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
Autumn View Brookhaven Garden Gate Harris Hill North Gate Seneca
Blue Cross/Blue Shield AETNA Blue Cross/Blue Shield Blue Cross/Blue Shield Blue Cross/Blue Shield Blue Cross/Blue Shield
AMERIGROUP Empire BC Amerigroup AMERIGROUP Amerigroup AMERIGROUP
CHS PACE GHI Commercial CHS PACE CHS PACE Comple Sr Care PACE CHS PACE
(Emblem)
FALLON Weinberg MLTC Fallon Weinberg MLTC Fallon Weinberg MLTC Fallon Weinberg MLTC AETNA
Heritage HP
iCIRCLE iCircle iCircle iCircle iCircle
HIP & VYTRA
KALOS Kalos Kalos Kalos Kalos
Magnacare Network
FAMILY CHOICE IHA Family Choice IHA Family Choice IHA Family Choice IHA Family Choice
Oxford
Independent Health Independent Health Independent Health Independent Health Independent Health
United Healthcare
Medisource Medisource Medisource Medisource Medisource
Vytra
GHI Commercial GHI Commercial GHI Commercial GHI Commercial GHI Commercial
(Emblem) US Fam Health Plan (Emblem) (Emblem) (Emblem) (Emblem)
MAGNACARE Network Wellcare Magnacare Network Magnacare Network Magnacare Network Magnacare Network
UNITED HEALTHCARE SUNRISE United Healthcare United Healthcare United Healthcare United Healthcare
UNIVERA / RMSCO Univera / RMSCO Univera / RMSCO Univera / RMSCO Univera / RMSCO
VNA (NASCENTRIA) VNA (Nascentia) VNA (Nascentia) VNA (Nascentia) VNA (Nascentia)
WELLCARE Wellcare Wellcare Wellcare Wellcare
VETERANS Veterans Veterans Veterans Veterans

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