NOTICE OF PRIVACY PRACTICES
Advocates Community Counseling
1881 Worcester Road, Framingham, MA 01701
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 (“Notice”) describes how Advocates, Inc. (“Advocates” or “we”) may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice applies to the privacy practices Advocates, Inc. and Advocates Community Counseling, Inc., as affiliated covered entities. This Notice also describes the obligations we have to protect your privacy as well as your rights regarding health information we maintain about you.
I. PROTECTED HEALTH INFORMATION
“Protected Health Information” (“PHI”) is information about you that may identify you and that relates to your past, present or future physical or mental health condition and health care services.
II. OUR RESPONSIBILITIES
Advocates is committed to respecting your privacy and confidentiality. We are required by law to maintain the privacy of your PHI and to provide you with this notice of our legal duties and privacy practices with respect to your PHI. We are also required to comply with the terms of our current Notice. If we change our practices and this Notice, the updated Notice will be posted on Advocates’ website at www.Advocates.org. You also have a right to obtain a paper copy upon request.
We may use and disclose your PHI without your authorization as described in each category listed below. For some of these uses or disclosures, we need your written authorization. Below we describe the different categories of our uses and disclosures and give you some examples in each category. Except when disclosing PHI relating to your treatment, payment or health care operations, we must use or disclose only the minimum necessary PHI to accomplish the purpose of the use or disclosure.
A. Uses and Disclosures That May Be Made For Treatment, Payment and Operations.
Except where prohibited by state or federal law, Advocates staff may legally use and share your PHI for treatment, payment and health care operations. We do not need to obtain your written authorization to take such actions, as explained below.
1. For Treatment. We may use and disclose your PHI to manage, coordinate and provide your health care treatment and any related services. For example, we may disclose information to all members of the Advocates’ team who are involved in managing and providing your care, including case managers, therapists, clinicians, and other health care personnel. We may also disclose your PHI to other non-Advocates’ health providers, including but not limited to your primary care physician or a laboratory.
2. For Payment. We may use and disclose your PHI for billing purposes and to obtain payment for your health care services. By way of example, we may disclose your PHI to your insurer in order for it to take certain actions before approving or paying for your services. These actions may include:
- making a determination of eligibility or coverage for health insurance;
- reviewing your services to determine if they were medically necessary, appropriately authorized or certified in advance of your care; and/or
- for purposes of utilization review (e.g., ensuring the appropriateness of your care or charges).
We may also disclose PHI to your insurer in some instances in order to determine if the insurer will approve future treatment.
3. For Health Care Operations. We may use and disclose PHI for our health care operations. These uses and disclosures are necessary to run our organization and make sure that our clients receive quality care. This includes information shared with outside parties who perform health care operations or other services on behalf of Advocates (“business associates”). Such health care operations may include quality assessment and improvement, reviewing the performance or qualifications of our clinicians, licensing, accreditation, business planning and development, and general administrative activities.
4. Fundraising Activities. We may contact you as part of our fundraising efforts. If you do not wish to be contacted for such purposes, you have the right to opt out of receiving such communications.
A. Other Uses and Disclosures That You May Ask to Limit, or Request Not To Be Made
1. Persons Involved in Your Care. We may provide your PHI to someone who you indicate is involved with your care or the payment of your care, unless you object in whole or in part. We may also use or disclose your PHI to an entity assisting in disaster relief efforts and to coordinate uses and disclosures for such purpose to family or other individuals involved in your health care. If you are physically present and have the capacity to make health care decisions, your PHI may only be disclosed with your agreement to persons you designate to be involved in your care. But, if you are in an emergency situation, we may disclose your PHI to a spouse, a family member, or a friend so that such person may assist in your care. In this case we will determine whether the disclosure is in your best interest and, if so, only disclose information that is directly relevant to participation in your care. If you are not in an emergency situation but are unable to make health care decisions, we may disclose your PHI, as authorized by law, to third parties, such as: your health care agent if we have received a valid health care proxy from you, your guardian or medication monitor if one has been appointed by a court, or if applicable, the state agency responsible for consenting to your care.
B. Uses and Disclosures That May be Made Without Your Authorization or Opportunity to Object.
Advocates may also legally use and disclose your PHI to others for certain purposes that are not treatment, payment or health care operations, without your written authorization, such as: in an emergency treatment situation; when required by law; for research purposes; for public health activities; for health oversight activities; to avoid harm; for disclosures in legal proceedings; for law enforcement activities; to medical examiners or funeral directors; or, if you are a member of the armed forces, as required by military command authorities.
C. Uses and Disclosures of Your PHI with Your Permission.
All other uses and disclosures of your PHI not otherwise contained in this Notice will require your written authorization. Examples of uses and disclosures that require your authorization include, but are not limited to, most disclosures of clinical assesssments, progress notes and drug and alcohol abuse treatment records, and marketing purposes. Further, Advocates is prohibited from selling your PHI without your express written authorization. You have the right to revoke an authorization at any time. If you revoke your authorization we will not make any further uses or disclosures of your PHI under that authorization, unless we have already acted upon your previously provided consent.
III. YOUR RIGHTS
A. Right to Inspect and Copy.
You have the right to request an opportunity to inspect or copy your PHI, subject to federal and state laws. You must submit your request in writing either to your Advocates provider or the Chief Compliance Officer. If you request a copy of the information, we may charge a fee for the cost of copying, mailing and supplies associated with your request. We may deny your request to inspect or copy your PHI in certain limited circumstances.
B. Right to Amend.
For as long as we keep records about you, you have the right to request us to amend any PHI used to make decisions relating to your treatment or payment if you think there has been a mistake or that information is missing. Usually, this would include clinical and billing records. To request an amendment, you must notify your Advocates provider or the Chief Compliance Officer in writing explaining why you believe the information is incorrect or inaccurate. Your Advcoates provider can assist you in preparing your request if needed. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend PHI that: was not created by us; is not part of the PHI we maintain to make decisions about your care; is not part of the PHI that you would be permitted to inspect or copy; or is accurate and complete. If we deny your request to amend, we will send you a written notice of the denial stating the basis for the denial and offering you the opportunity to provide a written statement disagreeing with the denial. If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and our denial be attached to all future disclosures of the PHI that is the subject of your request. If you choose to submit a written statement of disagreement, we have the right to prepare a written rebuttal to your statement of disagreement. In this case, we will attach the written request and the rebuttal (as well as the original request and denial) to all future disclosures of the PHI that are the subject of your request.
C. Right to an Accounting of Disclosures.
You have the right to request that we provide you with a list of instances when your PHI has been released. You may request an accounting as far back as six years, except requests for electronic disclosures relating to treatment, payment or operations disclosures which are limited to three years. The accounting will not include (i) non-electronic disclosures relating to treatment, payment or operations; (ii) disclosures if you gave your written authorization to share the information; (iii) disclosures shared with individuals involved in your care; (iv) disclosures to you about your health condition; (v) disclosures made for national security or intelligence purposes or to correctional institutions or law enforcement officials who have custody of you. We will respond to your request within 60 days of receiving it. The first accounting you request within a twelve month period will be free. For additional requests during the same 12 month period, we may charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.
D. Right to Request Restrictions.
You have the right to request a restriction on how we use or disclosure your PHI. You must request the restriction in writing to your Advcoates provider the Chief Compliance Officer. The Chief Compliance Officer or your Advocates provider will then ask you to fill out a Request for Restriction Form, which you should complete and return to the Chief Compliance Officer or your Advocates provider. We are not required to agree to a restriction that you may request. If we do agree, we will honor your request, to the extent authorized by law, unless the restricted PHI is needed to provide you with emergency treatment.
E. Right to Restrict Disclosure
You have the right to restrict certain disclosures of PHI to a health plan if you pay out of pocket in full for the health care service.
F. Right to Request Confidential Communications.
You have the right to request that we communicate with you about your health care only in a certain location or through a certain method. For example, you may request that we contact you only at work or by e-mail. To request such a confidential communication, you must make your request to your Advcoates provider or to the Chief Compliance Officer in writing. You do not need to give us a reason for the request; however, your request must specify how and where you wish to be contacted.
Individuals whose PHI has been breached will be notified in writing as required by law.
IV. CONFIDENTIALITY OF SUBSTANCE ABUSE RECORDS:
For individuals who have received treatment, diagnosis or referral for treatment from our drug or alcohol abuse programs, the confidentiality of drug or alcohol abuse records is protected by state and/or federal law. As a general rule, we may not tell a person outside the programs that you attend any of these programs, or disclose any information identifying you as an alcohol or drug abuser, unless:
- you authorize the disclosure in writing; or
- the disclosure is permitted by a court order; or
- the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation purposes; or
- you threaten to commit a crime either at the drug abuse or alcohol program or against any person who works for our drug abuse or alcohol programs.
A violation by us of the federal law governing drug or alcohol abuse is a crime. Suspected violations may be reported to the Unites States Attorney in the district where the violation occurs. Federal law and regulations governing confidentiality of drug or alcohol abuse permit us to report suspected child abuse or neglect under state law to appropriate state or local authorities. See 42 U.S.C. 290dd–3 and 42 U.S.C. 290ee–3 for federal laws and 42 CFR part 2 for federal regulations.
If you believe your privacy rights have been violated, or you disagree with a decision we made about access to your PHI, you may file a complaint with our Chief Compliance Officer or his/her designee at the address listed below. You may also contact the Chief Compliance Officer with any questions about this Notice. Our Chief Compliance Officer will assist you with writing your complaint if you request such assistance. We will not retaliate against you for filing a complaint.
ADVOCATES’ PRIVACY OFFICER:
Chief Compliance Officer
1881 Worcester Road
Framingham, MA 01701
You may also file a written complaint with the Secretary of the United States Department of Health and Human Services as follows:
Office of Civil Rights
U.S. Department of Health and Human Services
J.F. Kennedy Federal Building-Room 1875
Boston, MA 02203
Phone: (617) 565-1340
Effective April 13, 2003;
Last update: July 26, 2013