ADAMH BOARD NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003
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.
If you have any questions about this
Notice, please contact Daniel P. Obertance at: The Jefferson County
Prevention & Recovery Board
At The Jefferson County Prevention and
Recovery Board we understand that health information about you and your health
is personal. We are committed to
protecting health information about you and safeguarding that information
against unauthorized use or disclosure. We
are required by law to: 1) assure health information that identifies you is kept
private; 2) give you Notice of our legal duties and privacy practices with
respect to health information about you; and, 3) follow the terms of the Notice
that is currently in effect. This
Notice will tell you about the ways in which we may use and disclose health
information about you. We also
describe your rights and certain obligations we have regarding the use and
disclosure of your health information. The
Notice applies to all of the records that we have related to your care.
WHY WE COLLECT PERSONAL HEALTH
INFORMATION?
We collect personal information to:
Determine eligibility for health care coverage
Provide benefits and pay claims
Conduct our service evaluation programs
Provide other information for planning and improving mental
health and substance abuse services in the community
We may also be required to collect and keep
certain information so that we meet legal and regulatory requirements. We keep
this information after a client's health care coverage ends.
PERSONAL INFORMATION WE COLLECT
We ask people seeking benefits to provide certain information when they complete an enrollment form.
This information may include, for example:
Name, Address, Phone
Date Of Birth
Marital Status
Social Security Number
Family Income
We may also receive personal information about
you from others, such as:
Health care providers (doctors, clinics, hospitals)
Other ADAMH Boards that provide coverage to our clients
Business partners (companies with whom we have arrangements
to assist us in providing products and services)
Other government agencies (criminal justice system, child
welfare, juvenile justice, etc.)
The information we collect from others may
include, for example, eligibility, claims and payment information. We create and maintain a record of your enrollment in the
public mental health and or drug addiction and substance abuse system of the
State of Ohio, and maintain records of payment for treatment you receive in the
public system. From time to time,
we also receive information from your treatment provider related to your
diagnosis, treatment and progress in recovery, and any major unexpected
emergencies or crises you may experience that help the Board to plan for and
improve the quality of services for the region’s citizens.
HOW WE MAY USE AND DISCLOSE HEALTH
INFORMATION ABOUT YOU.
When you receive services paid for in part or
in full by the ADAMH Board, we may use your personal information for such
activities as conducting our normal board business known as health care
operations. If the services we paid
for were mental health services, we may also use your personal information for
billing for such services.
If you have a guardian or a power of attorney
we will provide the information to your guardian or attorney in fact.
Examples of how we use your information
include:
Payment
for Mental Health Services – We keep records that include payment
information and documentation of the services provided to you. Your information
may be used to obtain payment for your services from Medicaid, insurance or
other sources. For example, we may
disclose personal information about the services provided to you to confirm your
eligibility for Medicaid and to obtain payment from Medicaid.
Health
Care Operations – We use personal information to train staff, manage
costs, conduct required business duties, and make plans to better serve you and
other community residents who may need mental health or substance abuse
services.
Other
Services We Provide
We may also use your personal information to:
·
Review and evaluate the quality, effectiveness, and efficiency of
the services you have received;
·
Conduct program and fiscal audits of programs who have provided
you with services;
· Iinvestigate
major unusual incidents, report these kinds of incidents and take steps to
protect your health and safety;
· Prepare
reports required by the Ohio Department of Mental Health, the Ohio Department of
Alcohol and Drug Addiction Services and the Ohio Department and Family Services;
·
Contact you for assistance in passing levies, unless you notify
the ADAMH Board that you do not wish to be contacted for these purposes.
Sharing
Your Personal Information
There are limited situations when we are
permitted or required to disclose personal information without your signed
authorization. These situations are:
· To
protect victims of abuse, neglect, or domestic violence;
· To
reduce or prevent a serious threat to public health and safety;
· For
health oversight activities such as investigations, audits, and inspections;
For local, state, federal agencies to monitor
your services:
· For
lawsuits and similar proceedings;
· For
public health purposes such as reporting communicable diseases, work-related
illnesses, or other diseases and injuries permitted by law; reporting births and
deaths, and reporting reactions to drugs and problems with medical devices;
· When
required by law;
· When
requested by law enforcement as required by law or court order, except as
limited by laws regarding disclosure of alcohol and other drug treatment;
· To
coroners, medical examiners, and funeral directors;
· For
organ and tissue donation;
· For
workers’ compensation or other similar programs if you are injured at work and
are covered by workers’ compensation or other similar programs;
· For
specialized government functions such as intelligence and national security;
All other uses and disclosures, not described
in this notice, require your signed authorization.
You may revoke your authorization at any time with a written statement.
We maintain physical, electronic and
procedural safeguards that comply with applicable federal and state laws and
regulations to guard your personal information against unauthorized use or
disclosure. Any third party
processor or consultant used by the Board has signed an agreement with us
requiring such entity to maintain the confidentiality of your personal
information. We also restrict access to your personal information to those
employees who need to know the information in order to perform their job duties.
The Board maintains policies and procedures that prohibit employees and
agents of the Board from using, disclosing, transferring, providing access to or
otherwise divulging client health information to any person or entity other than
to the individual who is the subject of the information.
INDIVIDUAL CLIENT RIGHTS
You have the following rights regarding the
health information we maintain about you:
Right to Request
Restrictions. You have
the right to request a restriction or limitation on the health information
we use or disclose about you for payment or health care operations. We will consider all requests for
restrictions carefully but are not required to agree to any requested
restrictions.*
You also have the
right to request a limit on the health information we disclose about you to a
family member who is involved in your care if you are receiving mental health
services and have previously agreed to limited disclosure to such a family
member. We will comply with any
restrictions you request regarding disclosure to such a family member.*.
Right to Request
Confidential Communications.
You have the right to
request that we communicate with you about health matters in a certain way
or at a certain location. For
example, you can ask that we only contact you at work or by mail.
Right to Inspect and Copy.
You have the right to access the personal information we collect upon
request. Under certain circumstances, we may not share information that we
collected, for example, if the information is the subject of a lawsuit or
legal claim or if release of mental health information may present a danger
to you or someone else. Fees
may apply to copied information.*
Right to Amend.
You have the right to request corrections or additions to your
personal information. You must
give the reasons for wanting the change.*
Right to An Accounting of Disclosures.
You have the right to request an accounting of disclosures made of
your personal information that were not related to our business operations
or your authorization. Under
certain circumstances, we may not share information that we collected, for
example, if the information is the subject of a lawsuit or legal claim or if
release of the information may present a danger to you or someone else.
Your request must state the period of time desired for the
accounting, which must be within the six years prior to your request. The
first accounting is free but a fee will apply if more than one request is
made in a 12-month period.*
Right to a Paper Copy of Notice.
You have the right to a paper copy of this Notice. Although this Notice is available at our web site
www.jcprb.org, you may obtain a copy of the Notice by contacting the Board
Office.
Requests marked with a star (*) must be made
in writing. Contact the ADAMH Board Privacy Officer with your request.
To exercise any of your rights described in
this paragraph, please contact the Board Privacy Officer at the address or phone
number listed below.
Daniel P. Obertance
JCPRB
500 Market Street, Suite 600
Steubenville,
OH 43952
740-282-1300
CHANGES TO THIS NOTICE
We
reserve the right to change this Notice at any time.
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 post
a copy of the current Notice at the Board Office.
The Notice will contain on the first page in the top center, the
effective date. In addition, each
time there is a change in the Notice, you will receive a copy by mail at the
last known address we have in our plan enrollment file.
COMPLAINTS
If you have a complaint about our Privacy
policies and procedures or you believe your privacy rights have been violated,
you may file a complaint with the Board or with the Secretary of the Department
of Health and Human Services. To
file a complaint with the Board, contact the Privacy Officer at the address
below. We will investigate all
complaints and will not retaliate against you for filing a complaint. If you wish to file a complaint with the Secretary you may
send the complaint to:
HIPAA Complaint
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
Other uses and disclosures of your personal
health information not covered by this Notice or the laws that apply to us will
be made only with your written permission.
If you provide us permission to use or disclose health information about
you, you may revoke that permission, in writing, at any time.
If you revoke your permission, we will no longer use or disclose your
health information for the reasons covered by your written permission.
You understand that we are unable to take back any disclosures we have
already made with your permission, and that we are required to retain our
records of the services that we provided to you.
Daniel P. Obertance
JCPRB
500 Market Street, Suite 600
Steubenville,
OH 43952
740-282-1300