The Freedom of Information Act (FOIA), found in Title 5 of the United States Code, section 552, was enacted in 1966 and provides that, upon request from any person, a Federal agency or Federal Contractor must release any record unless that record falls within one of the nine statutory exemptions and three exclusions. The FOIA binds only Federal agencies, and covers only records in the possession and control of federal agencies.

How to Make a FOIA Request

Any individual may submit a FOIA request to Highmark Medicare Services by mail, fax, or in person. We will not accept telephone requests.

Making a written FOIA request is easy. You may print the FOIA form located on the Highmark Medicare Services internet site. Complete the form, sign it, and either mail it or fax it to the address/fax number listed below. You are not required to use this form. The form is offered as a courtesy and/or as a guide to assist you in providing a complete and valid FOIA request.

PA Part A	PA Part B	MD/DC Part A
Highmark Medicare Services	Highmark Medicare Services	Highmark Medicare Services
FOIA	FOIA	FOIA
Post Office Box 890385	Post Office Box 890700	Post Office Box 890386
Camp Hill, PA 17089-0385	Camp Hill, PA 17089-0700	Camp Hill, PA 17089-0386
Fax: (717) 302-3748	Fax: (717) 302-3748	Fax: (717) 302-3748

A request can be written on personal or business letterhead or on plain bond paper. Mark both the envelope and its contents: "FREEDOM OF INFORMATION ACT REQUEST." Do not include a return envelope or a check or any type of payment with your initial request. If processing fees apply, an invoice will be issued to you.

Within your request, identify the record(s) that you want. If you do not know the exact title of the record(s), you should provide a reasonable description of the record. The more details that you can provide about the record, such as its author, date, subject matter and location, if you know them, the better. Not having a good description could delay our response or prevent us from finding the records you want. We may ask you to clarify your request if we need more information to find the record(s).

FOIA Fees

FOIA authorizes us to assess the following three levels of fees: search fees, review fees and photocopying fees. The fees that we assess for a given request, however, are based upon the category of FOIA requester as detailed under the following fee categories.

Fee Categories - For fee purposes, the FOIA requires that requesters be placed in one of the following three categories: (1) commercial use requesters; (2) educational and scientific institutions and news media, and (3) all others.

In line with FOIA, we charge commercial use requesters the costs of search, review and duplication, associated with processing their requests. We charge scientific, educational, and news media requesters the cost of duplication only, except that we provide the first 100 pages free of charge. We charge all other requesters the costs of search and duplication, except that the first two hours of search and the first 100 pages of duplications are free of charge.

It is assumed you are willing to pay the fees we charge for processing your request. In your letter of request, you may specify the fee category in which you feel your request falls. You also may state the maximum amount of fees that you are willing to pay, or include a request for a fee waiver.

Fee Waivers - FOIA permits agencies to waive fees if disclosure of the record(s) is in the public interest because it: (a) is likely to contribute significantly to public understanding of the operations or activities of the government and (b) is not primarily in the commercial interest of the requester.

If you believe that your request meets both of the above tests, you can request a waiver or reduction of fees when you make your FOIA request. You must fully document and justify your waiver request by written explanation.

How We Process Your Request

All efforts are made to process your request within 20 working days from the date we receive it in the FOIA processing unit. Due to a variety of cicumstances; however, for some requests it may take longer. This longer processing time is sometimes due to the volume of records requested and the number of requests pending prior to receipt of your request. When we have a backlog of FOIA requests, we process them on a "first in" "first out" basis. The guidelines we follow in processing your FOIA request are detailed in our December 13, 1990 Federal Register Notice.

Expedited Process

Expedited processing is initiated when the FOIA requester asks for it and if a compelling need for disclosure is evident. Compelling need is evidenced by the fact that the records are required due to:
(1) An imminent threat to life or physical safety, (2) The media demonstrates an urgency to inform the publice concerning actual or alleged government activity; and/or, (3) the requested records are needed to meet a deadline in litigation or a deadline imposed by a governmental agency for commenting on a proposed regulation.

If you think that we should expedite your request, please explain your reasons fully in your FOIA request.

Denials and Appeals

If we decide to withhold a record from you, in whole or in part, we will provide written notification to you of this decision. We will explain our reason(s) for withholding the record/information and describe how you may file an appeal. Any administrative appeal decision that upholds a denial will inform you of the basis for the denial and of your right to judicial review in federal courts.

Requesting Records on Someone Other Than Yourself

If you are requesting your own record(s), we will process your request in compliance with the Privacy Act and the Freedom of Information Act (FOIA). If you are requesting another person's records, you need the person's written consent to disclose them to you. In these cases, send your request, with the signed consent, to the above address. The consent must adhere to the following criteria:

Core Elements and Required Statements of a Valid Authorization

A Valid Authorization Must Contain The Following Elements:

1. The signature of the individual and date. If the authorization is signed by a personal representative of the individual, proof of his/her authority to represent must be attached to the authorization.

2. The name and other specific identification of the person(s) or class of persons authorized to make the requested disclosure.

3. A description of the information to be disclosed that identifies the information in a specific and meaningful fashion.

4. The name or other specific identification of the person(s) or class of persons to whom the requested disclosure is to be made.

5. An expiration date or an expiration event that relates to the individual or the purpose of the disclosure. (If no time frame is given, we must assume that the consent is for a one-time-only disclosure).

6. A description of the purpose of the requested disclosure. The statement "at the request of the individual" is a sufficient description of the purpose when the beneficiary initiates the authorization and does not, or elects not to, provide a statement of the purpose); and

A Valid Authorization Must Contain The Following Elements (or similar statements that reflect the beneficiary's understanding of the articulated principles):

1. I understand that I have the right to revoke this authorization at any time. I must do so by writing to the same person(s) or class of persons that I directed this authorization to. The revocation will not apply to information that has already been released in response to this authorization.

2. I understand that my refusal to authorize disclosure of my personal medical information will have no effect on my enrollment, eligibility for benefits, or the amount Medicare pays for the health services I receive.

3. I understand that information disclosed pursuant to this authorization may be re-disclosed by the recipient and may no longer be protected by law.

   SOURCE: Transmittal AB-03-147 dated September 26, 2003, and 45 C.F.R. § 5b.9
   Prepared by: Freedom of Information Group, CMS (July 12, 2004)

   You may use this HIPAA Compliant Authorization Form located in the forms area. You are not required to use this form. The form is offered as a courtesy and/or guide to assist you.