Taconic Health 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) 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.

BEACON –

AETNA
Level 1 – 245
Level 2 – 325
Level 3 – 425

CDPHP
Level 1 – 270
Level 2 – 512
Level 3 – 542

CIGNA
Level 1 – 335
Level 2 – 435
Level – 525
Level 4 – 575

ELDERPLAN
Level 1 – 318
Level 2 – 424.36
Level 3 – 503.93
Level 4 – 668.37

EMPIRE BC
Level 1 – 325
Level 2 – 500
Level 3 – 600

EMPIRE MEDICAID
Level 1 – 290
Level 2 – 340
Level 3 – 440
Level 4 – 540
Custodial – MCD

EVERCARE CHOICE
255.73

EVERCARE SKILLED
Medicare Advantage

FIDELIS
Custodial – 255.73
Level 1 – 275
Level 2 – 300
Level 3 – 400
Level 4 – 500

HAMASPIK
Level 1 – 325
Level 2 – 400
Level 3 – 475
Level 4 – 650

HUMANA
Level 1 – 345
Level 2 – 415
Level 3 – 590

MEDINCREASE
Commercial – 90%
Comp or No Fault – 85%

MULTIPLAN
80%

MVP (COMMERCIAL)
Level A – 371.83
Level B – 451.14
Level C – 530.45
Level D – 584.01
Level E – 796.19

UNITED HEALTHCARE
Medicare/Commercial – 475
Dual Complete (Medicare) – 475
Dual Complete (Mcd) – 285
Dual Complete (Mcd) 255.73

WELLCARE
Level 1 – 275
Level 2 – 325
Level 3 – 375
Level 4 – 425
Level 5 – 600

 

HOPEWELL –

AETNA
Level 1 – 245
Level 2 – 325
Level 3 – 425

CDPHP
Level 1 – 270
Level 2 – 512
Level 3 – 542

CIGNA
Level 1 – 335
Level 2 – 435
Level – 525
Level 4 – 575

ELDERPLAN
Level 1 – 317.28
Level 2 – 424.36
Level 3 – 503.93

EMPIRE BC
Level 1 – 325
Level 2 – 500
Level 3 – 600

EMPIRE MEDICAID
Level 1 – 290
Level 2 – 340
Level 3 – 440
Level 4 – 540
Custodial – MCD

EVERCARE CHOICE
260.28

FIDELIS
Level 1 – Medicaid
Level 2 – 300
Level 3 – 400

HAMASPIK
Level 1 – 325
Level 2 – 400
Level 3 – 475
Level 4 – 650

HUMANA
Level 1 – 345
Level 2 – 415
Level 3 – 590

MEDINCREASE
Commercial – 90%
Comp or No Fault – 85%

MULTIPLAN
80%

MVP (COMMERCIAL)
Level A – 371.83
Level B – 451.14
Level C – 530.45
Level D – 584.01
Level E – 796.19

UNITED HEALTHCARE
Medicare/Commercial – 400
Dual Complete (Medicare) – 400
Dual Complete (Mcd) – 285

WELLCARE
Level 1 – 275
Level 2 – 325
Level 3 – 375
Level 4 – 425
Level 5 – 600

 

ULSTER –

AETNA
Level 1 – 245
Level 2 – 325
Level 3 – 425
Level 4 vent – 610

CDPHP
Level 1 – 270
Level 2 – 512
Level 3 – 542
Level 4 vent 663

ELDERPLAN
Level 1 – 317.28
Level 2 – 424.36
Level 3 – 503.93
Level 4 – 668.37

EMPIRE BC
Level 1 – 325
Level 2 – 500
Level 3 – 600
Level 4 vent – 650

EMPIRE MEDICAID
Level 1 – 290
Level 2 – 340
Level 3 – 440
Level 4 – 540
Level 5 vent – 625
Custodial – MCD

FIDELIS
Level 1 – Medicaid
Level 2 – 300
Level 3 – 400
Level 4 – 500

HAMASPIK
Level 1 – 325
Level 2 – 400
Level 3 – 475
Level 4 – 650

HUMANA
Level 1 – 345
Level 2 – 415
Level 3 – 590
Level 4 vent – 700

MEDINCREASE
Commercial – 90%
Comp or No Fault – 85%

MULTIPLAN
80%

MVP (COMMERCIAL)
Level A – 371.83
Level B – 451.14
Level C – 530.45
Level D – 584.01
Level E – 796.19

UNITED HEALTHCARE
Medicare/Commercial – 400
Dual Complete (Medicare) – 400
Dual Complete (Mcd) – 285

WELLCARE
Level 1 – 275
Level 2 – 325
Level 3 – 375
Level 4 – 425
Level 5 – 600

Facility

VS Servicer at Beacon LLC DBA Taconic Rehabilitation and Nursing at Beacon

Owners

Michael Farbenblum
Stephen Eaton-Mercurio

Landlord

CCP St. Francis 1742 LLC

Landlord Address

c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612

VS Servicer at Fishkill LLC DBA Taconic Rehabilitation and Nursing at Hopewell

Michael Farbenblum
Stephen Eaton-Mercurio

CCP Dutchess 1741 LLC

c/o Sabra Health Care REIT, Inc.
18500 Von Karman Avenue, Suite 550
Irvine, California 92612

VS Servicer at Ulster LLC DBA Taconic Rehabilitation and Nursing at Ulster

Michael Farbenblum
Stephen Eaton-Mercurio

CCP Ulster 1743 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:

Ulster Beacon Dutchess
Analytics Nicholas Aguilera WHC
Copiers, fax Eastern Mang. Print
Dental Dentserv
Dermatology
Electrical PM Duffy/Costa
Emergency Generator PM National Stanby Repair
Environmental and Dietary Services Health Care Service Group Health Care Service Group Health Care Service Group
Fire Alarm Monitoring Empire Alarm
Generator PM H.O. Penn
Inspection – sprinkler system Mid-Hudson Sprinkler
Kitchen Vent System Guardian
Kitchen Vent System Haight
Lab Mid-Hudson Sprinkler
Lab
Lab
Lease – Parking
Life Protection Service Agreement
Life Safety Systems
Medical Director/Physician Services Dr. Chili St Louis Dr. Chili St Louis Dr. Imtiaz Mallick
Pulmonologist
Medical Equipment Hill-Rom Hill-Rom Hill-Rom
Optometry Dr. Jacob Shafran
Patient Monitoring
Pest Control Ehrlich
Pesticide Ehrlich
Pharmacy Consultant Omnicare Omnicare Omnicare
PM – Gas (O2) Systems O2 Solution O2 Solution O2 Solution
Podiatry Dr. Seigel
Portable X-Ray Precision Health, Inc.
Postage Meter Pitney Bowles
Psychiatric Services Dr. Weidel
Referrals Allscripts Allscripts Allscripts
Service Agreement
Snowplow Red Cedar
Staffing – Nursing Ethan Allen
Supplies Medline Medline Medline
Telemedicine
Trash Royal Carting
Utilities – Natural Gas Central Hudson
Phamary Services Omnicare Omnicare Omnicare
Elevator Repair Excel Elevator
Emergency Water supply Troncillitto Brothers
Nuerology Dr. Burshtein
Psychology Dr. Michele Speranza
Woung Care Dr. Allyne Fraser

Beacon HMOs

Aetna
CDPHP
Cigna
Elderplan
Empire BC
Empire Medicaid
Evercare (Elant)
Fidelis
Hamaspik
Humana
MediNcrease
MVP (Commercial)
Medicare pays by PDPM
United Healthcare
Wellcare

Hopewell HMOs

Beacon HMOs

Aetna
CDPHP
Cigna
Elderplan
Empire BC
Empire Medicaid
Evercare (Elant)
Fidelis
Hamaspik
Humana
MediNcrease
MVP (Commercial)
Medicare pays by PDPM
United Healthcare
Wellcare

Ulster HMOs

Beacon HMOs

Aetna
CDPHP
Cigna
Elderplan
Empire BC
Empire Medicaid
Fidelis
Hamaspik
Humana
MediNcrease
MVP (Commercial)
Medicare pays by PDPM
United Healthcare
Wellcare

Facility

Agency

Taconic Rehabilitation and Nursing at Beacon

Ethan Allen Staffing
Norman Staffing
Staff NY LLC

Taconic Rehabilitation and Nursing at Hopewell

Ethan Allen Staffing
Norman Staffing
Staff NY LLC

Taconic Rehabilitation and Nursing at Ulster

Ethan Allen Staffing
Norman Staffing
Staff NY LLC