THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
Given the nature of Bailey et al. PLLC's work, it is imperative
that it maintains the confidence of client information that it
receives in the course of its work. Bailey et al. is a
mental health practice that provides mental health services.
Bailey et al.'s practice works solely to provide the best
counseling treatment options to its clients. Bailey et al. is
prohibited from releasing any client information to anyone
outside immediate staff, employees, interns, and/or volunteers
except in limited circumstances in accordance with this Notice of
Privacy Policies and Practices. Discussions or disclosures of
protected health information ("PHI") within the practice are
limited to the minimum necessary that is needed for the recipient
of the information to perform his/her job. Please review
this Notice of Privacy Policies and Practices ("Notice of Privacy
Policies"). It is my policy to:
fully comply with the requirements of the HIPAA General
Administrative Requirements, the Privacy and Security Rules;
provide every client who receives services with a copy of this
Notice of Privacy Policies; ask the client to acknowledge receipt
when given a copy of this Notice of Privacy Policies; ensure the
confidentiality of all client records transmitted by facsimile;
obtain from each client an informed Authorization for Release of
Protected Health Information form when required.
Bailey et al. is required to follow all state and federal
statutes and regulations including Federal Regulation 42 C.F.R.
Part 2 and Title 25, Article 4, Part 14 and Title 25, Article 1,
Part 1, CRS and the Health Insurance Portability and
Accountability Act (HIPAA), 45 C.F.R. Parts 142, 160, 162 and
164, governing testing for and reporting of TB, HIV AIDS,
Hepatitis, and other infectious diseases, and maintaining the
confidentiality of PHI.
PHI refers to any information that I create or receive, and
relates to an individual's past, present, or future physical or
mental health or conditions and related care services or the
past, present, or future payment for the provision of health care
to an individual; and identifies the individual or there is a
reasonable basis to believe the information can be used to
identify the individual. PHI includes any such information
described above that I transmit or maintain in any form; this
includes Psychotherapy Notes. HIPAA and federal law regulate the
use and disclosure of PHI when transmitted electronically.
YOUR RIGHTS AS A CLIENT:
When it comes to your health information, you have certain
rights. This section explains your rights and some of our
responsibilities to help you.
Get an electronic or paper copy of your mental health
record
- You can ask to see or
get an electronic or paper copy of your mental health record and
other health information we have about you. Ask us how to do
this.
- We will provide a
copy or a summary of your health information, usually within 30
days of your request. We may charge a reasonable, cost-based fee
to fulfill your request.
- If we deny your
request, in whole or in part, we will let you know why in writing
and whether you have the option of having the decision reviewed
by an independent third-party.
Ask us to correct your mental health record
- You can ask us to
correct health information about you that you think is incorrect
or incomplete. Ask us how to do this.
- We may say "no" to
your request, but we'll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to
contact you in a specific way (for example, home or office phone)
or to send mail to a different address.
- We will say "yes" to
all reasonable requests.
- Please review the
Consent For Communication Of Protected Health Information By
Non-Secure Transmissions
- You are required to
"opt-in" to receive communications electronically as set-forth in
the Consent for Communication of Protected Health Information by
Non-Secure Transmissions. If you choose not to "opt-in" to
receive electronic communications, we will not communicate with
you via electronic means.
Ask us to limit what we use or share
- You can ask us not to
use or share certain health information for treatment, payment,
or our operations. We are not required to agree to your request,
and we may say "no" if it would affect your care.
- If you pay for a
service or health care item out-of-pocket in full, you can ask us
not to share that information for the purpose of payment or our
operations with your health insurer. We will say "yes" unless a
law requires us to share that information.
Additional Restrictions
- You have the right to request additional
restrictions on the use or disclosure of your mental health
information. However, we do not have to agree to that
request, and there are certain limits to any restriction.
Ask us if you would like to make a request for any
restriction(s).
Get a list of those with whom we've shared information
- You can ask for a
list (accounting) of the times we've shared your health
information for six years prior to the date you ask, who we
shared it with, and why.
- We will include all
the disclosures except for those about treatment, payment, and
health care operations, and certain other disclosures (such as
any you asked us to make). We'll provide one accounting a year
for free but will charge a reasonable, cost-based fee if you ask
for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a
paper copy of this notice at any time, even if you have agreed to
receive the notice electronically. We will provide you with a
paper copy promptly.
Choose someone to act for you
- If you have given
someone medical power of attorney or if someone is your legal
guardian, that person can exercise your rights and make choices
about your health information.
- We will make sure the
person has this authority and can act for you before we take any
action.
File a complaint if you feel your rights are violated
- You can complain if
you feel we have violated your rights by contacting us using the
information on page 1.
- You can file a
complaint with the U.S. Department of Health and Human Services
Office for Civil Rights by sending a letter to 200 Independence
Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or
visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate
against you for filing a complaint.
- You may also file a
complaint with the Colorado Department of Regulatory Agencies,
Division of Professions and Occupations, Mental Health Section;
1560 Broadway, Suite 1350, Denver, Colorado, 80202, 303-894-2291;
DORA_Mentalhealthboard@state.co.us. Please note that the
Department of Regulatory Agencies may direct you to file your
complaint with the U.S. Department of Health and Human Services
Office for Civil Rights listed above and may not be able to take
any action on your behalf.
USES AND DISCLOSURES OF PROTECTED HEALTH
INFORMATION
A use of PHI occurs within a covered entity (i.e.,
discussions among staff regarding treatment). A disclosure
of PHI occurs when Bailey et al. reveal PHI to an outside party
(i.e., Bailey et al. provides another treatment provider with
PHI, or shares PHI with a third party pursuant to a client's
valid written authorization).
Bailey et al. may use and disclose PHI, without an individual's
written authorization, for the following purposes:
Treatment: disclosing and using your PHI by those who are
involved in your care for the purpose of providing, coordinating,
or managing your health care treatment and related services. This
includes consultation with clinical supervisors or other treatment
team members and for coverage arrangements during your therapist's
absence, and for sending appointment reminders or information about
treatment alternatives or other health-related benefits and
services that may be of interest to you. Payment: disclosing
and using your PHI so that Bailey et al. can receive payment for
the treatment services provided to you, such as: making a
determination of eligibility or coverage for insurance benefits,
processing claims with your insurance company, reviewing services
provided to you to determine medical necessity, or undertaking
utilization of review activities. Health Care Operations:
disclosing and using your PHI to support Bailey et al.'s business
operations which may include but not be limited to: quality
assessment activities, licensing, audits, and other business
activities.
Uses and disclosures for payment and health care operations
purposes are subject to the minimum necessary requirement. This
means that Bailey et al. may only use or disclose the minimum
amount of PHI necessary for the purpose of the use or disclosure
(i.e., for billing purposes Bailey et al. would not need to
disclose a client's entire medical record in order to receive
reimbursement. Bailey et al. would likely only need to include a
service code and/or diagnosis etc.). Uses and disclosures for
treatment purposes are not subject to the minimum necessary
requirement.
Bailey et al. is required to promptly notify you of any breach
that may have occurred and/or that may have compromised the
privacy or security of your PHI.
Confidentiality of client records and substance abuse client
records maintained are protected by federal law and
regulations. It is Bailey et al.'s policy that a client
must complete an Authorization for Release of Protected Health
Information it provides prior to disclosing health information to
another individual and/or entity for any purpose, except for
treatment, payment, or health care operations in accordance with
this Notice of Privacy Policies.
Absent the above referenced form, other than for treatment,
payment, or health care operations purposes, Bailey et al. is
prohibited from disclosing or using any PHI outside of or within
the organization, including disclosing that the client is in
treatment without written authorization, unless one of the
following exceptions arises:
1. Responding to lawsuit and legal
actions (Disclosure by a court order, in response to a complaint
filed against Bailey et al., etc. This does not include a request
by you or another party for your records).
2. Disclosure is made to medical
personnel in a medical emergency or to qualified personnel for
research, audit or program evaluation.
3. Help with public health and
safety issues (Client commits or threatens to commit a crime
either at Bailey et al.'s office or against any person who works
for Bailey et al.; A minor or elderly client reports having been
abused or there is reasonable suspicion that abuse has or will
take place; Client is planning to harm another person, including
but not limited to the harm of a child or at-risk elder; Client
is imminently dangerous to self or others).
4. Address workers' compensation,
law enforcement, and other government requests.
5. Respond to organ and tissue
donation requests.
6. Business Associates: Bailey et
al. may enter into contracts with business associates to provide
billing, legal, auditing, and practice management services that
are outside entities. In those situations, protected health
information will be provided to those contractors as is needed to
perform their contracted tasks. Business associates are
required to enter into an agreement maintaining the privacy of
the protected health information released to them.
7. In compliance with other state
and/or federal laws and regulations.
The above exceptions are subject to several requirements under
the Privacy Rule, including the minimum necessary requirement and
applicable federal and state laws and regulations. See 45
C.F.R. 164.512. Before using or disclosing PHI for one of
the above exceptions, Bailey et al.'s staff must consult its
Privacy Officer (Jeff Bailey, LPC, 970-710-3336,
group@mbabailey.com) to ensure compliance with the Privacy
Rule. Violation of these federal and state guidelines is a
crime carrying both criminal and monetary penalties.
Suspected violations may be reported to appropriate authorities,
as listed above in the "Client Rights" section, in accordance
with federal and state regulations. Know that Bailey et al. will
never market or sell your personal information without your
permission.
SPECIAL AUTHORIZATIONS
Certain categories of information have extra protections by law,
and thus require special written authorizations for disclosures.
Psychotherapy Notes: Bailey et al. may keep and
maintain "Psychotherapy Notes", which may include but are not
limited to notes Bailey et al. makes about your conversation
during a private, group, joint, or family counseling session,
which is kept separately from the rest of your record. These
notes are given a greater degree of protection than PHI. These
are not considered part of your "client record." Bailey et al.
will obtain a special authorization before releasing your
Psychotherapy Notes.
HIV Information: Special legal protections apply to
HIV/AIDS related information. Bailey et al. will obtain a special
written authorization from you before releasing information
related to HIV/AIDS.
Alcohol and Drug Use Information: Special legal
protections apply to information related to alcohol and drug use
and treatment. Bailey et al. will obtain a special written
authorization from you before releasing information related to
alcohol and/or drug use/treatment.
You may revoke all such authorizations to release information
(PHI, Psychotherapy Notes, HIV information, and/or Alcohol and
Drug Use Information) at any time, provided each revocation is in
writing, signed by you, and signed by a witness. You may not
revoke an authorization to the extent that (1) Bailey et al. has
relied on that authorization; or (2) if the authorization was
obtained as a condition of obtaining insurance coverage, the law
provides the insurer the right to contest the claim under the
policy.
As a covered entity under the Privacy and Security Rules, Bailey
et al. is required to reasonably safeguard PHI from impermissible
uses and disclosures. Safeguards may include, but are not
limited to the following:
1. Not leaving test results
unattended where third parties without a need to know can view
them.
2. Any PHI received as an employee,
independent contractor, intern, or volunteer about a client or
potential client, may not be used or disclosed for non-work
purposes or with unauthorized individuals. Bailey et al.
may only use and disclose such PHI as described above.
3. When speaking with a client
about his or her PHI where third parties could possibly overhear,
the conversation will be moved to a private area.
4. Seeking legal counsel in
uncertain situations and/or incidences.
5. Obtaining a Business Associates
Agreement with those third-parties that have access to and/or
store client information. Some of the functions of the practice
may be provided by contracts with business associates. For
example, some of the billing, legal, auditing, and practice
management services may be provided by contracting with outside
entities to perform those services.
6. Implementing FAX security
measures
7. Obtaining your consent prior to
sending any PHI by unsecure electronic transmissions
8. Providing information on my
electronic record-keeping.
YOUR CHOICES:
For certain health information, you can tell Bailey et al.
(verbal authorization) your choices about what it shares. If
you have a clear preference for how Bailey et al. shares your
information in the situations described below, talk to Bailey et
al.. Tell Bailey et al. what you want it to do, and it will
follow your instructions. Bailey et al. may request you sign a
separate document if you authorize it to share certain PHI. You
may revoke that authorization at anytime for future disclosure.
In these cases, you have both the right and choice to tell Bailey
et al. to:
- Share information
with your family, close friends, or others involved in your care
- Share information in
a disaster relief situation
- Include your
information in a hospital directory
If you are not able to tell Bailey et al. your preference, for
example if you are unconscious, Bailey et al. may go ahead and
share your information if Bailey et al. believes it is in your
best interest and for your care/treatment. Bailey et al. may also
share your information when needed to lessen a serious and
imminent threat to public health or safety.
In these cases we never share your information unless you give us
written permission:
- Marketing purposes
- Sale of your
information
- Most sharing of
psychotherapy notes
Changes to the Terms of this Notice
Bailey et al. can change the terms of this notice, and the
changes will apply to all information Bailey et al. has about
you. The new notice will be available upon request, in Bailey et
al.'s office, and on its web site.
This notice is effective 23 SEPTEMBER 2020.
For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
