NOTICE OF PRIVACY PRACTICES
April, 2003
Dear Employee,
Attached is a notice that
tells you how FEC uses your clinical information and protects your privacy.
New federal regulations
require us to send this notice to everyone who gets services from FEC. These regulations are known as the HIPAA
Privacy rule. HIPAA is short for the
Federal Health Insurance Portability and Accountability Act of 1996.
The HIPAA Privacy rule DOES NOT CHANGE the way you get
services from FEC. It does not change
the privacy rights that you have always had under New York State Mental Hygiene
law. The Privacy rule requires FEC to
take some additional steps to make sure you are aware of your privacy rights.
FEC is not the only
organization that must give people a privacy notice. Some others who have to give Privacy notices include:
. Medicaid,
. Medicare,
. doctors,
. hospitals,
. drug
stores (pharmacies) and
. other
persons or organizations who give health care services.
You can expect to receive a
Privacy notice from everyone who provides or pays for your health care.
Please take time to read the
FEC Privacy notice. It has two
parts. First there is a short notice
that gives a summary of FEC Privacy protections. Next, there is a longer notice with more details about how FEC
uses and discloses your clinical information.
The notices tell you who you can call or write for more information
about the privacy of your clinical information in FEC.
We hope this information
helps you to better understand your privacy rights regarding your clinical
information.
Sincerely,
Amy Anderson-Winchell
Executive Director
April 2003
Short Privacy Notice
This notice briefly describes
FEC privacy practices and the privacy rights of people we serve. A longer Privacy Notice (required by the
Federal HIPAA Privacy Rule) is attached.
The HIPAA Privacy rule DOES NOT CHANGE the way you get
services from FEC, or the privacy rights you.ve always had under State Mental
Hygiene law. The Privacy rule adds some
details about how you can exercise your rights.
This notice becomes effective on April 14, 2003. If
you have any questions about this notice, please contact our .Privacy Officer.
Kim-Marie Mallin at 845-343-8100 x
279.
Our Privacy Commitment to
You
At FEC, we are committed to protecting your privacy and
sharing information about you only with those who need to know and are allowed
to see the information.to assure that you get quality services.
Your Clinical Information
Rights
. You have a right to look at your
clinical records and to get a copy.
. If we
deny your request to see your clinical records, you may ask for a review of
that denial.
. You
may ask FEC to change or amend your clinical record if you believe it is
incorrect or incomplete.
. In certain
cases, you may ask for a list of the people who have received clinical
information about you from FEC.
. You may ask FEC not to use or share
our clinical records in some cases.
. You
may ask FEC to communicate with you in a way that keeps your information
confidential.
. You may ask for a paper copy of this
notice.
How FEC Will Use and
Disclose Clinical Information About You
FEC will use or share your
clinical information without your consent for the following reasons:
. Treatment
& Services: To
provide you with treatment &
services. We may disclose
health/clinical information about you to:
doctors, nurse, psychologists, social workers, qualified mental
retardation professionals (QMRPs), developmental aides, your service
coordinator, other FEC personnel, volunteers or interns who provide you with
care, to other providers outside of FEC who provide you with services
identified in your Individualized Service Plan, or to other providers to obtain
new services for you.
. Payment: To bill and collect payment
from either: you, a third party, an
insurance company, Medicare or Medicaid, or other government agencies.
. Health Care Operations: For FEC administrative
operations, such as: for quality
improvement to review our treatment and services.
. Other reasons allowed by law. Besides disclosures for treatment, payment,
and health care operations, FEC may also use health information about you
without your permission when allowed by
law. Some examples are: when we are required to do so by federal or
state law; for health oversight activities (including audits, investigations,
surveys and inspections); for law enforcement purposes; and to prevent or
lessen a serious and imminent threat to your health and safety or to someone
else.s.
Other Uses and Disclosures
that Require Your Agreement or Authorization
If you have no
objections, FEC may disclose health/clinical information about you to:
. Family members and friends who are
involved in your care, if the information is relevant to their
involvement.
For all other types of uses
and disclosures, FEC will use or disclose health/clinical information about you
only with a written authorization signed
by you.
Changes to this Notice
We may change this notice in the future. If we do, we will provide you with a copy at
your request after we change the notice and all changes will be posted on our
web site www.familyempowerment.org.
Complaints
If you believe your privacy
rights have been violated you can file a complaint with:
. Our FEC
Executive Director, Amy Anderson-Winchell, Family Empowerment Council, 225
Dolson Avenue, Suite 403, Middletown, NY 10940, 845-343-8100 x 237.
. The
Secretary of the Federal Department of Health and Human Services (200
Independence Avenue S.W. Washington D.C. 20210, phone 1-877-696-6775.)
. The Federal Office for Civil Rights:
(200
Independence Avenue S.W., Room 509F, HHH Building, Washington, D.C. 20201,
phone 1-866-OCR-PRIV or 1-866-788-4989; or by email: ocrmail@hhs.gov)
New York State Office of Mental
Retardation and Developmental Disabilities
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW IDENTIFIABLE MEDICAL* INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
This notice is effective as
of April 14, 2003. If you have any
questions about this notice, please contact our .Privacy Officer,. Kim-Marie
Mallin at 1-845-343-8100 x 279.
Our Privacy Commitment to
You
At FEC, we understand that information about you and your
family is personal. We are committed to
protecting your privacy and sharing information only with those who need to
know and are allowed to see the information to assure quality services for you. This notice tells you how FEC uses and discloses
information about you. It describes
your rights and what FEC responsibilities are concerning information about
you.
1. Who will follow this notice:
All
people who work for FEC in our day (non-residential) services programs, and in
our FEC administrative offices will follow this notice. This includes employees, persons FEC contracts with (contractors) who are authorized to enter information in your
clinical record or need to review your record to provide services to you, and
volunteers that FEC allows to assist you.
2. What information* is protected:
All
information we create or keep that relates to your health or care and
treatment, including your name, address birth date, social security number,
your medical information, your individualized service plan, and other
information (including photographs and other images) about your care in our
programs. In this notice, we refer to
protected information as .clinical information..
Your
Clinical Information Rights
You
have the following rights concerning your clinical information. When we use the word .you. in this notice we
also mean your personal representative.
Depending on your circumstances and in accordance with state law, this
may be your guardian, your health care proxy, or your involved parent, spouse,
or adult child.
♦ You
have a right to see or inspect your clinical information and obtain a
copy. Some exceptions apply, such as
records regarding incident reports and investigations, and information compiled
for use in court or administration proceedings.
♦ If
we deny your request to see your clinical information, you have the right to
request a review of that denial.
Professionals chosen by FEC who were not involved in denying your
request will review the record and decide if you may have access to the
record. We will give you a written
explanation if we deny your request for review.
♦ You
have the right to ask FEC to change or amend clinical information that you
believe is incorrect or incomplete. We
may deny your request in some cases, for example, if the record was not created
by FEC or if after reviewing your request, we believe the record is accurate
and complete. We will give you a written explanation if we deny your request
for amendment.
♦ You
have the right to request a list of the disclosures FEC has made of your
clinical information. The list,
however, does not include certain disclosures, such as those made for
treatment, payment, and health care operations, or disclosures made to you or
made to others with your permission.
♦ You
have the right to request that FEC communicates with you in a way that will
help keep your information confidential.
♦ You
have the right to request a restriction on uses or disclosures of your clinical
information related to treatment, payment, health care operations and
disclosures to involved family. FEC,
however, is not required to agree to your request. Your request should include
the following:
1. What information you want to limit;
2. Whether you want to limit how we use the information,
how we share the information with others, or both;
3. To whom you want the limits to apply.
♦ You
have the right to receive a paper copy of this notice. You may ask FEC staff to give you another
copy or you may obtain one from our website at www.familyempowerment.org
♦ To
request access to your clinical information or to request any of the rights
listed here, you may contact our .Privacy Officer,. Kim-Marie Mallin at Family
Empowerment Council, Inc, 225 Dolson Avenue, Suite 403, Middletown, New York
10940.
NOTE: FEC
requires you to make your requests in writing.
We will respond to your request within ten days.
FEC.s Responsibilities For
Your Clinical Information
FEC is required to:
♦ Maintain the privacy of your
information in accordance with federal and state laws.
♦ Give
you this notice of our legal duties and practices concerning the clinical
information we have about you.
♦ Follow
the rules in this notice. FEC will use
or share information about you only with your permission except for the reasons
explained in this notice.
♦ Tell
you if we make changes to our privacy practices in the future. If significant changes are made, FEC will
give you a new notice and post a new notice on our website at www.familyempowerment.org
How FEC Uses and
Disclosures Clinical Information
FEC may use and disclose
clinical information without your permission for the purposes described below. For each of the categories of uses and
disclosures, we explain what we mean and offer an example. Not every use or disclosure is described,
but all of the ways we will use or disclose information will fall within these
categories.
♦ Treatment
& Services: FEC will use your
clinical information to provide you with treatment and services. We may disclose clinical information to
doctors, nurses, psychologists, social workers, qualified mental retardation
professionals (QMRPs), developmental aides, and other FEC personnel, volunteers
or interns who are involved in providing you care. For example, involved staff may discuss your clinical information
to develop and carry out your Individualized Service Plan (ISP). Other FEC staff may share your clinical
information to coordinate different services you need, such as medical tests,
respite care, transportation, etc. We
may also need to disclose your clinical information to your service coordinator
and other providers outside of FEC who are responsible for providing you with
the services identified in your ISP or to obtain new services for you.
♦ Appointment
Reminders: We may use and disclose
medical information to contact you as a reminder that you have an appointment
for treatment or services at one of our programs.
♦ Payment: FEC will use your clinical information so
that we can bill and collect payment from you, a third party, and insurance
company, Medicare or Medicaid or other government agencies. For example, we may need to provide the NYS
Department of Health (Medicaid) with information about the services you
received in our facility or through one of our HCBS waiver programs so they
will pay us for the services. In
addition, we may disclose your clinical information to receive prior approval
for payment for services you may need.
Also, we may disclose your clinical information to the US Social
Security Administration, or the Department of Health to determine your
eligibility for coverage or your ability to pay for services.
♦ Health
Care Operations: FEC will use
clinical information for administrative operations. These uses and disclosures are necessary to operate FEC programs
and residences and to make sure all consumers receive appropriate, quality
care. For example, we may use clinical
information for quality improvement to review our treatment and services and to
evaluate the performance of our staff in caring for you. We may also disclose information to
clinicians and other personnel for on-the-job training. We will also share your clinical
information with FEC staff to resolve complaints or objections to your
services. We may also disclose clinical
information to our
consultants who need access to the information to perform administrative or
professional services on our behalf.
Other Uses and Disclosures
that Do Not Require your Permission
In addition to treatment,
payment and health care operations, FEC will use your clinical information
without your permission for the following reasons:
♦ When we are required to do so by federal or state law;
♦ For
public health reasons, including
prevention and control of disease, injury or disability, reporting births and
deaths, reporting child abuse or neglect, reporting reactions to medication or
problems with products, and to notify people who may have been exposed to a
disease or are at risk of spreading the disease;
♦ To
report domestic violence and adult abuse
or neglect to government authorities if you agree or if necessary to
prevent serious harm;
♦ For
health oversight activities,
including audits, investigations, surveys and inspections, and licensure. These activities are necessary for
government to monitor the health care system, government programs, and
compliance with civil rights laws.
Health oversight activities do not include investigations that are not
related to the receipt of health care or receipt of government benefits in
which you are the subject;
♦ For
judicial and administrative proceedings,
including hearings and disputes. If you
are involved in a administrative proceeding we will disclose clinical
information if the judge or presiding officer orders us to share the
information;
♦ For
law enforcement purposes, in
response to a court order or subpoena to report a possible crime, to identify a
suspect or witness or missing person, to provide identifying data in connection
with a criminal investigation, and to the district attorney in furtherance of a
criminal investigation of client abuse;
♦ Upon
your death, to coroners or medical
examiners for identification purposes or to determine cause of death, and
to funeral directors to allow them
to carry out their duties;
♦ To
organ procurement organizations to accomplish cadaver, eye, tissues, or organ donations in compliance with state law;
♦ For
research purposes when you have
agreed to participate in the research and the Institutional Review Board or
Privacy Committee has approved the use of the clinical information for the
research purposes;
♦ To prevent or lessen a serious and imminent
threat to your health and safety or someone else.s;
♦ To
authorized federal officials for intelligence and other national security activities authorized by law or to provide protective services to the President
and other officials;
♦ To
correctional institutions or law enforcement officials if you are an
inmate and the information is necessary to provide you with health care,
protect your health and safety or that of others, or for the safety of the
correctional institution;
♦ To
governmental agencies that administer
public benefits if necessary to coordinate the covered functions of the
programs.
Uses and Disclosures that
Require Your Agreement
FEC may disclose clinical
information to the following persons if we tell you we are going
to use or disclose it and you agree or do not object:
♦ To family members and personal
representatives who are involved in your care if the information is
relevant to their involvement and to notify them of your condition and
location; or
♦ To
disaster relief organizations that need to notify your
family about your condition and location should a disaster occur.
Authorization Required For
All Other Uses and Disclosures
♦ For
All other types of uses and disclosures not described in this
Notice, FEC will use or disclose clinical information only with a written
authorization signed by you that states who may receive the information, what
information is to be shared, the purpose of the use or disclosure and
expiration for the authorization.
Written authorizations are always required for use and disclosure of
psychotherapy notes and for marketing purposes.
Note: If you cannot give permission due to an
emergency, FEC may release clinical information in your best interest. We must tell you as soon as possible after
releasing the information.
You may revoke your
authorization at any time. If you
revoke your authorization in writing we will no longer use or disclose you
clinical information for the reasons stated in your authorization. We cannot, however, take back disclosures we
made before you revoked and we must retain clinical information that indicates
the services we have provided to you.
Changes to this Notice
We reserve the right to change this notice. We reserve
the right to make changes to terms described in this notice and to make the new
notice terms effective to all clinical information that FEC maintains. We will post the new notice with the
effective date on our website at www.familyempowerment.org
and in our facilities. In addition, we
will offer you a copy of the revised notice at your next scheduled service planning meeting.
If you believe your privacy
rights have been violated:
♦ You may
file a complaint with the FEC Executive Director, Amy Anderson-Winchell at
Family Empowerment Council, Inc., 225 Dolson Avenue, Suite 403, Middletown, New
York 10940, 845-343-8100 x 237.
♦ You
may contact the Secretary of the Department of Health and Human Services.
You may call him at 1-877-696-6775 or write to him at 200 Independence Ave. S.W., HHH Building Room 509H, Washington DC, 20201.
♦ You
may file a grievance with the Office of Civil Rights by calling 1-866-OCR-PRIV
or 1-866-627-7748; or (TTY) 1-866-788-4989; or by email at ocrmail.hhs.gov
All complaints must be
submitted in writing. You will not be penalized for filing a
complaint.