HIPAA Policies Notice of Privacy PracticesAdults and Children with Learning and Developmental Disabilities, Inc. 807 South Oyster Bay Road Bethpage, NY 11714 Phone: (516) 822-0028 Fax: (516) 822-0470 Effective Date: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL AND CLINICAL INFORMATION ABOUT ACLD CONSUMERS MAY BE USED AND DISCLOSED, AND HOW CONSUMERS, THEIR GUARDIANS AND/OR THEIR PERSONAL REPRESENTATIVES, CAN GET ACCESS TO THIS INFORMATION. Guardians and personal representatives should be aware that the word “you” in this notice refers to the consumer, not to the guardian. Please review this notice carefully. ACLD is required by federal law [Health Information Portability and Accountability Act (HIPAA)] to protect the privacy of health information that may reveal your identity, and to provide you with a copy of this notice which describes the health information privacy practices of ACLD, its staff, and affiliated health care providers that jointly provide treatment, and perform payment activities and business operations with ACLD. A copy of our Notice of Privacy Practices will be posted in the reception area of each of our facilities. You will also be able to obtain a copy of the notice by accessing our website at www.acldd.org, or by contacting ACLD's Privacy Officer, by phone at (516) 822-0028 or by mail at the address above. If you have any questions about this Notice of Privacy Practices or would like further information, please contact Georgienne Harris, Privacy Officer, by phone at (516) 822-0028, Ext. 130 or by mail at the address above. WHAT HEALTH INFORMATION IS PROTECTED • The fact that you are a participant at ACLD or receiving medical treatment, mental hygiene services or other health-related services from ACLD; • Information about your health condition (such as a disease you may have); • Information about health care products or services you have received or may receive in the future (such as medication or treatment); or • Information about your health care benefits under an insurance plan (such as whether a prescription is covered); When combined with: • Geographical information (such as where your live or work); • Demographic information (such as your race, gender, ethnicity or marital status); • Unique numbers that may identify you (such as your social security number, your phone number or your driver’s license number); and • Other types of information that may identify who you are. HOW ACLD MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR WRITTEN AUTHORIZATIONACLD will generally obtain your written authorization before using your health information or sharing it with others outside of ACLD. There are some situations in which ACLD does not need your written authorization before using your health information or sharing it with others. Some examples of these exceptions are: 1. Treatment, Payment And Business Operations ACLD and its staff may use your health information or share it with others in order to treat your condition, obtain payment for that treatment, and run ACLD’s normal business operations. Your health information may also be shared with affiliated agencies so that they may jointly perform certain payment activities and business operations along with ACLD. Your health information also may be disclosed to another health care provider for its treatment or payment activities, and for certain limited business operations. Below are further examples of how your health information may be used or disclosed by ACLD. Treatment. ACLD may share your health information with doctors, nurses, therapists, aides and other health care professionals at ACLD who are involved in providing services to you, and they may in turn use that information to diagnose or treat you, or to develop a plan of services for you. A health care professional at ACLD may share your health information with another health care professional at ACLD, or with another health care professional at another agency, to determine how to diagnose or treat you. Your health care professional may also share your health information with another agency or provider to whom you have been referred for further health care. Finally, ACLD may share your health information with others outside of ACLD as necessary to carry out your treatment plan. Payment. ACLD may use your health information or share it with others so that we can obtain payment for your health care services. For example, we may share information about you with your health insurance company in order to obtain reimbursement after we have provided services to you. In some cases, we may share information about you with your health insurance company to determine whether your health care services are covered. We might also need to inform your health insurance company about your condition in order to obtain pre-approval for services, such as care provided at a residential treatment facility. Finally, we may share your health information with other providers or payors for their payment activities. Business Operations. ACLD may use your health information or share it with others in order to conduct our normal business operations. For example, we may use your health information to evaluate the performance of our staff in caring for you, or to educate our staff on how to improve the care they provide to you. We may also share your health information with another company that performs business services for us, such as a billing company. In this case, we will have a written contract to ensure that this company also protects the privacy of your health information. Finally, we may share your health information with other providers and payors for certain of their business operations if the other party also has or had a treatment or payment relationship with you, and in that event we will only share information that pertains to that relationship. Appointment Reminders, Treatment Alternatives, Benefits And Services. ACLD may use your health information when we contact you with a reminder that you have an appointment for treatment or services at one of our facilities. We may also use your health information in order to recommend possible treatment alternatives or health-related benefits and services that may be of interest to you. Fundraising. We may use demographic information, including information about your age and gender, and where you live or work, and the dates that you received treatment, in order to contact you to raise money to help us operate. We may also share this information with a charitable foundation that will contact you to raise money on our behalf. If you do not want to be contacted for these fundraising efforts, please contact ACLD's Privacy Officer, by phone at (516) 822-0028 or by mail at the address above. 2.Friends And Family, Facility Directory ACLD may share your health information with friends and family involved in your care without your written authorization or other written permission. We will always give you an opportunity to object unless there is insufficient time because of a medical emergency (in which case we will discuss your preferences with you as soon as the emergency is over). We will follow your wishes unless we are required by law to do otherwise. Friends And Family Involved In Your Care. If you do not object, ACLD may share your health information with a family member, relative or close personal friend who is involved in your care or payment for that care. We may also notify a family member, personal representative, or another person responsible for your care about your location and general condition at our facility, or about the unfortunate event of your death. In some cases, we may need to share your information with a disaster relief organization that will help us notify these persons. Facility Directory. ACLD does not maintain a Facility Directory. Information about your location in our facilities will not be shared with individuals outside of ACLD. 3. Public Need ACLD may use your health information, and share it with others, in order to meet important public needs. ACLD will not be required to obtain your written authorization, consent or any other type of permission before using or disclosing your information for these reasons. As Required By Law. ACLD may use or disclose your health information if we are required by law to do so. ACLD will notify you of these uses and disclosures if notice is required by law. Public Health Activities. ACLD may disclose your health information to authorized public health officials (or a foreign government agency collaborating with such officials) so they may carry out their public health activities. For example, we may share your health information with government officials who are responsible for controlling disease, injury or disability. We may also disclose your health information to a person who may have been exposed to a communicable disease or be at risk for contracting or spreading the disease, if we are permitted to do so by law. And finally, ACLD may release some health information about you to your employer if your employer hires us to provide you with a physical exam and we discover that you have a work-related injury or disease that your employer must know about in order to comply with employment laws. Victims Of Abuse, Neglect Or Domestic Violence. ACLD may release your health information to a public health authority that is authorized to receive reports of abuse, neglect or domestic violence. For example, we may report your information to government officials if we reasonably believe that you have been a victim of abuse, neglect or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases we may be required or authorized to act without your permission. Health Oversight Activities. ACLD may release your health information to government agencies authorized to conduct audits, investigations, and inspections of our facility. These government agencies monitor the operation of the health care system, government benefit programs such as Medicare and Medicaid, and compliance with government regulatory programs and civil rights laws. Product Monitoring, Repair And Recall. ACLD may disclose your health information to a person or company that is required by the Food and Drug Administration to: (1) report or track product defects or problems; (2) repair, replace, or recall defective or dangerous products; or (3) monitor the performance of a product after it has been approved for use by the general public. Lawsuits And Disputes. ACLD may disclose your health information if we are ordered to do so by a court or administrative tribunal that is handling a lawsuit or other dispute. Law Enforcement. ACLD may disclose your health information to law enforcement officials for the following reasons: • To comply with court orders or laws that we are required to follow; • To assist law enforcement officials with identifying or locating a suspect, fugitive, witness, or missing person; • If you have been the victim of a crime and we determine that: (1) we have been unable to obtain your consent because of an emergency or your incapacity; (2) law enforcement officials need this information immediately to carry out their law enforcement duties; and (3) in our professional judgment disclosure to these officials is in your best interests; • If we suspect that your death resulted from criminal conduct; • If necessary to report a crime that occurred on our property; or • If necessary to report a crime discovered during an offsite medical emergency (for example, by emergency medical technicians at the scene of a crime). To Avert A Serious Threat To Health Or Safety. ACLD may use your health information or share it with others when necessary to prevent a serious threat to your health or safety, or the health or safety of another person or the public. In such cases, we will only share your information with someone able to help prevent the threat. We may also disclose your health information to law enforcement officials if you tell us that you participated in a violent crime that may have caused serious physical harm to another person (unless you admitted that fact while in counseling), or if we determine that you escaped from lawful custody (such as a prison or mental health institution). National Security And Intelligence Activities Or Protective Services. ACLD may disclose your health information to authorized federal officials who are conducting national security and intelligence activities or providing protective services to the President of the United States or other important officials. Military And Veterans. I f you are in the Armed Forces, ACLD may disclose health information about you to appropriate military command authorities for activities they deem necessary to carry out their military mission. We may also release health information about foreign military personnel to the appropriate foreign military authority. Inmates And Correctional Institutions. If you are an inmate or you are detained by law enforcement authorities, we may disclose your health information to prison officials or law enforcement officials if necessary to provide you with health care, or to maintain safety, security and good order at the place where you are confined. This includes sharing information that is necessary to protect the health and safety of other inmates or persons involved in supervising or transporting inmates. Workers’ Compensation. ACLD may disclose your health information for Workers’ Compensation or similar programs that provide benefits for work-related injuries. Coroners, Medical Examiners And Funeral Directors. In the unfortunate event of your death, ACLD may disclose your health information to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death. We may also release this information to funeral directors as necessary to carry out their duties. Organ And Tissue Donation. I n the unfortunate event of your death, ACLD may disclose your health information to organizations that procure or store organs, eyes or other tissues so that these organizations may investigate if donation or transplantation is possible under applicable laws. Research. I n most cases, ACLD will ask for your written authorization before using your health information or sharing it with others in order to conduct research. However, under some circumstances, we may use and disclose your health information without your authorization if we obtain approval through a special process to ensure that research without your authorization poses minimal risk to your privacy. Under no circumstances, however, would ACLD allow researchers to use your name or identity publicly. We may also release your health information without your authorization to people who are preparing a future research project, so long as any information identifying you does not leave our facility. In the unfortunate event of your death, we may share your health information with people who are conducting research using the information of deceased persons, as long as they agree not to remove from our facility any information that identifies you. Incidental Disclosures. While ACLD will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur during, or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. For example, during the course of a treatment session, other consumers in the treatment area may see, or overhear discussion of, your health information. YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATIONACLD wants you to know that you have the following rights to access and control your health information. These rights are important because they will help you ensure that the health information we have about you is accurate. They may also help you control the way we use your information and share it with others, or the way we communicate with you about your medical matters. 1. How Someone May Act On Your Behalf You have the right to name a personal representative who may act on your behalf to control the privacy of your health information. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf. 2. Right To Inspect And Copy Records You have the right to inspect and obtain a copy of any of your health information that may be used to make decisions about you and your treatment for as long as we maintain this information in our records. This includes medical and billing records. To inspect or obtain a copy of your health information, please submit your request in writing to ACLD's Privacy Officer, at the address above. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies we use to fulfill your request. The standard fee is $0.75 per page and must generally be paid before or at the time we give the copies to you. ACLD will respond to your request for inspection of your health records within 10 days. We ordinarily will respond to requests for copies within 30 days if the information is located in our facility, and within 60 days if it is located off-site at another facility. If we need additional time to respond to a request for copies, we will notify you in writing within the time frame above to explain the reason for the delay and when you can expect to have your request fulfilled. Under certain very limited circumstances, ACLD may deny your request to inspect or obtain a copy of your health information. If we do, we will provide you with a summary of the information as an alternative. We will also provide a written notice that explains our reasons for providing a summary, and a complete description of your rights to have that decision reviewed and how you can exercise those rights. The notice will also include information on how to file a complaint about these issues with ACLD or with the Secretary of the Department of Health and Human Services. If we have reason to deny only part of your request, we will provide complete access to the remaining parts after excluding the information we cannot let you inspect or copy. 3. Right To Request Amendment of Records If you believe that your health information is incorrect or incomplete, you may request that ACLD amend the information. You have the right to request an amendment for as long as the information is kept in our records. To request an amendment, please write to ACLD's Privacy Officer, at the above address. Your request should include the reasons why you think we should amend the record. Ordinarily we will respond to your request within 60 days. If we need additional time to respond, we will notify you in writing within 60 days to explain the reason for the delay and when you can expect to have your request fulfilled. If ACLD denies part or all of your request, we will provide a written notice that explains our reasons for doing so. You will have the right to have certain information related to your requested amendment included in your records. For example, if you disagree with our decision, you will have an opportunity to submit a statement explaining your disagreement, which we will include in your records. We will also include information on how to file a complaint with ACLD or with the Secretary of the Department of Health and Human Services. These procedures will be explained in more detail in any written denial notice we send you. 4. Right To An Accounting Of Disclosures After April 14, 2003, you have a right to request an “accounting of disclosures” which is a list that contains certain information about how we have shared your health information with others. An accounting list, however, will not include any information about: • Disclosures we made to you; • Disclosures we made pursuant to your authorization; • Disclosures we made for treatment, payment or health care operations; • Disclosures made to your friends and family involved in your care or payment for your care; • Disclosures made to federal officials for national security and intelligence activities; • Disclosures that were incidental to permissible uses and disclosures of your health information; • Disclosures for purposes of research, public health, our normal business operations or of limited portions of your health information that do not directly identify you; • Disclosures about inmates to correctional institutions or law enforcement officers; or • Disclosures made before April 14, 2003. To request this accounting list, please write to ACLD's Privacy Officer, at the address above. Your request must state a time period within the past six years (but after April 14, 2003) for the disclosures you want us to include. For example, you may request a list of the disclosures that we made between January 1, 2004 and January 1, 2005. You have a right to receive one accounting list within every 12-month period for free. However, we may charge you for the cost of providing any additional accounting list in that same 12-month period. ACLD will always notify you of any cost involved so that you may choose to withdraw or modify your request before any costs are incurred. Ordinarily ACLD will respond to your request for an accounting list within 60 days. If we need additional time to prepare the accounting list you have requested, we will notify you in writing about the reason for the delay and the date when you can expect to receive the accounting list. In rare cases, we may have to delay providing you with the accounting list without notifying you because a law enforcement official or government agency has asked us to do so. 5. Right To Request Additional Privacy Protections You have the right to request that ACLD further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, or run our ACLD’s normal business operations. You may also request that we limit how we disclose information about you to your family or friends involved in your care. For example, you could request that we not disclose information about a surgery you had. To request restrictions, please write to ACLD's Privacy Officer, at the address above. Your request should include (1) what information you want to limit; (2) whether you want to limit how we use the information, how we share it with others, or both; and (3) to whom you want the limits to apply. ACLD is not required to agree to your request for a restriction, and in some cases the restriction you request may not be permitted under law. However, if we do agree, we will be bound by our agreement unless the information is needed to provide you with emergency treatment or comply with the law. Once we have agreed to a restriction, you have the right to revoke the restriction at any time. Under some circumstances, we will also have the right to revoke the restriction as long as we notify you before doing so; in other cases, we will need your permission before we can revoke the restriction. 6. Right To Request Confidential Communications You have the right to request that ACLD communicate with you about your medical matters in a more confidential way by requesting that we communicate with you by alternative means or at alternative locations. For example, you may ask that we contact you by fax instead of by mail, or at work instead of at home. To request more confidential communications, please write to ACLD's Privacy Officer, at the address above. We will not ask you the reason for your request, and we will try to accommodate all reasonable requests. Please specify in your request how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location. SPECIAL PROTECTIONS CONFIDENTIALITY OF PSYCHOTHERAPY NOTESPsychotherapy notes are notes that ACLD’s mental health counseling staff might make about your private counseling sessions, or your group, joint, or family counseling sessions, that are maintained separate from the rest of your clinical records. These notes can only be used and disclosed as described below. With your general written consent, psychotherapy notes about you may be used and disclosed in the following situations: - The mental hygiene professional who created the notes may use them to provide you with further treatment;
- The mental hygiene professional who created the notes may disclose them to students, trainees or practitioners in mental hygiene who are learning, under supervision, to practice or improve their skills in group, joint, family, or individual counseling;
- The mental hygiene professional who created the notes may disclose them as necessary to defend him or herself, or ACLD, in a legal proceeding initiated by you or your personal representative;
Without your general written consent, psychotherapy notes may be used and disclosed only in the following situations: - The mental hygiene professional who created the notes may disclose them as required by law;
- The mental hygiene professional who created the notes may disclose the notes to appropriate government authorities when necessary to avert a serious and imminent threat to the health or safety of you or another person;
- The mental hygiene professional who created the notes may disclose them to the United States Department of Health and Human Services when that agency requests them in order to investigate the mental hygiene professional’s compliance, or ACLD’s compliance, with Federal privacy and confidentiality laws and regulations; and
- The mental hygiene professional who created the notes may disclose them to medical examiners and coroners, if necessary to determine your cause of death.
Your special written authorization is required for all other uses and disclosures of psychotherapy notes. CONFIDENTIALITY OF HIV-RELATED INFORMATION Confidential HIV-related information is any information indicating that you had an HIV-related test, have an HIV-related illness or AIDS, or have an HIV-related infection, as well as any information which could reasonably identify you as a person who has had a test or has HIV infection. Under New York State law, confidential HIV-related information can only be given to persons allowed to have it by law, or to persons you allow to have it by signing a written authorization form. You can ask to see a list of people who can be given confidential HIV-related information by law without a written authorization form. Confidential HIV-related information about you may be used by personnel within ACLD who need the information to provide you with direct care or treatment, to process billing or reimbursement records, or to monitor or evaluate the quality of care provided by ACLD. Generally, we may not reveal to a person outside of ACLD, any confidential HIV-related information that we obtain in the course of treating you unless: We obtain your written authorization; The disclosure is to a person who is authorized under applicable law to make health care decisions on your behalf and the information disclosed is relevant to that person fulfilling such a role; The disclosure is to another health care provider or payor for treatment or payment purposes; The disclosure is to an external agent of ACLD who needs the information to provide you with direct care or treatment, to process billing or reimbursement records, or to monitor or evaluate the quality of care provided at ACLD. In such cases, ACLD will ordinarily obtain your general written consent and have an agreement with the agent to ensure that your confidential HIV-related information is protected as required under federal and New York State confidentiality laws and regulations; The disclosure is required by law or court order; The disclosure is to an organization that procures body parts for transplantation; You receive services under a program monitored or supervised by a federal, New York State, or local government agency and the disclosure is made to such government agency or other employee or agent of the agency when reasonably necessary for the supervision, monitoring, administration or provision of the program’s services; ACLD is required under federal or New York State law to make the disclosure to a health officer; The disclosure is required for public health purposes; If you are an inmate at a correctional facility and disclosure of confidential HIV-related information to the medical director of such facility is necessary for the director to carry out his or her functions; You are deceased, in which case disclosure may be made to a funeral director who has taken charge of your remains and who has access in the ordinary course of business to confidential HIV-related information on your death certificate; or The disclosure is made to report child abuse or neglect to appropriate New York State or local authorities. Violation of these privacy regulations may subject ACLD to civil or criminal penalties. Suspected violations may be reported to appropriate authorities in accordance with Federal and State law. HOW TO LEARN ABOUT ADDITIONAL SPECIAL PROTECTIONS FOR ALCOHOL & SUBSTANCE ABUSE AND GENETIC INFORMATION Special privacy protections apply to alcohol & substance abuse treatment information and genetic information. Some parts of the general Notice of Privacy Practices may not apply to these types of information. If your treatment involves this information, you will be provided with separate notices explaining how the information will be protected. To obtain copies if these other notices, please contact ACLD's Privacy Officer, by phone at (516) 822-0028 or by mail at the address above. HOW TO OBTAIN COPIES OF THIS NOTICE You have the right to a paper copy of this notice. You may request a paper copy at any time, even if you have previously agreed to receive this notice electronically. To do so, please contact ACLD's Privacy Officer, by phone at (516) 822-0028 or by mail at the address above. You may also obtain a copy of this notice from our website at www.acld.org or by requesting a copy at your next visit to one of ACLD’s facilities. We may change our privacy practices from time to time. If we do, we will revise this notice so you will have an accurate summary of our practices. The revised notice will apply to all of your health information held by ACLD, and ACLD will be required by law to abide by its terms. We will post any revised notice in our reception area. You will also be able to obtain your own copy of the revised notice by accessing our website at www.acld.org, or contacting ACLD's Privacy Officer, by phone at (516) 822-0028 or by mail at the address above. You may also ask for one at the time of your next visit to one of ACLD’s facilities. The effective date of the notice will always be located in the top right corner of the first page. HOW TO FILE A COMPLAINT If you believe your privacy rights have been violated, you may file a complaint with ACLD or with the Secretary of the Department of Health and Human Services. To file a complaint with ACLD, please contact ACLD's Privacy Officer, by phone at (516) 822-0028 or by mail at the above address. No one will retaliate or take action against you for filing a complaint. Additionally, if you experience discrimination because of the release of confidential HIV-related information, you may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting your rights.
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