HIPAA Compliance Office

Welcome to the Agency for Health Care Administration's HIPAA Compliance Office. Our primary function is to advise and assist the Agency in its compliance efforts and to assist Medicaid recipients in exercising their rights as provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This includes making sure that all AHCA employees safeguard the privacy of any Protected Health Information (PHI) in our custody.

HIPAA, AHCA and You

If you are a Medicaid recipient, the HIPAA Compliance Office can assist you or your authorized representative in obtaining your Medicaid claims information and in exercising your rights under HIPAA. For a detailed description of your rights, as well as information on how Medicaid may use your Protected Health Information (PHI), please see The Agency for Health Care Administration Notice of Privacy Practices.

The following forms are available to assist you with requesting your health information maintained by the agency and to exercise your rights provided by HIPAA.

1. Access Forms: Complete and submit this form to request copies of your or your child’s health information.
   • Access Form [152 KB, PDF]
     • Spanish Version [132 KB, PDF]
2. Authorization Forms: Complete and submit this form to allow someone else access to your health information.
   • Authorization Form [181 KB, PDF]
     • Spanish Version [181 KB, PDF]
3. Accounting of Disclosures Forms: Complete and submit this form to see who the Agency has shared your health information with for purposes other than treatment, payment, or health care operations.
   • Accounting of Disclosures Form [144 KB, PDF]
     • Spanish Version [146 KB, PDF]
4. Restriction Request Forms: Complete and submit this form to restrict with whom the Agency shares your health information.
   • Restriction Request Form [180 KB, PDF]
     • Spanish Version [156 KB, PDF]
5. Request to Receive Confidential Communications at an Alternative Location Forms: Complete and submit this form to request the Agency send your health information to a location other than your address on file. If you need to change/update your address on file, you must contact the Department of Children and Families.
   • Alternative Location Form [123 KB, PDF]
     • Spanish Version [124 KB, PDF]

HIPAA Questions and Complaints

Our Agency, including our Medicaid Area Offices, does not have the authority to advise non-AHCA personnel on any HIPAA related issues. All such questions should be directed to the Office for Civil Rights HIPAA Website: https://www.hhs.gov/hipaa/index.html, or contact them at 1-866-627-7748 or 1-800-368-1019. Included on this site are the Privacy Rule, Frequently Asked Questions and directions on how to file a HIPAA complaint.

The following is a list of commonly asked questions that should be directed to the Office for Civil Rights:

• What is HIPAA, and what are my rights?
• How do I file a HIPAA complaint against my health care provider?
• What do I do if my doctor will not give me my medical records?
• If I am a health care provider, how do I comply with HIPAA?

Please Note: If you feel that an AHCA employee has violated HIPAA, in addition to contacting the Office for Civil Rights, please notify AHCA's HIPAA Compliance Office at (850) 412-3960.

• If you wish to file a general complaint against a health care provider or facility please contact the AHCA Consumer Hotline at 1-888-419-3456.
• To make a public records request, including facility complaint files, please contact the Public Records Coordinator at (850) 412-3688.
• For all other concerns or questions that do not relate to HIPAA please contact your local area Medicaid office.