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. PLEASE NOTE THAT THIS NOTICE IS SEPARATE FROM THE NOTICE YOU HAVE
RECEIVED RELATIVE TO YOUR RIGHTS UNDER THE MICHIGAN MENTAL HEALTH CODE.
I.
Uses and Disclosures of Protected Health Information:
The Agency may use or disclose your
protected health information for purposes of providing treatment, obtaining
payment for treatment, and conducting health care operations.
Your protected health information may be used or disclosed only for these
purposes unless the Agency has obtained your authorization or the use or
disclosure is otherwise permitted by the HIPAA Privacy Rule or State law.
Note that the Agency may be required under Michigan law to obtain consent
from you in connection with certain disclosures that fall within the below
listed categories.
Treatment.
We will use and disclose your protected health
information to provide, coordinate, or manage your care and any related
services. This includes the
coordination or management of your health care with a third party for treatment
purposes. For example, we may
disclose your protected health information to a pharmacy to fulfill a
prescription or to a subcontracted provider who is also providing services for
you. We may also disclose protected
health information to physicians who may be treating you or consulting with the
Agency with respect to your care. In some cases, we may also disclose your protected health
information to an outside treatment provider for purposes of the treatment
activities of the other provider.
Payment.
Your protected health information will be used and disclosed, as needed,
to obtain payment for the services that we provide.
This may include certain communications to your health insurer to get
approval for the treatment that we recommend.
For example, if a certain level of service is recommended, we may need to
disclose information to your health insurer to get prior approval for the level
of service. We may also disclose
protected health information to your insurance company to determine whether you
are eligible for benefits or whether a particular service is covered. In order to get payment for your services, we may also need
to disclose your protected health information to your insurance company to
demonstrate the medical necessity of the services or to demonstrate that
required documentation exists. We may also disclose patient information to
another provider involved in your care for the other provider’s payment
activities.
Operations.
We may use or disclose your protected health information, as necessary,
for our own health care operations in order to facilitate the function of the
Agency and to provide quality care to all consumers.
Health care operations include such activities as:
·
Quality
assessment and improvement activities.
·
Employee
review activities.
·
Training
programs including those in which students, trainees, or practitioners in health
care learn under supervision.
·
Accreditation,
certification, licensing or credentialing activities.
·
Review
and auditing, including compliance reviews, medical reviews, legal services and
maintaining compliance programs.
·
Business
management and general administrative activities.
In
certain situations, we may also disclose consumer information to another
provider or health plan for their health care operations.
Other
Uses and Disclosures.
As
part of treatment, payment and healthcare operations, we may also use or
disclose your protected health information for the following purposes:
·
To
remind you of an appointment including the use of post cards and/or messages
left on answering machines.
·
To
inform you of potential treatment alternatives or options.
·
To
inform you of health-related benefits or services that may be of interest to
you.
II.
Uses and Disclosures Beyond Treatment, Payment, and Health Care
Operations Permitted Without Authorization or Opportunity to Object:
The
HIPAA Privacy Rule also allows us to use or disclose your protected health
information without your permission or authorization for a number of reasons
including the following:
When
Legally Required.
We will disclose your protected health information when we are required
to do so by any Federal, State or local law.
When
There Are Risks to Public Health.
We may disclose your protected health information for the following
public activities and purposes:
·
To prevent, control, or
report disease, injury or disability as permitted by law.
·
To report vital events
such as birth or death as permitted or required by law.
·
To conduct public
health surveillance, investigations and interventions as permitted or required
by law.
·
To collect or report
adverse events and product defects, track FDA regulated products, enable product
recalls, repairs or replacements to the FDA and to conduct post marketing
surveillance.
·
To notify a person who
has been exposed to a communicable disease or who may be at risk of contracting
or spreading a disease as authorized by law.
·
To report to employer
information about an individual who is a member of the workforce as legally
permitted or required.
To
Report Abuse, Neglect Or Domestic Violence.
We may notify government authorities if we believe that a consumer is the
victim of abuse, neglect or domestic violence.
We will make this disclosure only when specifically required or
authorized by law or when the consumer agrees to the disclosure.
To
Conduct Health Oversight Activities.
We may disclose your protected health information to a health oversight
agency for activities including audits; civil, administrative, or criminal
investigations, proceedings, or actions; inspections; licensure or disciplinary
actions; or other activities necessary for appropriate oversight as authorized
by law. We will not disclose your
health information if you are the subject of an investigation and your health
information are not directly related to your receipt of health care or public
benefits.
In
Connection With Judicial And Administrative Proceedings.
We may disclose your protected health information in the course of any
judicial or administrative proceeding in response to an order of a court or
administrative tribunal as expressly authorized by such order or in response to
a signed authorization (in a format approved by the Michigan Court
Administrator).
For
Law Enforcement Purposes.
We may disclose your protected health information to a law enforcement
official for law enforcement purposes as follows:
·
As required by law for
reporting of certain types of wounds or other physical injuries.
·
Pursuant to court
order, court-ordered warrant, subpoena, summons or similar process.
·
For the purpose of
identifying or locating a suspect, fugitive, material witness or missing person.
·
Under certain limited
circumstances, when you are the victim of a crime.
·
To a law enforcement
official if the Agency has a suspicion that your death was the result of
criminal conduct.
·
In an emergency in
order to report a crime.
To
Coroners, Funeral Directors, and for Organ Donation.
We may disclose protected health information to
a coroner or medical examiner for identification purposes, to determine cause of
death or for the coroner or medical examiner to perform other duties authorized
by law. We may also disclose
protected health information to a funeral director, as authorized by law, in
order to permit the funeral director to carry out their duties.
Protected health information may be used and disclosed for cadaveric
organ, eye or tissue donation purposes.
For
Research Purposes.
We may use or disclose your protected health
information for research when the use or disclosure for research has been
approved by an institutional review board or privacy board that has reviewed the
research proposal and research protocols to address the privacy of your
protected health information.
In
the Event of A Serious Threat To Health Or Safety.
We may, consistent with applicable law and ethical standards of conduct,
use or disclose your protected health information if we believe, in good faith,
that such use or disclosure is necessary to prevent or lessen a serious and
imminent threat to your health or safety or to the health and safety of the
public.
For
Specified Government Functions.
In certain circumstances, the Federal regulations authorize the Agency to
use or disclose your protected health information to facilitate specified
government functions relating to military and veterans activities, national
security and intelligence activities, protective services for the President and
others, medical suitability determinations, correctional institutions, and law
enforcement custodial situations.
For
Worker's Compensation.
The Agency may release your health information to comply with worker's
compensation laws or similar programs.
III.
Uses and Disclosures Permitted Without HIPAA Authorization But With
Opportunity to Object:
Although
HIPAA does not require that we obtain a written HIPAA authorization for
disclosures made to family members in certain circumstances, Michigan law
requires that we obtain your written consent prior to disclosing your health
information to a family member who is not your personal representative.
The Agency will continue to follow its current policy to obtain written
consent under State law when disclosing patient information to a family member
or friend who is not a personal representative of the patient.
IV.
Uses and Disclosures That You Authorize:
Other
than as stated above, we will not disclose your health information other than
with your written authorization. You
may revoke your authorization in writing at any time except to the extent that
we have taken action in reliance upon the authorization.
In
addition to other rights you may have under State law, such as the rights you
have under Michigan Mental Health Code, you have the following rights under
HIPAA regarding your health information:
The
right to inspect and copy your protected health information.
You may inspect and obtain a copy of your protected health information that is
contained in a designated record set for as long as we maintain the protected
health information. Subject to
limitations imposed upon us by MCL 330.1748 (4) of the Michigan Mental Health
Code, under Federal law, however, you may not inspect or copy the following
records: information compiled in
reasonable anticipation of, or for use in, a civil, criminal, or administrative
action or proceeding; and protected health information that is subject to a law
that prohibits access to protected health information.
Depending on the circumstances, you may have the right to have a decision
to deny access reviewed. We may deny your request to inspect or copy you’re
protected health information if, in our professional judgment, we determine that
the access requested is likely to endanger your life or safety or that of
another person, or that it is likely to cause substantial harm to another person
referenced within the information. You
have the right to request a review of this decision.
To
inspect and copy your health information, you must submit a written request to
the Privacy Officer whose contact information is listed on the last pages of
this Notice. If you request a copy
of your information, we may charge you a fee for the costs of copying, mailing
or other costs incurred by us in complying with your request.
Please contact our Privacy Officer if you have questions about access to your
health record.
The
right to request a restriction on uses and disclosures of your protected health
information. You may ask us not to use or disclose certain parts of your
protected health information for the purposes of treatment, payment or health
care operations. Your request must
state the specific restriction requested and to whom you want the restriction to
apply. The Agency is not required to agree to a restriction that you may
request. We will notify you if we
deny your request to a restriction. If
the Agency does agree to the requested restriction, we may not use or disclose
your protected health information in violation of that restriction unless it is
needed to provide emergency treatment. Under
certain circumstances, we may terminate our agreement to a restriction.
You may request a restriction by contacting the Privacy Officer.
The
right to request to receive confidential communications from us by alternative
means or at an alternative location.
You have the right to request that we communicate with you in certain
ways. We will accommodate
reasonable requests. We may condition this accommodation by asking you for
information as to how payment will be handled or specification of an alternative
address or other method of contact. We
will not require you to provide an explanation for your request.
Requests must be made in writing to our Privacy Officer.
The
right to request amendments to your protected health information.
You may request an amendment of protected health information about you in
a designated record set for as long as we maintain this information.
In certain cases, we may deny your request for an amendment.
For example, if we believe that the information is correct as is.
If we deny your request for amendment, you have the right to file a
statement of disagreement with us and we may prepare a rebuttal to your
statement and will provide you with a copy of any such rebuttal.
Requests for amendment must be in writing and must be directed to our
Privacy Officer. In this written
request, you must also provide a reason to support the requested amendments.
The
right to receive an accounting.
For
accountings that we are required to make under HIPAA you have the right to
request an accounting of certain disclosures of your protected health
information made by the Agency. The
request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the
accounting. We are not required to provide a HIPAA accounting for disclosures
that take place prior to April 14, 2003. HIPAA
accounting requests may not be made for periods of time in excess of six years.
We will provide the first accounting you request during any 12-month
period without charge. Subsequent
accounting requests under HIPAA may be subject to a reasonable cost-based fee.
We are also required to track certain disclosures under Michigan law.
We will continue to do so.
The
right to obtain a paper copy of this notice.
Upon request, we will provide a separate paper copy of this notice even
if you have already received a copy of the notice or have agreed to accept this
notice electronically.
VI.
Our Duties:
The
Agency is required by law to maintain the privacy of your health information and
to provide you with this Notice. We
are required to abide by terms of this Notice as may be amended from time to
time. We reserve the right to
change the terms of this Notice and to make the new Notice provisions effective
for all protected health information that we maintain.
VII.
Complaints:
You
have the right to express complaints to the Agency and to the Secretary of
Health and Human Services if you believe that your privacy rights have been
violated. You may complain to the
Agency by contacting the Agency’s Privacy Officer verbally or in writing,
using the contact information below. We
encourage you to express any concerns you may have regarding the privacy of your
information. You will not be
retaliated against in any way for filing a complaint.
The
Agency’s contact person for all issues regarding patient privacy and your
rights under HIPAA is the Privacy Officer.
Information regarding matters covered by this Notice can be requested by
contacting the Privacy Officer. Complaints
against the Agency, can be mailed to the Privacy Officer by sending it to:
SHIAWASSEE
COUNTY COMMUNITY MENTAL HEALTH
P.O. 428
OWOSSO, MI 48867
ATTN:
Privacy Officer
The
Privacy Officer can be contacted by telephone at (989) 723-0725