PRIVACY NOTICE

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

REVISED: 04/15/13

Your Privacy is Important

Frontier Health understands your privacy is important. We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice. We will handle this information only as allowed by federal/state law and agency policy, adhering to the most stringent law that protects your health information.

Each time you receive services from us, the provider makes a record of the visit. Typically, this record contains your assessment, service plan, progress notes, diagnoses, treatment, and plan for future care or treatment.

Complaints

If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.

If you have any questions, requests, or complaints, please contact our office at (423) 467-3600 and ask for the Privacy Officer.

Your Federally defined rights under 45 CFR Parts 160 and 164 (HIPAA Privacy Standards)

There are several rights concerning your protected health information that we want you to be aware of.

• You have the right to inspect or to request copies of your medical records. This process will be kept confidential. This right is not absolute. In certain situations, such as if access would cause harm, we can deny access. You must make this request in writing to your counselor, therapist, case manager, psychiatrist, or other treatment provider at Frontier Health. If denied access, you will receive a timely, written notice of the decision and reason, and a copy of this notice becomes a part of your record.
• You have the right to request amendment of your medical records if you believe information in the records is inaccurate or incomplete. You must make this request in writing to your counselor, therapist, case manager, psychiatrist, or other treatment provider at Frontier Health. We may deny the request for proper reasons but you will be provided with a written explanation of the denial.
• You have the right to receive an accounting of the agency’s disclosures of your protected health information (for up to six years prior to the date on which you request the accounting, but not prior to April 14, 2003), that were not for the purpose of treatment, payment, health care operations, or that were not otherwise authorized by you. You also have the right to be given the names of anyone, other than employees of the agency, who received information about you from the agency.
• You have the right to request from your counselor, therapist, case manager, psychiatrist, or other treatment provider at Frontier Health a restriction with regards to the use or disclosure of your protected health information. This request will be given serious consideration by the Privacy Officer and you will be informed promptly whether we will be able to honor the requested restriction and still offer effective services, receive payment and maintain health care operations. Legally we are not required to agree to any restrictions you request, but if we do agree, we are bound by that agreement except under certain emergency circumstances.
• You have the right to restrict certain disclosures of your protected health information to your health plan if you pay out of pocket in full for that service, as allowed by law.
• You have the right to be notified in the event of a breach of your unsecured protected health information in a timely manner as required by law.
• You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Such requests must be made in writing to the office manager at the site where you receive services. We will agree to all reasonable requests.
• You have the right to obtain a paper copy of this Privacy Notice at any time upon request.

Use and Disclosure of Your Information

Upon signing the agency’s Consent to Treatment/Service form, you are allowing us to use and disclose necessary information about you within the agency and with business associates in order to provide treatment/service, receive payment of provided treatment/service, and conduct our day-to-day health care operations.

EXAMPLES:

In order to effectively provide treatment/service, your Primary Service Coordinator may consult with various service providers within the agency. During those consultations health information about you may be shared.

In order to receive payment of services provided, your health information may be sent to those companies or groups responsible for payment coverage, and a monthly bill is sent to the Responsible Party identified by you and noted on the financial form.

In day-to-day health care operations, trained staff may handle your physical medical record in order to have the record assembled, available for review by the Primary Service Coordinator, or for filing of documentation. Certain data elements are entered into our computer system that processes most billing, and for state statistical reporting, grant compliance, and licensure of the following applicable “Departments”:

• Virginia Department of Behavioral Health and Developmental Services
• Virginia Department for Aging and Rehabilitative Services
• Tennessee Department of Mental Health and Substance Abuse Services
• Tennessee Department of Health
• Tennessee Department of Human Services – Vocational Rehabilitation Services
• Tennessee Department of Children’s Services
• Tennessee Department of Finance & Administration

As a part of our continuous quality improvement efforts to provide the most effective services, your record may be reviewed by professional staff to assure accuracy, completeness and organization.  Records may also be reviewed during accreditation surveys by the Commission on Accreditation of Rehabilitation Facilities (CARF), and/or any licensing authority of the States of Virginia or Tennessee.

Enhancing Your Health Care

Some agency programs provide the following support to enhance your overall health care and may contact you to provide:

• Appointment reminders by call or letter.
• Information about treatment alternatives.
• Information about health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for That Care
Unless you object, we may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.

Specific Circumstances for Disclosure of Protected Health Information (PHI)
This agency is also allowed by federal and state law in certain circumstances to disclose specific health information about you. These specific circumstances are:

• As required by law (ex: reports required for public health purposes, such as reporting certain contagious diseases).
• Judicial and Administrative proceedings (ex: order from a court or administrative tribunal, or legal counsel to the agency, or Inspector General).
• Law Enforcement purposes (ex: reporting of gun shot wounds; limited information requested about suspects, fugitives, material witnesses, missing persons; criminal conduct on premises).
• To avert a serious threat to health or safety, we may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
• Children or incapacitated adults who are victims of abuse, neglect or exploitation.
• Essential Government Functions.
• Military Services (ex: in response to appropriate military command to assure the proper execution of the military mission).
• National Security and Intelligence activities (ex: in relation to protective services to the President of the United States).
• State Department (ex: medical suitability for the purpose of security clearance).
• Protecting the health and safety of inmates or employees in a correctional institute.
• Workers Compensation to facilitate processing and payment.
• Coroners and Medical Examiners for identification of a deceased person or to determine cause of death.
• To the Department of Health and Human Services in connection with an investigation of us for compliance with federal regulations.
• Determining eligibility for or conducting enrollment in certain government benefits programs.

Other Uses and Disclosures of Your Information by Authorization Only

We are required to get your authorization to use or disclose your protected health information for any reason other than for treatment/services, payment, or health care operations, and those specific circumstances outlined previously. Most uses and disclosures of psychotherapy notes require authorization. We use an Authorization to Use/Disclose form that specifically states what information will be given to whom, for what purpose, and is signed by you or your legal representative.

You have the ability to revoke the signed authorization at any time by a written statement except to the extent that we have acted on the authorization.

Changes to Privacy Practices

Frontier Health reserves the right to change any of its privacy policies and related practices at any time, as allowed by federal and state law, and to make the change effective for all protected health information that we maintain. When we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting area at each site and on our website. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the agency Privacy Officer at (423) 467-3600.