C-4100, Privacy Notice

Revision 21-4; Effective December 1, 2021 HIPAA requires HHSC to provide a notice of privacy practices that explains:

the person’s privacy rights;

the duties of HHSC to protect the person’s health information; and

how HHSC may use or disclose the person’s health information without an authorization. For example, HHSC may share health information with the person’s providers to: arrange for services; or with other government entities to report suspected abuse or neglect.

Provide Form 0401, Notice of Privacy Practices (English), or Form 0401S, Aviso de Normas Sobre la Privacidad (Spanish), as appropriate, to each household with a person enrolled in a medical program.

Provide Form 0401 or Form 0401S with Form TF0001, Notice of Case Action, to each household enrolled in a medical program:

at initial certification; or

at recertification after a break in services of more than 180 days.

Form 0403, Explanation to Health Information Privacy Rights, provides a reminder of privacy practices and where to locate Form 0401.

Provide Form 0403 with Form TF0001 to each head of household:

at each recertification;

after a break in services of at least 30 days but not more than 180 days; or

when a new person is added to a case.