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Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Notice of Privacy Practices:
This notice describes how Mental, Behavioral and other Health Care information may be used and disclosed and how you can gain access to this information. Please review it carefully.
1. Purpose: We are required by state and federal law to maintain confidentiality and privacy of your protected health information and to give you our legal duties and privacy practices regarding your protected health information. "Protected health information is information about you that may identify you and relates to your past, your present or your future physical health, mental health or condition and related health care services. This notice describes how we may use your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
2. Uses and disclosure of protected health information for treatment, payment or operations: We are permitted by the state and federal law to disclose to our staff and professionals to disclose your protected health information for treatment, payment and other health care operations of the agency. Relevant portions or summaries of your protected health information may be used and may be disclosed to those actively involved in your treatment or to persons at other licensed facilities, when you are referred to that facility and a summary or portion of the record is necessary to provide for continuity of proper care and treatment. Your protected health information maybe limited to staff names, dates, types and cost of therapies or services, and a short description of the general purpose of each treatment session or service. We may also use your protected health information to assist in the operation of the agency.
Described below are examples of the types of uses and disclosures of your protected health care information that we are permitted to make. Please be aware that not every use or disclosure is listed.
A. Treatment: We will use and disclose your protected heath information to provide, coordinate, or manage your mental, behavioral and other health care and any related services. For example, we may disclose your protected health information to:
- Clinical staff or other health care personnel who are helping to provide you with health care services.
- Members of the community participating in inter-agency team meetings required for behavioral health rehabilitation services for children.
- Intensive care managers or other county officials permitted to participate and contribute to your care.
- Consultation with another provider or your referral to another provider
- Psychiatrists, Psychologists, Social Workers, Mental Health Plan Professionals, other agency personnel who are helping to care for you
- Different departments of the agency may share protected health information about you in order to coordinate the different services you need such as, prescription or lab work.
B. Payments: Your protected health information will be used to obtain approval for, and payment for your mental, behavioral, or other health care services. This may include certain activities that your health insurance planer government agency may undertake before it approves or pays for the mental, behavioral or other health care services that we may recommend for you such as, making a determination of eligibility or coverage of benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. [For example, obtaining approval for behavioral health rehabilitation services for children that require your relevant health protected information may be disclosed to county or state officials in order to obtain prior approval for services.]
C. Mental Health Care Operations: We may use or disclose your protected health information as needed in order to support our operations. These activities include but are not limited to quality assessment activities, employee review activities, personnel training programs, licensing, case management and care coordination, auditing, and other agency business functions. For example, your protected health information may be disclosed to:
- State licensure and other reviewers and inspectors, including the Department of Public Welfare, and other accreditation organization
- Parents, guardians and others when necessary to obtain consent to medical treatment
- Use of sign-in sheet at the registration desk or may call you by name in the waiting room.
- Contact you to remind you of your appointment.
- Business and clinical development, such as conducting cost management and planning as well as related analysis.
- A court, when production of the documents is ordered by a court.
Finally, we will share your protected health information with third party "business associates" that perform various activities involving protected health information (e.g. billing, transcription services auditors) for us.
3. Other permitted and required uses and disclosure:
We may use and disclose your protected health information in the following instances. Disclosure is in your best interest. In this case, only the protected health information that is relevant to your mental, behavioral or other health care will be disclosed. For example:
A. Others Involved in your Health Care: Unless you object, we may disclose to your member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are able to agree or object to such a disclosure, we may disclose such information as necessary if we determine that is your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of location, general condition or death. Finally, we may use or disclose your protected health information to an unauthorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
B. Emergencies: We may use or disclose your protected health information in an emergency treatment situation when use and disclosure of the protected health information is necessary to prevent serious risk of bodily harm or death. Only specific information pertinent to the relief of the emergency may be released without you authorization.
4. Other required and permitted uses and disclosure that maybe made without your consent or authorization: In certain circumstances, we may use or disclose your protected health information without your consent or authorization. These situations include, but are not limited to the following:
[Required by Law: We may use or disclose your protected health information if and to the extent we are required by federal or state law. You will be notified, if required by law, of any such uses or disclosure.]
Abuse or Neglect: We may disclose protected health information to public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, if we believe that you have been a victim of abuse, neglect or domestic violence, we may disclose your protected health information to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable Pennsylvania laws.
Health Oversight: We may disclose protected health information to the department of public welfare for overseeing health care activities through audits, investigations, inspections, and licensure. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Legal Preceding: We may disclose protected health information in the course of any judicial proceeding, in response to an order of a court or administrative tribunal (but only the protected health information expressively authorized by such order).
Required uses and disclosures: Under the law, we must make disclosures required by the secretary of the department of health and human services to investigate or determine our compliance with the requirements of section 164.500 et. seq.
5. Uses and disclosure of protected health information based upon your written authorization: Other uses and disclosure of your protected health information not covered by this notice or by laws that apply to us will be made only by your written authorization. If you revoke this authorization, we will no longer use or disclose your protected health information for the reasons covered by the authorization. However, we can not undo any disclosures that have already been made with the authorization and are required to retain our records of the care that we provided to you.
6. Your rights regarding your protected Health Information: You have the following rights with respect to your protected health information and a brief description of how you may exercise these rights.
A. You have the right to request restriction: You have the right to request a limitation or a restriction on the protected health information we use or disclose about you for treatment, payment or health care operations. You may also request that we limit the protected health information that we disclose to family members or friends who maybe involved in your care for the payment of your case. For example, you could ask that we not use or disclose information about a test that you had.
However, we are not required to a restriction that you may request. If we agree to a restriction, we may not use or disclose your protected health information in violation of the restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request in with [identity]. You may request a restriction by making your request in writing, including (a) what protected health information you wish to limit; (b) whether you want us to limit or use, disclose or both; and (c) whom you want the limits to apply (e.g., disclosure to your spouse).
B. Rights to request confidential communication: You have the right to request to receive confidential communication from us in a certain way or at an alternative location. For example, you can ask that we only contact you at home or by e-mail. We will accommodate reasonable requests. We may also condition this accommodation by asking you for specification of an alternative address or other method of contact. We will not request any explanation from you as to the basis of the request. Please make this request in writing to our privacy contact specifying how or where you wish to be contacted.
C. Right to inspect and copy: You have the right to request and obtain a copy of protected health information. A "designated record set" contains medical and billing records and any other record that we use for making decisions about your care. To inspect and copy protected health information, submit sub A. Others involved in your Health Care: Unless you object, we may disclose to your member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are able to agree or object to such a disclosure, we may disclose such information as necessary if we determine that is your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of location, general condition or death. Finally, we may use or disclose your protected health information to an unauthorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
D. You may have the right to amend: If you believe that we have protected health information about you in a designated record set that is incorrect or misleading, you may prepare a statement for inclusion as part of your record. Your statement shall accompany all released records. In certain cases we may deny your request for amendment; you have the right to file a statement of disagreement with us and we may prepare a rebuttal. Please contact our privacy contact if you have questions about amending your medical record.
E. Right to receive an accounting of disclosure: You have the right to an accounting of disclosure for purposes other than treatment, payment or health care operations as described in this notice. It excludes disclosures we may have made to you, to family members, or to friends involved in your care, or for notification purposes. You have the right to receive information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions, and limitations.
F. Right to a paper copy of this notice: You have the right to a paper copy of this notice, upon request even if you have agreed to accept this notice electronically. To obtain a paper copy, p lease contact us at 412-731-2353. You may also obtain an electronic copy of this notice from this website - [www.abcpgh.org]
7. Complaints: If you believe that we have violated your privacy rights, you may complain to us or to the Secretary of Health and Human Services, or to the Department of Public Welfare. You may also file a complaint with us by notifying our privacy contact of your complaint.
You may contact our privacy contact by phone at 412-731-2353, or by e-mail at bturner@abcpgh.org for further information about the complaint process. We are required by law to inform you that we will not retaliate against you for filing a complaint. You may request in writing to our privacy contact. If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other related cost.