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Department of Elementary and Secondary Education
Office of Special Education

Privacy Notice/HIPAA/Applicable to Families who are Medicaid Eligible

Effective April 14, 2003

THIS NOTICE DESCRIBES HOW YOUR CHILD'S MEDICAL INFORMATION (MEDICAID BILLING FOR SERVICES WE PROVIDE TO YOUR CHILD) MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice applies to any Medicaid billing information that we have about your child. This Medicaid billing information is considered protected health information under the Health Insurance Portability and Accountability Act (HIPAA), unlike your child's educational records, which are not considered protected health information under HIPAA, but are protected as confidential under the Family Educational Rights and Privacy Act (FERPA). With some exceptions, we must obtain your authorization to disclose (or release) such protected health care information. There are some situations in which we do not have to obtain your authorization. We can, for instance, share the protected information with the state Medicaid agency, without your permission. If you have any questions, please contact our Privacy Officer.

Who has access to protected Medicaid billing information?

Medicaid billing information will be used to submit bills to Medicaid.

Without your permission, we may use your Medicaid billing information:

Without your permission, we may use your Medicaid billing information:

What are your rights?

  • To know to whom we have sent Medicaid billing information about your child for up to the last six years.  The first request in a 12 month period is free. We may charge you for additional requests.
  • To limit how we use or disclose Medicaid billing information about your child. For example - not to release information to your spouse or a particular provider agency. This must be made in writing, and we are not required to agree to the request.
  • To have a paper copy of this notification of our Privacy Practices.
  • To file a complaint if you believe any of your rights have been violated. All complaints must be in writing.  You will not be penalized if you file a complaint.

If you wish to exercise any of these rights, or to file a complaint, you should contact the Privacy Officer, for the program your child is enrolled in, or you may file a complaint with the Secretary of the United States Health and Human Services Department.

Privacy Officer:
Missouri Schools for the Severely Disabled (MSSD): Archie Derboven, Superintendent, Department of Elementary and Secondary Education, Missouri Schools for the Severely Disabled, 205 Jefferson Street, Jefferson City, MO 65102-0480, (573) 751-4427.


Revised:  July 2010