – 467
ISP Stop Loss – 350
ALF Stop Loss – 400
IHA
Skilled – 389
Subacute – 481
Subacute – Rehab Pilot – 3,550
Custodial 235.60
GHI
Level 1 Skilled – 295
Level 2 Rehab – 375
Level 3 Subacute Rehab –
Level 1 Skilled –
Level 2 Rehab – 396
Level 3 Subacute Rehab – 425
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 630
Level 4 – 740
Magnacare
Level 1 Skilled Nursing or Restorative – 478
Level 2 Rehab Low – 478
Level 3 Rehab Medium – 478
Level 4 Rehab High – 478
United Healthcare
Medicare/Commercial – 475
Dual Complete (Medicare) – 475
Dual Complete (Medicaid – Americhoice) – 232.64
Medicaid – 338
Univera
Med Adv:
Skilled – PDPM
Subacute – PDPM
Subacute-Rehab – PDPM
Commercial/Special:
Skilled – 341/311
Subacute – 435/396
Subacute-Rehab – 495/451
VNA (Nascentria)
MLTC – 240.93
Wellcare
MLTC – 235.60
Level 1 – 300
Level 2 – 350
Level 3 – 400
Level 4 – 475
Level 5 – 600
Veterans
PDPM
Harris Hill Nursing Facility
BCBS
Medicaid HMO – 308.95
Skilled Level 1 – 339.58
Subacute Level 2 – 445.71
Subacute Level 3 – 551.83
Subacute Level 4 – 551.83
Amerigroup
Custodial – 222.81
Level 1 – 309.43
Level 2 – 365.25
CHS Pace
Respite – 235
Custodial – 235
Rehab – 425
Fallon
MLTC – 323.28
PACE – PDPM
Respite – 223.28
iCircle
MLTC – 345.61
Kalos
MLTC – 323.28
Family Choice
Level 1 – 378
Level 2 – 467
ISP Stop Loss – 350
ALF Stop Loss – 400
IHA
Skilled – 389
Subacute – 481
Subacute – Rehab Pilot – 3,550
Custodial – 223.28
GHI
Level 1 Skilled – 295
Level 2 Rehab – 375
Level 3 Subacute Rehab –
Level 1 Skilled –
Level 2 Rehab – 396
Level 3 Subacute Rehab – 425
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 630
Level 4 – 740
Magnacare
Level 1 Skilled Nursing or Restorative – 478
Level 2 Rehab Low – 478
Level 3 Rehab Medium – 478
Level 4 Rehab High – 478
Molina
Level 1 – 250
Level 2 – 350
Level 3 – 400
United Healthcare
Medicare/Commercial – 475
Dual Complete (Medicare) – 475
Dual Complete (Medicaid – Americhoice) – 232.64
Medicaid – 338
Univera
Med Adv:
Skilled – PDPM
Subacute – PDPM
Subacute-Rehab – PDPM
Special/Commercial:
Skilled – 341/311
Subacute – 435/396
Subacute-Rehab – 495/451
VNA (Nascentria)
MLTC – 230.62
Wellcare
MLTC – 223.28
Level 1 – 300
Level 2 – 350
Level 3 – 400
Level 4 – 475
Level 5 – 600
Veterans
PDPM
Northgate Health Care Facility
BCBS
Medicaid HMO – 308.95
Skilled Level 1 – 339.58
Subacute Level 2 – 445.71
Subacute Level 3 – 551.83
Level 4 – 551.83
Amerigroup
Custodial – 227.59
Level 1 – 309.43
Level 2 – 365.25
Complete Sr. Care Pace
Respite – 245
Custodial 231.35
Rehab – 400
Fallon
MLTC – 232.03
PACE – PDPM
Respite – 232.03
iCircle
MLTC – 255.23
Kalos
MLTC – 232.03
Family Choice
Level 1 – 378
Level 2 – 467
ISP Stop Loss – 350
ALF Stop Loss – 400
IHA
Skilled – 389
Subacute – 481
Covid Positive – 500
Subacute – Rehab Pilot – 3,550
Custodial – 232.03
GHI
Level 1 Skilled – 295
Level 2 Rehab – 375
Level 3 Subacute Rehab –
Level 1 Skilled –
Level 2 Rehab – 396
Level 3 Subacute Rehab – 425
Humana
Level 1 – 395
Level 2 – 465
Level 3 – 630
Level 4 – 740
Magnacare
Level 1 Skilled Nursing or Restorative – 478
Level 2 Rehab Low – 478
Level 3 Rehab Medium – 478
Level 4 Rehab High – 478
United Healthcare
Medicare/Commercial – 475
Dual Complete (Medicare) – 475
Dual Complete (Medicaid – Americhoice) – 232.64
Medicaid – 338
Optum – 0.01
Univera /RMSCO
Med Adv:
Skilled – PDPM
Subacute – PDPM
Subacute-Rehab – PDPM
Special/Commercial:
Skilled – 341/311
Subacute – 435/396
Subacute-Rehab – 495/451
VNA (Nascentria)
MLTC – 236.02
Wellcare
MLTC – 232.03
Level 1 – 300
Level 2 – 350
Level 3 – 400
Level 4 – 475
Level 5 – 600
Veterans
PDPM
Seneca Health Care Center
BCBS
Medicaid HMO – 308.95
Skilled Level 1 – 339.58
Subacute Level 2 – 445.71
Subacute Level 3 – 551.83
Level 4 – 551.83
Amerigroup
Custodial – 224.25
Level 1 – 309.43
Level 2 – 365.25
CHS Pace
Respite – 235
Custodial 235
Rehab – 425
Fallon
MLTC – 232.29
PACE – PDPM
Respite – 232.29
iCircle
MLTC – 255.52
Kalos
MLTC – 232.29
Family Choice
Level 1 – 378
Level 2 – 467
ISP Stop Loss – 350
ALF Stop Loss – 400
IHA
Skilled – 389
Subacute – 481
Subacute – Rehab Pilot – 3,550
Custodial – 232.29
GHI
Level 1 Skilled – 295
Level 2 Rehab – 375
Level 3 Subacute Rehab –
Level 1 Skilled –
Level 2 Rehab – 396
Level 3 Subacute Rehab – 425
Magnacare
Level 1 Skilled Nursing or Restorative – 478
Level 2 Rehab Low – 478
Level 3 Rehab Medium – 478
Level 4 Rehab High – 478
United Healthcare
Medicare/Commercial – 485
Dual Complete (Medicare) – 485
Dual Complete (Medicaid – Americhoice) – 232.64
Medicaid – 338
Univera /RMSCO
Med Adv:
Skilled – PDPM
Subacute – PDPM
Subacute-Rehab – PDPM
Commercial/Special:
Skilled 341/311
Subacute 435/396
Subacute-Rehab 495/451
VNA (Nascentria)
MLTC – 240.16
Wellcare
MLTC – 232.29
Level 1 – 300
Level 2 – 350
Level 3 – 400
Level 4 – 475
Level 5 – 600
Veterans
PDPM
Facility
Autumn View Health Care Facility, LLC
Owners
Edward Farbenblum, Orly Lieberman, Vestra SPV1 LLC, Vestra SPV2 LLC.
Landlord
CCP AUTUMN VIEW 7580 LLC
Landlord Address
c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612
Garden Gate Health Care Facility, LLC
Edward Farbenblum, Orly Lieberman, Vestra SPV1 LLC, Vestra SPV2 LLC.
CCP GARDEN GATE 7583 LLC
c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612
Harris Hill Nursing Facility, LLC
Edward Farbenblum, Orly Lieberman, Vestra SPV1 LLC, Vestra SPV2 LLC.
CCP HARRIS HILL 7582 LLC
c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612
North Gate Health Care Facility, LLC
Edward Farbenblum, Orly Lieberman, Vestra SPV1 LLC, Vestra SPV2 LLC.
CCP NORTH GATE 7584 LLC
c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612
Seneca Heath Care Center, LLC
Edward Farbenblum, Orly Lieberman, Vestra SPV1 LLC, Vestra SPV2 LLC.
CCP SENECA 7585 LLC
c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612
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 | Dermatology |
| 255 Greenwich Medical Services | Optometry |
| 255 Greenwich Medical Services | Podiatry |
| Allscripts | Referrals |
| Allscripts | Referrals |
| Apollo Fire Safety | Inspection – sprinkler system |
| Brookhaven Memorial Hospital Medical Center | Lab |
| Catholic Health Laboratory Services | Lab |
| Catholic Health Laboratory Services | Lab |
| Coastal Cleaning Solutions | Kitchen Vent System |
| Copier Fax | Copiers, fax |
| Copier Fax | Copiers, fax |
| Crothall Healthcare Technologies Solutions | PM – Gas (O2) Systems |
| Danforth | Service Agreement |
| David Pawlowski, MD | Medical Director/Physician Services |
| DentServ | Dental |
| DentServ | Dental |
| EarlySense | Patient Monitoring |
| Eastern Portable X-ray | Portable X-Ray |
| EnergyMark, LLC | Utilities – Natural Gas |
| Favorite | Staffing – Nursing |
| Ferguson Electric | Electrical PM |
| Formal Maintenance Services | Kitchen Vent System |
| Geriatric Associates | Medical Director/Physician Services |
| Great Lakes | Life Protection Service Agreement |
| Great Lakes Building Systems | Life Safety Systems |
| Guardian Consulting Services | Pharmacy Consultant |
| Integra | Analytics |
| Johnson Controls | Fire Alarm Monitoring |
| L and M Stone | Snowplow |
| Medline | Supplies |
| Medline | Supplies |
| Moblile Telemed | Telemedicine |
| Modern Disposal | Trash |
| Murata Vios Inc | Patient Monitoring |
| Niagara Landscaping | Snowplow |
| Penn Power | Emergency Generator PM |
| Pitney Bowes | Postage Meter |
| Power Pro Services | Generator PM |
| Preventive Diagnostics Inc | Portable X-Ray |
| Suburban Pest Control | Pest Control |
| Tru Green | Pesticide |
| University Psychiatric Practice | Psychiatric Services |
| William Held | Lease – Parking |
| Zerline Snyderman | Medical Director/Physician Services |
|
Facility
Agency
Autumn View Health Care Facility, LLC
Alliance
Care Stat
Favorite
Clinical Staffing
SambaCare
Brookhaven Health Care Facility, LLC
No Agency
Garden Gate Health Care Facility, LLC
Alliance
Care Stat
Favorite
Clinical Staffing
Harris Hill Nursing Facility, LLC
No Agency
Northgate Health Care Facility, LLC
Alliance
Care Stat
Favorite
Seneca Heath Care Center, LLC
Alliance
Care Stat
Favorite
Clinical Staffing