Information For Patients

PATIENTS RIGHTS & RESPONSIBILITIES

At Basic Home Infusion we take great care to ensure that the patient’s rights and responsibilities are upheld and maintained. Each professional is trained and aware of the need to provide privacy and maintain each individual’s rights.

Please follow the below links for more in depth information.

Advanced Medical Directives

Home Health Rights

HIPAA

Contact Health Services/JCAHO

ADVANCED MEDICAL DIRECTIVES

Definition “Advanced Directive” - A generic term that relates to the right of individuals to make decisions prior to illness regarding the type of care they would wish to receive as discussed in the Patient Self-Determination Act enacted by Congress as part of the Omnibus Reconciliation Act of 1990. Compliance is mandatory.

Advanced directives include:

Living Will Declaration- Allows the patient to state in advance life-sustaining measures they are to receive should they become terminally ill or in a permanently unconscious state.

Durable Power of Attorney for Health Care- Allows the patient to select someone to make health care decisions for them if they lose the capacity to make decisions. Any adult of sound mind may voluntarily create a valid durable power of attorney for health care.

Resources

You can obtain more information about Advanced Directives from your physician. Forms can also be obtained from:

Your attorney or

The State Department of Health & Senior Services

P.O. Box 360

Trenton, NJ 08625-0360

1-800-792-8820

NEW JERSEY HOME HEALTH RIGHTS

Home care consumers have a right to be notified in writing of their rights and obligations before treatment is begun. The patient’s family or guardian may exercise the patient’s rights when the patient has been judged incompetent. Home care providers have an obligation to protect and promote the rights of their patients.

Personal Rights and Freedoms

You have the right:

• To be treated with dignity, courtesy, consideration, and respect for your person and property

• To auditory and visual privacy in all your care, treatment, communications, and daily activity.

• To be free from restraints unless prescribed by your physician for a limited period of time to protect you or others from injury.

• To be free from mental and physical abuse, and from exploitation

• To expect treatment and service without discrimination based on race, age, religion, national origin, sex, sexual preference, handicap, diagnosis, ability to pay, or source of payment

• To exercise all your constitutional, civil, and legal rights, including religious liberties, the right to independent personal decisions, and the right to give advance instruction for your health care in the even you later become unable to make decisions for yourself.

General Information

You have the right to be informed in writing:

• Of the services available from the agency

• Of the names and professional status of personnel providing and/or responsible for your care

• Of the agency’s daytime and emergency phone number 1-888-822-7428

You have the right:

• To be fully informed, before care begins, of the agency’s ownership and control, as well as the relationships that may bring financial benefit to the agency if you are referred to other organizations, services, or individuals.

• To receive, as soon as possible, the services of a translator or interpreter to help you communicate with health care personnel. In addition, assistance to obtain a special device or other communication aid can be provided

• To be given information about liability insurance designed to cover provider practices

• To access professional on-call staff 24 hour a day, 7 days a week

Participation in Planning Care and Treatment

Before care beings, and throughout the course of your care, you have the right:

• To a clear explanation of your care plan

• To participate in the planning of your care and treatment and any changes in your care plan

• To be informed in writing of the disciplines that will furnish your care, and the proposed frequency of their visits

• To be given a clear explanation of the expected results and reasonable alternatives for care

• To receive the care as ordered in a continuous, consistent, and timely manner

• To guidance for continuing care when services are no longer necessary

If your physician determines that this information would be detrimental to your health or beyond your ability to understand, the explanation will be given to your next of kin or guardian. You may refuse services, including medication and treatment provided by the agency and you will be informed of available home health treatment options, including the option of no treatment, and if possible the benefits and risks of each option. You may refuse to participate in experimental research. If you choose to participate, your written, voluntary informed consent will be obtained. The experimental treatment will be provided only after it has been fully explained in a way that you can understand. You are entitled to discharge yourself from treatment by this agency and have the right to be referred to another agency if you are not satisfied with our services. If this agency cannot meet your needs, you have the right to be told, in advance, of your transfer and when and why care will be stopped.

Confidentiality

You have the right:

• To have your medical record and all information about yourself, your care, and the services you receive from the agency kept confidential.

• To confidentiality concerning your treatment and disclosures

Information in your records will not be released to anyone outside the agency without your written approval, unless it is required by law or by third party contract.

Financial Information

You have the right:

• To be told orally and in writing (before your care starts) about the agency’s fees and charges, whether they are covered by Medicare, Medicaid, health insurance or other sources, and any fees and charges that you may have to pay for services or care not covered by those payment sources

• To be told orally and in writing of any changes in the financial and payment information you were given as soon as the agency is aware of the change (no later than 30 calendar days from the date that the agency became aware of the change)

• To be told full information about the agency’s billing policies, procedures, and referrals systems for financial assistance, and to be given a copy of financial arrangements related to your care

Questions and Concerns

You have the right:

• To receive a clear explanation of how to voice your grievances, and what process the agency will use to resolve your concerns

• To voice grievances and ethical concerns about your care and treatment to recommend changes in policies and services without fear of discrimination or reprisal for having done so

• To voice grievances about lack of respect for property

• To join with others to work for improvements in patient care

Patient/Responsible Person’s Duties and Responsibilities

When you participate in services from Basic Home Infusion, you, your family or designated responsible persons involved in your care agrees to:

• Provide all Basic Home Infusion staff or their designees’ entrance into your home

• Treat Basic Home Infusion staff in a respectable and courteous manner

• Have the patient seen as needed by his/her physician and notify the Basic Home

• Infusion staff of any changes in condition

• Provide a safe environment in which Basic Home Infusion staff can render

• Participate in development of the plan of treatment

• Cooperate in adhering to the developed plan of treatment

• Provide Basic Home Infusion staff with information regarding past and present health status

• Cooperate with Basic Home Infusion’s primary nurse in the completion of the physical assessment

• Cooperate with all supportive therapists and other Basic Home Infusion caregivers

• Report to Basic Home Infusion any physical, psychological changes that would affect the delivery of services

• Provide Basic Home Infusion with information regarding financial status that may affect the provision of health

• Be available at home for scheduled visits or contact Basic Home Infusion in advance when you will not be available for scheduled appointment

THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (“HIPAA”)

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

This Notice of Privacy Protection (the “Notice”) describes the privacy practices of Basic Home Infusion. Basic Home Infusion wants you to know that nothing is more central to our operations than maintaining the privacy of your health information (“Protected Health Information” or “PHI”). PHI is information about you, including basic information that may identify you and relates to your past, present, and future health or condition and the dispensing of pharmaceutical products to you. We take responsibility very seriously.

Our Pledge Regarding Your Health Information

We are required by federal and applicable state law, regulations, and other authorities to protect the privacy of health information and to provide you with this notice. Our pharmacy staff is required to protect the confidentiality of your PHI and will disclose your PHI to a person other than you or your personal representative only when permitted under federal or state law. This protection extends to any PHI that is oral, written, or electronic, such as prescriptions transmitted by facsimile, modem, or other electronic device. This Notice describes how we may use and disclose your PHI. In some circumstances, as described in the Notice, the law permits us to use and disclose your PHI without your express permission. In all other circumstances, we will obtain your written authorization before we use or disclose your PHI.

This Notice also describes your rights and the obligations we have regarding the use and disclosure of your PHI. Under federal and applicable state law, we are required to follow the terms of the Notice currently in effect.

How We May Use and Disclose Your PHI Without Your Authorization

Treatment, Payment, or Health Care Operations

Below are examples of how Federal law permits use or disclosure of your PHI for these purposes without your permission.

Treatment

Dispensing Medications

PHI obtained by Basic Home Infusion will be used to dispense prescription medications. We will document information related to the medications dispensed and services provided in your record.

Patient Contacts

We may contact you to provide treatment-related services.

Payment

We may contact your insurer, payor, or other agent and share your PHI with that entity to determine whether it will pay for your prescription and the payment amount. We may also contact you about a payment or balance due for prescriptions dispensed to you by Basic Home Infusion.

Healthcare Operations

Service

Your PHI may be used to monitor the effectiveness of our services.

Transfer

Your PHI may be transferred for purposes of carrying out the pharmacy services if we buy or sell pharmacy locations.

Other Special Circumstances

We are permitted under federal and applicable state law to use or disclose your PHI without your permission only when certain circumstances may arise, as described below.

We are likely to use or disclose your PHI for the following purposes:

Business Associates

We provide some service through other companies termed “business associates.” Federal law requires us to enter into business associate contracts to safeguard your PHI as requires by Basic Home Infusion and by law.

Individuals involved in your care or payment for care

We may disclose your PHI to a friend, personal representative, or family member involved in your medical care. For example, if we can reasonable infer that you agree, we may provide prescriptions and related information to your caregiver on your behalf.

Disclosure to parents or legal guardians

If you are a minor, we may disclose your PHI to a parent or legal guardian.

As required by law

We must disclose your PHI when required to do so by applicable federal or state law.

Judicial and administrative proceedings

If you are involved in a lawsuit or legal dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful purpose.

Public Health

We may disclose your PHI to federal, state, or local authorities, or other entities charged with preventing or controlling disease, injury, or disability for public health activities. These activities may include the following: disclosures to report reactions to medications or other products to the U.S. Food and Drug Administration or authorized entity; disclosures to notify individuals of recall, exposure to a disease, or risk for contracting or spreading a disease or condition.

Health oversight activities

We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for government monitoring of the health care system, government programs, and compliance with federal and applicable state law.

United States Department of Health and Human Services

Under federal law, we are required to disclose your PHI to the U.S. Department of Health and Human Services to determine if we are in compliance with federal laws and regulations regarding the privacy of health information.

Although we may not engage in the following activities, under federal or applicable state law, we are allowed to use or disclose your PHI, the research project must be approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

Coroners, medical examiners, and funeral directors

We may release your PHI to assist in identifying a deceased person or determine a cause of death.

Administrator or executor

Upon your death, we may disclose your PHI to an administrator, executor, or other individual so authorized under applicable state law.

Organ or tissue procurement organizations

Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

Notification

We may use or disclose your PHI to assist in a disaster relief effort so that your family, personal representative, or friends may be notified about your condition, status, and location.

Correctional Institution

If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents PHI necessary for your health and the health and safety of others.

To avert a serious threat to health or safety

We may use and disclose your PHI to appropriate authorities when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public.

Military and veterans

If you are a member of the armed forces, we may release your PHI as required to military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.

National Security and Intelligence activities

We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective services for the President and others

We may disclose your PHI to authorized federal officials so that they might provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.

How We May Use or Disclose Your PHI for Other Purposes Only With Your Authorization:

We will obtain your written authorization before using or disclosing your PHI for purposes other than those described above (or as otherwise permitted or required by law). You may revoke this authorization at any time by submitting a written notice to our office at the address listed below. Your revocation will become effective upon our receipt of your written notice.

You have the following rights with respect to your PHI:

Obtain a paper copy of the Notice upon admission to service
Inspect and obtain a copy of your PHI
You have the right to access and copy your PHI contained in the “designated record set,” which includes prescription, billing, and nursing records. To inspect or copy your PHI, submit a written request to the pharmacy address listed below. We will respond to your request in writing within 30 days. A fee may be charged for the expense of fulfilling your request. We may deny your request to inspect and copy in certain limited circumstances, such as if we have reasonably determined that providing access to PHI would endanger your life or safety or cause substantial harm to you or another person. If we deny your request, we will notify you in writing and provide you with the opportunity to request a review of the denial.

Request an amendment of PHI

If you feel that your PHI is incomplete or incorrect, you may request that we amend it for as long as we maintain the PHI. To request an amendment, a written request should be sent to the address listed below. Requests must identify: (i) which information you seek to amend, (ii) what corrections you would like to make, and (iii) why the information needs to be amended. We will respond to your request in writing within 60 days (with a possible 30 day extension). In our response we will either: (i) agree to make the amendment, or (ii) inform you of our denial, explain our reason and outline appeal procedures. If denied, you have the right to file a statement of disagreement with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal.

Receive an accounting of disclosures of PHI

After April 14, 2003 you have the right to request an accounting of your PHI disclosures for the purpose other than treatment, payment, or health care operations. This accounting will also exclude disclosures: made directly to you, made with your authorization, made incidentally, made to caregivers, made for notification purposes, and certain other disclosures. To obtain an accounting, submit a written request to the pharmacy address listed below. Requests must specify the time period, not to exceed six years. We will respond to writing within 60 days of receipt of your request (with a possible 30 day extension). We will provide an accounting per 12-month period free of charge, but you may be charged for the cost of any subsequent accountings. We will notify you in advance of the cost involved, and you may choose to withdrawal or modify your request at that time.

Request communications of PHI by alternative means or at alternative locations

You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may request that we contact you only in writing at a specific address. To request confidential communication of your PHI, submit a written request to the address listed below. Your request must state how, where, or when you would like to be contacted. We will accommodate all reasonable requests.

Request a restriction on certain uses and disclosures of PHI

You have the right to request a restriction or limitation on our use or disclosure of your PHI by submitting a written request to the pharmacy address listed below. You must identify in this request (i) what information you would like to limit, (ii) whether you want to limit use, disclosure, or both, and (iii) to whom you want the limits to apply. All requests will be carefully considered but we are not required to agree to those restrictions. We will provide you with a written response to your request within 30 days. If we do agree to restrict use or disclosure of your PHI, we will not apply these restrictions in the event of an emergency. We also have the right to terminate the restriction if: (i) you agree orally or in writing, or we inform you of the termination, which becomes effective only with respect to your PHI created or received after we inform you of the termination.

If you have any questions or complaints, please contact Basic Home Infusion's HIPAA Privacy Officer at:

Basic Home Infusion

1401 Valley Road

Wayne, NJ 07470

Telephone: 1-201-475-0500

Toll Free: 1-888-351-3346

Fax: 1-201-475-9630

CONTACT HEALTH SERVICES

How to file a formal complaint

You may voice a complaint with and/or suggest a change in health care services or staff without being threatened, restrained, or discriminated against. Any complaints may be addressed to:

Roy C. Putrino, RPh. Director of Operations

All information received will be handled confidentially.

Or you may voice any complaint to:

The Joint Commission Office of Quality Monitoring

Email: complain@jointcommission.org

Fax: 630-792-5636

Mail: Office of Quality Monitoring

The Joint Commission

One Renaissance Boulevard

Oakbrook Terrace, Illinois 60181

New Jersey State Board of Pharmacy

Phone: (973) 504-6450

New Jersey State Board of Pharmacy

124 Halsey Street

Newark, NJ 07102

- OR –

Notification regarding the filing of a complaint with:

New Jersey Department of Health

24-hour Complaint Hotline: 1-800-792-8820

Mail: State of New Jersey

Department of Health & Senior Services

P.O. Box 360

Trenton, NJ 08625-0360

FAQ

Service Offerings and Service Cost Coverage

Does my insurance cover your service?

Yes, most insurance policies cover this service. However, since coverage can vary from plan to plan, BHI will help coordinate your coverage.

Are there additional charges that I will have to pay?

No, there are no additional charges. In some cases you’ll even save money since many of BHI’s insurance contracts eliminate the deductibles and drug costs.

How long does it take to get started with service?

Depending on your insurance coverage, authorization takes 2 to 4 weeks.

What kind of experience does the nurse have?

BHI nurses are required to pass an extensive educational program. They become extremely proficient in this therapy through both clinical training and hands-on experience.

Can the nurse come to see me if I am in the hospital?

Yes, the BHI nurse goes anywhere the patient is, schools, day centers, long term care facilities, and rehab facilities are just a few of the locations that our nurses perform refills.

Will BHI be able to provide increases and decreases on the pump?

A BHI trained RN will be able to handle all your increases and decreases in your home. They can also handle additional types of programming including titration, drug changes, concentration changes, bridge bolus and PTM devices.

How will I know if I need a refill?

BHI’s Monitoring Center keeps track of your refills based on your telemetry readings and drug stability.

Who will coordinate the refills?

Your RN will schedule the next refill before they leave your house. BHI will follow-up with you as your alarm date approaches.

Lifestyle and Travel

Can I still do my normal activities with my pump?

Most normal activities are permitted with the SynchroMed Intrathecal Pump, skydiving; hyperbaric chambers, and scuba diving are all prohibited due to the potential changes in pressure. Please call the monitoring center if there is an activity that you would like to perform if you have a question.

Are there any activities that I cannot do because I have a pump?

Patients with pumps cannot sky dive, or go into hyperbaric chambers

Can I scuba dive with the pump?

Scuba diving is contraindicated because of the potential pressure changes that can potentially affect the pump

Can I fly with my SynchroMed Intrathecal Pump?

Yes, individuals can fly with the SynchroMed Intrathecal Pump, but only in a pressurized cabin. When flying the individual should not go through the regular metal detectors they will have to be scanned manually. Each patient should also keep convenient the Medtronic Pump Card given at time of implant to show airport security

Ongoing Medical Treatment

Will I still see my physician?

Yes, you will continue to see your physician regularly. The home care component supplied by BHI will allow your physician to monitor you via our nursing notes.

How often do I need to see my MD?

Each doctor has different ranges of the need for office visits. Some MD’s require every three months, some every month. Your MD will continue to provide with your oral meds. BHI will do the home refills/titrations.

How does my MD know my progress?

Basic Home Infusion makes available to your MD all of the assessment notes and pain scale levels for their patients.  This helps the doctor to know know if the patient needs adjustments or if they are therapeutic (at a good pain level)

Should I have oral medications available in my house just in case?

Yes, we recommend that each individual have oral medications available in case of natural disasters, when we may not be able to get to you.

Does Basic Home Infusion take care of my oral medications?

Basic Home Infusion does only intrathecal medications. Please refer to your physician for any questions or refills regarding your oral medications.

Can I have a CT Scan?

Yes, there are no contraindications with the SynchroMed Pump and CT Scans; you can always call the monitoring center also for this information.

Treatment Concerns

How do I know if I am therapeutic?

When you initially meet the RN along with many other things you and the RN will discuss your pain goal. A pain goal is a realistic number that each patient decides is the best for them to maintain their daily habits. This number is individual and represents the highest level of pain tolerable.

How long does it take for good pain control?

The process can be quick or it can take months to identify the correct dosage for the best pain relief. We need to be very cautious with this type of delivery system. Therefore, we do small increases to obtain the best possible pain relief.

What should I do if I notice warmth or redness over my pump site?

These findings would definitely warrant a call to the monitoring center, these are two red flags of a potential infection

What should I do if I have new or unusual pain?

This would require a call to the monitoring center. Any new or different pain should be relayed to the physician.

Is it typical for me to have more spasms when I have an active urinary tract infection?

Yes, this is a normal finding, many individuals will have increased spasticity with any secondary infections, urinary tract infections, any changes in skin integrity, but as always you should call the monitoring center so that we can let your MD know.

Monitoring Center Questions

How do I reschedule an appointment?

You should call to notify the Monitoring Center when you need to reschedule an appointment. The Monitoring Center will contact your field nurse to notify them of the new date and time. Your nurse will contact you to confirm.

How do I request an increase or decrease in dosage?

You should call the Monitoring Center and speak to an RN. The Monitoring Center RNs will do a phone assessment with you and send a progress note to your MD. Once the Monitoring Center RN gets a response from the MD, they will notify you and your Nurse of what your MD would like carried out.

What do I do if I go on vacation?

Notify your field nurse and/or the Monitoring Center of any scheduled vacations so the appointment can be rescheduled at a different time or location depending on available times.

What do I do if I change doctors?

Contact the Monitoring Center if a doctor change will happen. This is essential for continued communication between your doctor and our company to facilitate quality of care.

What do I do if I get a new pump?

You should notify the Monitoring Center of any scheduled pump replacement. BHI will make every effort to provide the medication and facilitate the pump replacement.

What do I do if I have a scheduled MRI?

You should notify the Monitoring Center or your Field Nurse when an MRI has been scheduled. The magnet in the MRI does make the motor stall in the pump. This is the safety mechanism developed by Medtronic. The BHI nurse must make a visit 2 to 4 hours after the MRI to ensure the motor stall has recovered.