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 CAREFULLY.
If you have questions about this notice, please contact the Privacy Officer of PCMS at 301-791-3087, ext 203.
This Notice of Privacy Practice is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation.
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgment of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgement. If you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment and health care operations when necessary.
WHO WILL FOLLOW THIS NOTICE
This notice describes Potomac Case Management’s practices regarding your protected health information. For this notice, PCMS includes the following:
All PCMS staff authorized to enter information in your file.
Any over-site authority from which eligibility of treatment must be obtained.
Any facility or entity involved in the continuity of your care (these may include hospitals, treatment facilities, behavioral health providers and all individual providers/staff that operate under their auspices).
Identified entities (such as Maryland Health Partners) responsible for reimbursement of services or from whom payment is received.
All of these entities are bound to follow the terms of the Notice of Privacy.
Potomac Case Management is part of the continuum of care in Washington County and the treatment facilities within the county, all of which follow the Notice of Privacy requirements.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
“Protected health information” is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future physical or mental health or condition and related health care services. PCMS is required by law to do the following:
Make sure that your protected health information is kept private.
Give you this notice of our legal duties and privacy practices related to the use and discourse of your protected health information.
Follow the terms of the notice currently in effect.
Communicate any changes in the Notice to you.
We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. 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. You may obtain a Notice of Privacy Practices by calling the PCMS Privacy Officer at 301-791-3087, ext. 203 and requesting a copy or by asking for a copy at your next appointment.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Following are examples of permitted uses and disclosures of your protected health information. These examples are NOT exhaustive.
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities PCMS might complete before it undertakes services recommended for you such as determining eligibility or coverage for benefits, reviewing services provided to you, and undertaking utilization review activities. For example, obtaining approval for services requires that your relevant protected health information be disclosed to obtain authorization for services to begin.
Health Care Operations
We may use or disclose, as needed, your protected health information to support the daily activities related to case management or health care. These activities include, but are not limited to, quality assessment activities, investigations, oversight or staff performance review, training of new staff or students, licensing, communications about services provided and conducting or arranging for other case management related activities.
For example, we may disclose your protected health information to intern students providing services at PCMS. We may call you by name in the waiting room when your case manager is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third-party “business associates” who perform various activities (for example, billing, community team planning) for or with PCMS. The business associates will also be required to protect your health information and will sign a contract with PCMS attesting to the same.
We may use of disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other related benefits and services that might interest you. For example, your name and address may be used to send you information about PCMS services or other relevant information that we believe could benefit you.
Required by Law
We may use or disclose your protected health information if federal, state, or local law or regulation requires the use or disclosure.
To Avert a Serious Threat to Health or Safety
We may use and disclose your protected health information when necessary to present a serious threat to your health and safety or the health and safety of the public or another person. Such disclosure would be to those persons who would be able to prevent or manage such a serious situation.
We may disclose your protected health information to a public health authority which is permitted by law to collect or receive the information. The disclosure may be necessary to do the following:
Prevent or control disease, injury, or disability
Report child abuse or neglect or exploitation
Report elder abuse or neglect or exploitation
Report reactions to medications
Notify proper authorities if we believe you have been a victim of domestic violence
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the mental health care system, government benefit programs, or government regulatory programs and civil rights laws.
Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to do the following:
Report adverse events, product defects, or problems and biologic product deviations
Enable product recalls
We may disclose protected health insurance information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process.
We may disclose protected health information for law enforcement purposes, including the following:
Responses to legal proceedings
Information requests for identification and location
Circumstances pertaining to victims of a crime
Deaths suspected from criminal conduct
Crimes occurring at any Potomac Case Management site
Medical emergencies (not on PCMS premises) believed to result from criminal conduct
Coroners, Funeral Directors, and Organ Donations
We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may also disclose established protocols to ensure the privacy of your protected health information.
We may disclose protected health information to researchers when authorized by law, for example, if
their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Under applicable Federal and state laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
National Security and Intelligence Activities
When the appropriate conditions apply, we may use or disclose protected health information to Federal officials for conducting national security and intelligence activities including protective services to the President or others. Other national security activities authorized by law or authorized persons or foreign heads of state or conduct special investigations.
Military and Veterans
If you are a member of the armed forces, we may use or disclose protected health information about you as required by military command authorities. We may use or disclose protected health care information about foreign military personnel to the appropriate military authority.
We may use or disclose protected health information about you for workers compensation to comply with compensation laws and other similar legally established programs. These programs provide benefits forwork-related injuries or illness.
We may use or disclose your protected health information if you are an inmate of a correctional facility, and PCMS created your protected health information while providing care to you. The disclosure would be necessary (1) for the institution to provide you with health care, (2) for your health and safety or health and safety of others, or (3) for the safety and security of the correctional institution.
Some state laws concerning minors permit or require disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the laws of Maryland and make disclosures following such law.
USES AND DISCLOSURE OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION
In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required.
Individuals Involved in Your Health Care
Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. We may also give information to someone who helps pay for your care. Additionally, we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and coordinates uses and disclosures to family or other individuals involved on your health care.
Your Rights Regarding Your Health Information
You may exercise the following rights by submitting a written request to the PCMS Privacy Officer. Depending on your request, you may also have rights under the Privacy Act of 1974. The PCMS Privacy Officer can guide you in pursuing these options. Please be aware that PCMS may deny your request; however, you may seek a review of the denial.
Right to Inspect and Copy
You may inspect and obtain a copy of your protected health information that is contained in a “designated record set” or file for as long as we maintain the protected health information. A designated record set/file contains medical and billing records and any other records that PCMS used for making decisions about you.
This right does not include inspection and copying of the following records: psychotherapy notes; information compiled in reasonable anticipation of or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.
PCMS RETAINS THE RIGHT NOT TO RELEASE ANY INFORMATION OBTAINED FROM A THIRD PARTY. ALL INFORMATION MUST BE REQUESTED FROM THE SOURCE OF ORIGIN.
If you request a copy of information, a fee for the costs of copying, and/or other costs associated with compliance to your request, will be charged. Copies will be released directly to you or an identified source, which must be put in writing to the Privacy Officer of PCMS. Payment of costs incurred is required prior to release.
Right to Request Restrictions
You may ask us not to sue or disclose any part of your protected health information for treatment, payment, or health care operations. Your request must be made in writing to the PCMS Privacy Officer where you wish the restriction instituted. Restrictions are not transferable. In your request, you must tell us (1) what information you want restricted; (2) whether you want to restrict our use, disclosure, or both; (3) to whom you want the restriction to apply, i.e., disclosures to your spouse; and (4) an expiration date.
Right to Request Confidential Communication
You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.
Right to Request Amendment
If you believe that the information we have about you is incorrect or incomplete, you may request amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.
Right to an Accounting of Disclosures
You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. The disclosure must
have been made after April 14, 2003, and no more than 6 years from the date of request. The right to receive this information is subject to additional exceptions, restriction and limitations as described earlier in this notice.
Right to Obtain a Copy of this Notice
You will receive a paper copy of this notice from PCMS during your intake process to begin treatment. A copy of this notice will be available at request from employees of PCMS.
Federal Privacy Laws
The PCMS Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply including the Freedom of Information Act, the Privacy Act, and the Alcohol Drug Abuse, and Mental Health Administration Reorganization Act. These laws have not been superseded and have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information.
Changes to this Notice
Potomac Case Management Services, Inc., reserves the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 in our office. The notice will contain on the first page, in the top right-hand corner, the effective date.
If you believe these privacy rights have been violated, you may file a written complaint with the PCMS Privacy Officer or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint. You will not be penalized for filing a complaint.
You may contact the PCMS Privacy Officer or the Security Officer for further information about the complaint process or for further explanation of this document.