X

Nursing Home Disclosure Information

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) 650-7750.
  • 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

$617 per day for residency and/or services.

Absolut Care of Allegany

BCBS

Skilled Level 1 – 236.9

Subacute Level 2 – 329.6

Subacute Level 3 – 432.6

 

Amerigroup ST

Level 1 – 236.9

Level 2 – 329.6

Level 3 – 432.6

 

Centers Plan MLTC

3810 – 210.09

3839 – 208.36

 

Fallon MLTC

3810 – 210.09

3839 – 208.36

 

Fidelis MLTC

3810 – 210.09

3839 – 208.36

 

Fidelis Managed Care

Level 1 – 225

Level 2 – 300

Level 3 – 375

Level 4 – 475

Custodial – 210.09

 

Humana

Level 1 – 395

Level 2 – 465

Level 3 – 640

Level 4 – 740

 

iCircle MLTC

Level 1 – 350

Level 2 – 400

Level 3 – 450

Respite – 295

3810 – 210.09

3839 -208.36

 

Kalos MLTC

3810 – 210.09

3839 – 208.36

 

IHA

Managed Medicaid:

Level 1 – 310

Level 2 – 375

3810 – 210.09

3839 – 208.36

 

United Healthcare

Medicare/Commercial – 378

Dual Complete (Medicare) – 378

Dual Complete (Mcd – Americhoice) – 242

Medicaid (Rehab) – 242

Optum (Capitated Rate $400) – 0.01

 

Univera/RMSCO

Skilled – 235

Subacute – 325

Subacute Rehab – 375

 

Veterans

Bed Hold – 204.57

Rehab + Extensive – 691.90

Extensive – 523.63

Rehab – 508.63

Special Care-High – 334.87

Special Care-Low – 324.88

Clinically Complex – 310

Behavior Problems – 218

Reduced Physical Functions – 288.53

 

VNA MLTC

3810 – 210.09

3839 – 208.36

 

Wellcare

3810 – 210.09

3839 – 208.36

Level 1 – 300

Level 2 – 355

Level 3 – 395

Level 4 – 475

Level 5 – 600

 

YourCare/Molina

3810 – 210.09

3839 – 208.36

Level 1 – 250

Level 2 – 350

Level 3 – 400

Absolut Care of Aurora Park

BCBS

Skilled Level 1 – 236.9

Subacute Level 2 – 329.6

Subacute Level 3 – 432.6

 

Aetna

Level 1 – 199

Level 2 – 398

Level 3 – 592

 

Amerigroup ST

Level 1 – 236.9

Level 2 – 329.6

Level 3 – 432.6

 

Centers Plan MLTC

3810 – 251.58

3839 – 249.71

 

Fallon MLTC

3810 – 251.58

3839 – 249.1

 

Fidelis MLTC

3810 – 251.58

3839 – 249.1

 

Fidelis Managed Care

Level 1 – 225

Level 2 – 300

Level 3 – 375

Level 4 – 475

Custodial – 251.58

 

iCircle Services Finger Lakes

Level 1 – 350

Level 2 – 400

Level 3 – 450

Respite – 295

3810 – 251.58

3839 – 249.71

 

IHA Family Choice

Level 1 – 302

Level 2 – 363

ISP Stop Loss

ALF Stop Loss

 

IHA

Level 1 – 302

Level 2 – 363

Managed Medicaid 3810 – 251.58

3839 – 249.71

 

MVP

Level 1 – 275

 

United Healthcare

Medicare/Commercial – 430

Dual Complete (Medicare) –

Dual Complete (Mcd – Americhoice) – 249.71

Medicaid (Rehab) – 270

Optum (Capitated Rate $410) – 0.01

 

Univera/RMSCO

Med Adv & Commercial:

Skilled – 235

Subacute – 325

Subacute-Rehab – 375

 

VNA MLTC

3810 – 251.58

3839 – 249.71

 

VNS MLTC

3810 – 251.58

3839 – 249.71

 

Wellcare

3810 – 251.58

3839 – 249.71

Level 1 – 300

Level 2 – 355

Level 3 – 395

Level 4 – 475

Level 5 – 600

 

YourCare/Molina

3810 – 251.58

3839 – 249.71

Level 1 -250

Level 2 – 350

Level 3 -400

 

Absolut Care of Gasport

BCBS

Medicaid HMO (Custodial)

Skilled (Level 1) – 236.90

Subacute (Level 2) – 329.60

Subacute (Level 3) – 432.60

 

Aetna

Level 1 – 199

Level 2 – 398

Level 3 – 592

 

Amerigroup

Level 1 – 236.90

Level 2 -329.60

Level 3 -432.60

 

Centers Plan MLTC

3810 – 222.82

3839 -220.90

 

Complete Senior Care LT

3810 – 222.82

3839 – 220.90

Subacute – 370

Respite – 225

 

Elderwood MLTC

3810 – 222.82

3839 – 220.90

 

Fallon MLTC

3810 – 222.82

3839 – 220.90

 

Fidelis MLTC

3810 – 222.82

3839 – 220.90

 

Fidelis Managed Care

Level 1 – 225

Level 2 – 300

Level 3 – 375

Level 4 – 475

Custodial – 222.82

 

iCircle MLTC

Level 1 – PDPM

Level 2 – PDPM

Level 3 -PDPM

Respite – N/A

3810 – 222.82

3839 – 220.90

 

Kalos MLTC

3810 – 222.82

3839 – 220.90

 

IHA Family Choice

Level 1 – 302

Level 2 – 363

ISP Stop Loss

ALF Stop Loss

 

IHA

Level 1 – 370

Level 2 – 460

3810 – 222.82

3839 – 220.90

 

United Healthcare

Medicare/Commercial – 410

Dual Complete (Medicare)

Dual Complete (Mcd – Americhoice)

Medicaid (Rehab) – 270

Optum (Capitated Rate N/A) – 0.01

 

Univera/RMSCO

Med Adv & Commercial:

Skilled – 235

Subacute – 325

Subacute-Rehab – 375

 

VNA MLTC

3810 – 222.82

3839 – 220.90

 

Veterans

Bed Hold – 191.18

Rehab + Extensive – 633

Extensive – 578

Rehab – 551

Special Care-High – 403

Special Care-Low – 374

Clinically Complex – 323

Behavior Problems – 281

Reduced Physical Functions – 281

 

Wellcare

3810 – 222.82

3839 – 220.90

Level 1 – 300

Level 2 – 355

Level 3 – 395

Level 4 – 475

Level 5 – 600

 

YourCare/Molina

3810 – 222.82

3839 – 220.90

Level 1 – 250

Level 2 – 350

Level 3 – 400

 

Absolut Care of Three Rivers

BCBS

Skilled Level 1 – 236.9

Subacute Level 2 – 329.6

Subacute Level 3 – 432.6

 

Aetna

Level 1 – 199

Level 2 – 398

Level 3 – 592

 

Amerigroup ST

Level 1 – 236.9

Level 2 – 329.6

Level 3 – 432.6

 

Fidelis MLTC

3810 – 221.92

3839 – 220.04

 

Fidelis Managed Care

Level 1 – 225

Level 2 – 300

Level 3 – 375

Level 4 – 475

Custodial – 221.92

 

iCircle

Level 1 – 350

Level 2 – 400

Level 3 – 450

Respite – 295

3810 – 221.92

3839 – 220.04

 

Humana

Level 1 – 395

Level 2 – 465

Level 3 – 640

Level 4 – 740

 

Molina

Level 1 – 250

Level 2 – 350

Level 3 – 400

 

MVP

Level 1 – 210

Level 2 – 300

 

United Healthcare

Medicare/Commercial – 350

Dual Complete (Medicare)

Dual Complete (Mcd – Americhoice)

Medicaid (Rehab) – 232

Optum (Capitated Rate $410) – 0.01

 

VNA MLTC

3810 – 221.92

3839 – 220.04

 

Wellcare

3810 – 227.25

3839 – 233.53

Level 1 – 300

Level 2 – 355

Level 3 – 395

Level 4 – 475

Level 5 – 600

 

YourCare/Molina

3810 – 221.92

3839 – 220.04

Level 1 -250

Level 2 – 350

Level 3 -400

 

Absolut Care of Westfield

BCBS

Medicaid HMO (Custodial)

Skilled Level 1 – 236.9

Subacute Level 2 – 329.6

Subacute Level 3 – 432.6

 

Aetna

Level 1 – 199

Level 2 – 398

Level 3 – 592

 

Amerigroup ST

Level 1 – 236.9

Level 2 – 329.6

Level 3 – 432.6

 

Fidelis MLTC

3810 – 216.28

3839 – 214.50

 

Fidelis Managed Care

Level 1 – 225

Level 2 – 300

Level 3 – 375

Level 4 – 475

Custodial – 216.28

 

iCircle MLTC

Level 1 – 350

Level 2 – 400

Level 3 – 450

Respite – 295

3810 – 216.28

3839 – 214.50

 

Humana

Level 1 – 395

Level 2 -465

Level 3 – 640

Level 4 – 740

 

IHA

Level 1 – 310

Level 2 – 375

3810 – 216.28

3839 – 214.50

 

Kalos MLTC

3810 – 216.28

3839 – 214.50

 

United Healthcare

Medicare/Commercial – 400

Dual Complete (Medicare)

Dual Complete (Mcd – Americhoice)

Medicaid (Rehab) – 233

Optum (Capitated Rate $410) – 0.01

 

Univera/RMSCO

Skilled – 235

Subacute – 325

 

VNA MLTC

3810 – 216.28

3839 – 214.50

 

Wellcare

3810 – 216.28

3839 – 214.50

Level 1 – 300

Level 2 – 355

Level 3 – 395

Level 4 – 475

Level 5 – 600

 

YourCare/Molina

3810 – 216.28

3839 – 214.50

Level 1 -250

Level 2 – 350

Level 3 -400

Facility

ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ALLEGANY, LLC

Owners

Israel Sherman, Samuel Sherman

Landlord

2178 N. Fifth Street, LLC

Landlord Address

c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT AURORA PARK, LLC
Israel Sherman, Samuel Sherman
292 Main Street, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT GASPORT, LLC
Israel Sherman, Samuel Sherman
4540 Lincoln Drive, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT THREE RIVERS, LLC
Israel Sherman, Samuel Sherman
101 Creekside Drive, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT WESTFIELD, LLC
Israel Sherman, Samuel Sherman
26 Cass Street, LLC
c/o The ARBA Group
6300 Wilshire Boulevard, Suite 1800
Los Angeles, CA 90048
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, PCDermatology
255 Greenwich Medical Services, PCOptometry
292 Main Street, LLCLease – Operating
Advantage Funding Commercial CapitalTransport – Mini Bus
ADVO WasteMedical Waste Disposal
All State Fire and SecurityPM – Fire Alarm System Testing and Inspection: Hand Portable, Kitchen Fire Systems, Fire Alarm, Sprinkler
American HealthTechSoftware Agreement
Busy BeaverLandscaping Services
Catholic HealthLab – Covid
CHEPsychological Services
DanforthHVAC/Plumbing Services
DentservDental Services
Dialyze DirectDialysis
EcolabDish machine Rental
Ferguson ElectricElectrical Service
FFAEArchitectural Services
Forefront BehavioralPsychological Services
General Physicians, PCMedical Director/Physician Services
H&R HealthcareBilling
Health System ServicesPart B Supplier
Hudson EnergyEnergy Supply
Lehigh ConstructionBuilding Services
Liberty RC, IncDialysis
M and M AsphaltSnow Plowing
MedlineSupplies
Mobile Dysphagia Diagnostics Speech Language Swallowing ServicesFEES
Modern DisposalWaste Disposal
Nova Healthcare Solutions
OtisPM – Elevators
PDIPortable X-ray
Penn PowerPM – Generators
Pitney BowesPostage Meter
ProcarePharmacy
Pure Life RenalDialysis
SRXPharmacy
The Browne CompanyRoof Consulting Services
Tri R MechanicalRefrigeration Services
US FoodsFood
US FoodsFood
Vital Healthcare SolutionsDiabetic Services
AlleganyAurora ParkGasportThree RiversWestfield
EMPIRE BCBS AMERIGROUPBCBS OF WESTERN NYCENTERS PLAN FOR HEALTHY LIVINGFIDELIS CAREFIDELIS
FIDELIS CARE NYCATHOLIC HEALTH/ LIFECOMPLETE SENIOR CAREICIRCLE FINGER LAKESiCIRCLE FINGERLAKES
iCIRCLE FINGERLAKESCENTERS PLAN FOR HEALTHY LIVINGFIDELIS CAREMVP HEALTH PLANINDEPENDENT HEALTH
INDEPENDENT HEALTHFIDELIS CARE NYICIRCLE OF FINGER LAKESNASCENTIA HEALTHMVP HEALTH PLAN
NASCENTRIA HEALTH OPTIONSICIRCLE SERVICES FINGER LAKESINDEPENDENT HEALTHUNITED HEALTHCARENASCENTIA HEALTH
UNITED HEALTHCAREINDEPENDENT HEALTHMVP HEALTH PLANUNIVERA COMM HEALTHUNITED HEALTH
UNIVERA EXCELLUSNASCENTRIA HEALTH OPTIONSNASCENTRIA HEALTHWELLCAREEXCELLUS HEALTH
FIDELIS CARE
VNS CHOICEUNIVERA HEALTHCARE (EXELLUS)UNITED HEALTHWELLCARE
WELLCAREUNITED HEALTHUNIVERA HEALTHCARE
VNS CHOICEVETERAN’S AFFAIRS
 
 WELLCAREVNS CHOICE
 
 YOURCARE HEALTH PLAN, INCWELLCARE
 
 FIDELIS CAREYOURCARE HEALTH PLAN
 BCBS OF WESTERN NY