THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, and our duties with respect to that information. This notice also describes your rights with respect to your protected health information.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgment of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment.
WHO WILL FOLLOW THIS NOTICE
This notice covers (a) workforce members of this treatment facility and (b) workforce members of Foundations Recovery Network that may see your protected health information.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
“Protected health information” is individually identifiable health information about you. This information includes such information as your name, age, address, and e-mail address, and relates to your past, present, or future physical or mental health or condition, health care services provided to you, and the past, present, or future payment for those services. We are required by law to do the following:
- Make sure that your protected health information is kept private.
- Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information.
- Follow the terms of the notice currently in effect.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future.
We will make our current revised Notice of Privacy Practices available upon request to patients or other persons on or after the effective date of the revision and post the revised Notice of Privacy Practices in our facility and on our website, www.michaelshouse.com. Patients and other persons may also obtain the current Notice of Privacy Practices by calling the Foundations Recovery Network Privacy Officer at (615) 345-3200 and requesting that a copy be mailed or e-mailed to them. We will also provide the current Notice of Privacy Practices to patients on their first visit to our facility.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Following are examples of required and permitted uses and disclosures of your protected health information under HIPAA. Remember that you signed a confidential release form during the intake process to allow us to get medical records of your prior medical treatment or health history. You also signed a release of information form to allow us to contact government payers and insurance companies or other private payers regarding payment for services you receive at our facilities.
Required Uses and Disclosures
In most cases, you have the right to look at and to get a copy of your medical records and billing records that we maintain or that are maintained for us, when you submit a written request. If we deny your request to review or obtain a copy of your medical or billing records, you may submit a written request for a review of that decision.
You have the right to obtain an accounting of disclosures from us as discussed below.
We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.
Permitted Uses and Disclosures
We have a signed consent on file for each client’s medical history.
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services, with a signed consent from you. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a hospital where you were being treated for an acute condition, provided you had signed a consent form. We may disclose your protected health information from time to time to a physician, nurse, or health care provider (for example, a specialist, pharmacist, or laboratory) who, at the request of our staff, becomes involved in your care by providing assistance with your health care diagnosis or treatment, provided you had signed a consent. We will, with a signed consent from you, talk to a pharmacist who may be provided information on other drugs you have been prescribed to identify potential interactions.
In emergencies, we will use and disclose your protected health information to provide the treatment you require, regardless of whether you have signed a consent for such uses and disclosures.
We have a signed consent form from you to contact payers, but you may revoke that consent. Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities such as determining eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay might require that your relevant protected health information be disclosed to obtain approval for the hospital admission.
Health Care Operations
We may use or disclose, as needed, your protected health information to support the daily activities related to operating our facilities, provided you sign a consent form allowing us to do so. These uses and disclosures are necessary to run our facilities and make sure that all of our clients receive quality care. These activities include, but are not limited to, quality assessment activities, investigations, oversight or staff performance reviews, training of students or interns, licensing, communications about a product or service, and conducting or arranging for other health care related activities. We may combine medical information about many clients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.
Appointment Reminders/Treatment Alternatives
While we will not identify our name or agency, we may contact you to remind you of your appointments.
We may use or disclose your protected health information to provide you with information about treatment alternatives or other health-related benefits and services that might interest you. For example, your name and address may be used to send you a newsletter about the services we offer. We may also send you information about products or services that we believe might benefit you after treatment. If you do not want to receive this information you may tell us so.
We will share your protected health information with third-party “business associates” who perform various activities (for example, billing or transcription services) for Foundations Recovery Network. The business associates will also be required to protect your health information.
Required by Law
We may use or disclose your protected health information if law or regulation requires the use or disclosure.
You signed, or declined to sign, a release of certain limited information for research purposes at your intake assessment. Under certain circumstances we may use and disclose medical information about you for research purposes, only with your signed consent. If you declined to sign, we will not use any protected health information for research purposes. For example, a research project may involve comparing the health and recovery of all clients who received one kind of therapy or medication to those who received another kind. All research projects are subject to a special approval process, which would balance the research needs with the clients’ need for privacy of their medical information. Most information used in research will be “de-identified’; that is, we will remove anything which would specifically identify you such as your name or social security number.
While HIPAA allows us to disclose medical information about you for workers’ compensation or similar programs which provide benefits for work-related injuries or illness, we will not do so without your written authorization or a court order.
We may disclose your protected health information to a public health authority which is permitted by law to collect or receive such information. The disclosure may be necessary to do the following:
- Report deaths or other vital statistics, including cause of death.
- Report child abuse or neglect.
While HIPAA allows us to disclose medical information about you if authorized to do so by law in the conduct of a public health intervention or investigation, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition, we will not do so without your written authorization or a court order, unless we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person (including you) or the public.
While HIPAA allows us to disclose medical information about you to your employer, for the purposes of conducting an evaluation of medical surveillance of the workplace or for the purposes of evaluating whether your have a work-related illness or injury, we will not do so without your written authorization or a court order.
Victim of Abuse or Neglect
We may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, if you do not agree to the disclosure, the disclosure will be made consistent with the requirements of applicable federal and state laws, and only if required or authorized by law.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, evaluations, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Food and Drug Administration
We may disclose your protected health information to medical personnel of the FDA who assert a reason to believe that the health of any individual may be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction, and that the information will be used for the exclusive purpose of notifying patients or their physicians of potential dangers.
While HIPAA allows us to disclose medical information about you to a person or company required by the FDA to do the following:
- Report adverse events, product defects, or problems and biologic product deviations.
- Track products.
- Enable product recalls.
- Make repairs or replacements.
- Conduct post-marketing surveillance as required by the FDA;
we will not do so without your written authorization or a court order.
We may disclose protected health information to the extent authorized by an appropriate court order of a court with jurisdiction, if the order was granted after application showing good cause for the issuance of the order.
While HIPAA allows us to disclose medical information about you in response to other types of court and administrative orders, subpoenas, and other lawful process, we will not do so without your written authorization or a court order complying with the requirements of 42 USC 290dd-3 and 42 USC 290ee-3, and their implementing regulations, 42 CFR Part 2.
We may disclose protected health information for law enforcement purposes, including the following:
- Investigation of a crime occurring on our premises
- Pursuant to a court order of a court with jurisdiction, if the order was granted after application showing good cause for the issuance of the order.
Coroners and Medical Examiners
We may disclose protected health information to coroners or medical examiners as required by laws concerning the collection of death or other vital statistics or permitting inquiry into the cause of death.
Funeral Directors and Organ Donations
While HIPAA allows us to disclose medical information about you to funeral directors as authorized by law, we will not do so without your written authorization or a court order.
While HIPAA allows us to disclose medical information about you if you are an organ donor to an organ bank as necessary for organ, eye, or tissue donations, we will not do so without your written authorization or a court order.
Serious Threat to Safety
Under applicable Federal and state laws, we may disclose your protected health information in the instance that we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person (including you) or the public. We will comply with any legal mandates which require therapists to report the imminent threat of physical harm to an identifiable target to certain authorities.
Military Activity and National Security
For each of the following uses and disclosures, we reserve the right to use or disclose medical information about you in the instance that we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person (including you) or the public. We will comply with any legal mandates which require therapists to report the imminent threat of physical harm to an identifiable target to certain authorities.
- While HIPAA allows us to disclose medical information about you if you are in the Armed Forces for activities deemed necessary to assure proper execution of military missions, we will not do so without your written authorization or a court order.
- While HIPAA allows us to disclose medical information about you if you are in a foreign military to the appropriate foreign military authority for activities deemed necessary to assure proper execution of military missions, we will not do so without your written authorization or a court order.
- While HIPAA allows us to disclose medical information about you to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act and implementing authority, we will not do so without your written authorization or a court order.
- While HIPAA allows us to disclose medical information about you to authorized federal officials for the protection of the President or other persons, or for certain federal investigations, we will not do so without your written authorization or a court order.
Should you be an inmate of a correctional institution or be in the lawful custody of a law enforcement official, HIPAA allows us to disclose medical information about you we may disclose your protected health information to the institution or the official if necessary for your health, the health and safety of other inmates or law enforcement, and the safety of the institution at which you reside; however, we will not do so without your written authorization or a court order unless we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person (including you) or the public. We will comply with any legal mandates which, require therapists to report the imminent threat of physical harm to an identifiable target to certain authorities.
Some state laws concerning minors permit or require disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the state where the treatment is provided and will make disclosures following such laws.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION
In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required.
Although permitted by HIPAA, it is not our practice to maintain an inpatient directory.
Individuals Involved in Your Health Care
We may disclose medical information about you to a friend or family member who is involved in your medical care after giving you the opportunity to agree or object, unless you are unconscious or not present, in which case we will exercise our professional judgment as to whether to do so. If you have identified a family member or other person we may contact in the event of a medical emergency, we may use our professional judgment to contact that person to save your life, or in the event of a clinical emergency. We may also give information to someone who helps pay for your care if you have authorized us to do so, in order to pay for your treatment. You may identify a payer separate from a family member or next of kin by using your right to confidential communications described elsewhere in this notice.
While HIPAA allows us to disclose medical information about you to notify, or assist in the notification of, a person responsible for your care of your location, general condition or death, or disclose such information to disaster relief authorities so that your family can be notified of your location and condition, we will not do so without a written consent from you, unless you are unconscious or not present, in which case we will exercise our professional judgment as to whether to do so.
Other uses of medical information
In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you chose to authorize a use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.
Your Rights Regarding Your Health Information
You may exercise the following rights by submitting a written request or electronic message to the Privacy Officer listed at the end of this document. Depending on your request, you may also have rights under the Privacy Act of 1974. Our Privacy Officer can guide you in pursuing these options. Please be aware that we might deny your request if allowed to do so by law; however, you may seek a review of the denial in writing or by electronic message.
Right to Inspect and Copy
In most cases, you may inspect and obtain a copy of your protected health information that is contained in a “designated record set” for as long as we maintain the protected health information, when you submit a written request. A designated record set contains medical and billing records and any other records that we use for making decisions about you. Your first request for a copy in a 12 month period will be provided free. If you request a second copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.
Right to Request Restrictions
You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask us not to disclose a specific treatment that you had. Your request must be made in writing or by electronic message to the Privacy Officer listed at the end of this document. In your request, you must tell us (1) what information you want restricted; (2) whether you want to restrict our use, disclosure, or both; (3) to whom you want the restriction to apply, for example, disclosures to your spouse; and (4) expiration date.
If you have requested a restriction and we have agreed to your request, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment. You may revoke a previously agreed upon restriction, at any time, by notifying the Privacy Officer in writing.
Right to Request Confidential Communications
You may request in writing or by electronic message that we communicate with you using alternative means or at an alternative location. For example you may request that all correspondence from us to you be sent to your office, to a PO Box, or to a third party. We will not ask you the reason for your request. We will accommodate reasonable requests. We may condition the accommodation upon knowing how payment will be handled, if appropriate to your request, and you must specify an alternate address or other method of contact.
Right to Request Amendment
If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. You may submit a written request to amend your record to the Privacy Officer, with a reason why you wish to make the amendment. While we will accept requests for amendment, we are not required to agree to the amendment. While we may, under HIPAA, deny the request if you ask us to amend information that was not created by us, is not part of your medical record, or if the information is accurate and complete, it is our practice to add a client’s requested amendment to the file. We will not deny your request to add information to the file.
Right to an Accounting of Disclosures
You may request in writing or by electronic message that we provide you with an accounting of the disclosures we have made of your protected health information. We do not have to provide an accounting with respect to certain disclosures we have made, such as: disclosures for treatment, payment, health care operations; disclosures made to you; disclosures incident to a use or disclosure permitted or required by the Federal HIPAA Privacy Rule; disclosures specifically authorized by you; disclosures to persons involved in your care or to disaster relief authorities; disclosures for national security and intelligence purposes; disclosures to correctional institutions or law enforcement officials; disclosures that are part of a limited data set; and disclosures occurring prior to April 14, 2003.
Your request must state the time period desired for the accounting, which must be less than a 6-year period from the date of the request and starting after April 14, 2003. You may receive the list in paper or electronic form. We may charge you for the costs involved in providing the list.
Right to Obtain a Copy of this Notice
You may obtain a paper copy of this notice from us upon request.
Other Privacy Laws
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that may apply to clients in this kind of treatment program, including the Freedom of Information Act, the Federal Privacy Act, and the Mental Health Bill of Rights. There are also important state laws to protect the confidentiality of medical records and the privacy rights of the mentally ill.
Michael’s House chooses to abide by the federal confidentiality of substance abuse patient records statutes, 42 USC 290dd-3 and 42 USC 290ee-3, and their implementing regulations, 42 CFR Part 2 (“Confidentiality Statutes and Regulations”), to protect the very sensitive patient records we maintain and to ensure our patients feel comfortable in divulging their complete medical history to us so that we may give them the best care possible. However, we will comply with the HIPAA Privacy Rule, even if it conflicts with the Confidentiality Statutes and Regulations, with respect to required uses and disclosures of patient information and requirements regarding patients’ rights and our legal obligations, and we reserve the right permitted us by the HIPAA Privacy Rule to use and disclose patient information without a consent, authorization or an appropriate court order if we are reporting abuse, neglect or domestic violence in accordance with the HIPAA Privacy Rule or if we believe a disclosure of PHI is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person (including the patient) or the public.
These laws have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information. We have applied the most stringent protection of client privacy wherever these laws overlapped or conflicted.
If you believe these privacy rights have been violated, you may file a written complaint with the Privacy Officer listed above, or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint.
You may contact the Privacy Officer for further information about the complaint process, or for further explanation of this document. The Privacy Officer may be contacted at Foundations Recovery Network, HIPAA Request, 210 Westwood Place Ste 120, Brentwood, TN 37027, Attn: Privacy Officer, or by phone at 1-888-869-9230. You may also email questions to [email protected]
This notice is effective as of February 18, 2010 and supersedes any prior notices.
Speak with an Admissions Coordinator 760-548-4032