Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices for Protected Medical/Health Information

• Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices for Protected Medical/Health Information

This notice describes how identifiable medical/health information about you (your family member or someone else) may be used and disclosed and how you can get access to this information. Please review it carefully.

This notice is effective on April 14, 2003. If you have questions about this notice please call SKIP at (212) 268-5999 and ask for Mary Mulvey, the Compliance Officer.

This is your Health Information Privacy Notice from SKIP. You are receiving this notice because you, a member of your family or someone else you know have requested or are receiving services from SKIP. (For simplicity this notice will refer to you, a member of your family or someone else as “you” throughout this document.) We understand that information about you is personal. We strongly believe in protecting the confidentiality and security of all the information we collect. We will share information only with those who need to know, and are permitted to see the information to assure the provision of quality goods and services.

This notice describes how we safeguard the Protected Health Information we have which relates your involvement with SKIP, and how we may use and disclose this information. Protected Health Information includes individually identifiable information, which relates to your past, present or future health, treatment and/or payment for health care services. This notice also describes your rights with respect to Protected Health Information and how you can exercise those rights.

HIPAA requires that we:

• maintain the privacy of your Protected Health Information;
• Provide you this notice of our legal duties and privacy practices with respect to your Protected Health information;
• Follow the terms of this notice.

All SKIP employees, business associates and volunteers are bound by the contents of this notice. Protected Health Information consists of all the information we create or keep that relates to your health or care and treatment. It includes, but may not be limited to, your name, address, birth date, social security number, your medical information and other information regarding the care you receive.

We safeguard your Protected Health Information from inappropriate use or disclosure. Our employees, and others who provide you with services, are required to comply with these requirements that protect the confidentiality of your Protected Health Information. They may look at your Protected Health Information only when there is an appropriate reason to do so, such as to furnish goods or services, or to administer these, etc.

We will not disclose your Protected Health Information to any other company for their use in marketing their products to you. However, as described below, we will use and disclose Protected Health Information about you for business purposes relating to services you have requested or receive from SKIP. We will request you to sign a global Authorization for the Request and/or Release of Health-Related Information so that we can use and disclose certain types of information. Although we will not deny you services, we will be unable to provide you with effective services without this non-specific authorization. You must reauthorize this document on an annual basis.

We may use and disclose your Protected Health Information with an Authorization for the Request and/or Release of Health-Related Information without your specific permission for the purposes described below. For each use and disclosure category, we offer a brief explanation and an example. While not every use or disclosure is described, all of the ways we will use or disclose will fall into these categories. Your specific written authorization is required for release of Protected Health Information for other purposes. This is described later in this notice.

• TREATMENT: SKIP will use your Protected Health Information to provide you with treatment and services. We will disclose this information to doctors, nurses, psychologists, social workers, qualified mental retardation professionals (QMRPs), developmental aides, other SKIP personnel, etc. For example, involved staff may discuss your Protected Health Information to develop and carry out your Plan of Care. Other SKIP staff may share your Protected Health Information to coordinate the services you need, such as medical tests, respite care, transportation, etc. We will be in contact with other providers who are responsible for furnishing you with services identified in your Plan of Care or to obtain new and additional services for you.
• PAYMENT: SKIP will use your Protected Health Information so that we can bill and collect payment for services we have rendered to you. For example, we will need to provide the NYS Department of Health (Medicaid) or the NYS Office of Mental Retardation and Developmental Disabilities (OMR/DD) with information about the services you received by or through us so they will pay us for those services. We may also disclose your information to receive prior approval from an insurance company or Medicaid or to the Social Security Administration, the NYS Department of Health, or the NYS Office of Mental Retardation and Developmental Disabilities to determine your program eligibility.
• HEALTH CARE OPERATIONS: SKIP will use Protected Health Information for administrative operations. These uses and disclosures are necessary to operate SKIP programs and to make sure that all our clients receive appropriate, quality care. For example, we may use Protected Health Information for quality improvement to review our services and to evaluate the performance of our staff. We may also disclose information to other personnel for on-the-job training, for conducting fiscal and program audits and to resolve complaints. We may also disclose information to our business associates to perform administrative or professional services on our behalf.

OTHER USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR SPECIFIC PERMISSION:

• Where Required by Law of for Public Health Activities: We must disclose Protected Health Information when required by federal, state or local statute. Examples of such mandatory disclosure include notifying state or local health authorities regarding particular communicable diseases, or providing Protected Health Information to a governmental agency with health care oversight responsibilities. We may also release Protected Health Information to a coroner or medical examiner to assist in identifying a deceased individual or to determine the cause of death. Other public health reasons include prevention and control of disease, injury or disability, reporting child abuse or neglect, and reporting reactions to medications or problems with products;
• To Worker’s Compensation: We may disclose your Protected Health Information to comply with workers’ compensation laws and other similar programs that provide benefits for work related injuries or illness;
• To Avert a Serious Threat to Health or Safety: We may disclose Protected Health Information to avert a serious threat to someone’s health or safety. We may also disclose Protected Health Information to government agencies engaged in disaster relief. We will also report domestic violence and adult abuse or neglect to government authorities if necessary to prevent serious harm;
• For Health Oversight Activities: These include audits, investigations, surveys, and inspections. These activities are necessary for government to monitor the health care system, government programs, and compliance with civil rights laws. Health oversight activities do not include investigations that are not related to the receipt of health care or government benefits in which you are the subject;
• For Judicial and Administrative Proceedings, including Hearings and Disputes: If you are involved in a court or administrative proceeding, we will disclose Protected Health Information if the judge or presiding officer orders us to share the information.
• For Law Enforcement Purposes: We will disclose Protected Health Information in response to a subpoena, or other legal process, to identify a suspect or witness or missing person, regarding a victim of a crime, a death, criminal conduct, and in emergency circumstances to report a crime;
• For Health-Related Benefits or Services: We may use Protected Health Information to provide you with information about benefits available to you and about health related products available to you.

USES AND DISCLOSURES THAT REQUIRE YOUR VERBAL AGREEMENT AND AUTHORIZATION

SKIP may disclose Protected Health Information to the following persons if we tell you we are going to use or disclose it and you agree and do not object:

• To family members and personal representatives who are involved in your care if the information is relevant to their involvement and to notify them of your condition and location;
• To disaster relief organizations that need to notify your family about your condition and location;
• In response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the Protected Health Information requested.

USES AND DISCLOSURES THAT REQUIRE YOUR SPECIFIC AUTHORIZATION

Other uses and disclosures of Protected Health Information not covered by this notice, and permitted by law, will be made only with your specific written authorization or that of your legal representative. This authorization must indicate what information is to be shared, who is to receive the information, the purpose of the disclosure and an expiration date for the authorization. Specific authorizations are always required for use and disclosure of psychotherapy notes and for marketing purposes. You may revoke this specific authorization in writing at any time. If we have already used or disclosed Protected Health Information based upon your specific authorization, we will not be able to take back any disclosures we have made during the time the specific authorization was in effect.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION THAT SKIP MAINTAINS

The following are your rights under HIPAA concerning your Protected Health Information:

• You have the right to inspect and copy your Protected Health Information. Some exceptions apply, such as psychotherapy notes, records regarding incident reports and investigations, and information compiled for use in court or administrative proceedings. You must call SKIP to make an appointment and inspect your record. If you wish a copy of your record, you will be charged a fee for the costs of copying, mailing and other supplies associated with your request. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time prior to incurring any costs. We may require that your request for a copy of the record be in writing.
• If we deny your request to inspect or copy your Protected Health Information, you have the right to request a review of that denial. An individual chosen by SKIP who was not involved in the original decision to deny your request will conduct the review. We will comply with the outcome of that review.
• If you believe that information is incorrect or that an important part is missing, you have the right to amend your Protected Health Information while it is kept by or for us. You must provide your request and your reason for your request in writing. We may deny your request if it is not in writing or does not include a reason that supports the request. Additionally, we may deny your request if you ask us to amend Protected Health Information that:
  1. (1) is accurate and complete;
  2. (2) was not created by SKIP;
  3. (3) is not part of the Protected Health Information kept by or for us, or
  4. (4) is not part of the Protected Health Information which you were permitted to inspect and copy.
• You have the right to request a list of disclosures we have made of Protected Health Information about you. This list will not include disclosures made for treatment, payment or health care operations, made to law enforcement or corrections personnel or made pursuant to your specific authorization or made directly to you. You must make this request in writing. It must state the time period from which you wish to receive the list of disclosures. The time period must not be longer than six years and may not include dates prior to April 14, 2003. You will be charged a fee for the costs of copying, mailing and other supplies associated with your request. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time prior to incurring any costs.
• You have the right to request a restriction or limitation on the Protected Health Information we use or disclose about you for treatment, payment or health care operations, or that we disclose to someone who may be involved in your care or payment for your care, such as a family member or friend. While we will consider your request, we are not required to agree to it. Your request for a restriction must be in writing. Your request must include (1) the information you wish to limit; (2) whether you wish to limit our use, disclosure, or both; and (3) to whom you wish the limits to apply (for example, disclosure to your parents). We cannot agree to restrictions on Protected Health Information uses or disclosures that are legally required, or which are necessary to administer our programs.
• You have the right to request that we communicate with you about your Protected Health Information in a certain way or at a certain location if you tell us that communication in another manner may endanger you. For example, you can ask that we only communicate with you at work or by mail. Your request must be in writing.
• You have the right to file a complaint if you believe your privacy rights have been violated. You may file your complaint with SKIP or the Secretary of the Department of Health and Human Services. You must submit your complaint in writing to:
  
  SKIP of New York, Inc.
  601 West 26th Street, Suite 522
  New York, NY 10001
  ATTENTION: Mary Mulvey.

  You will not be penalized for filing a complaint.

ADDITIONAL INFORMATION

We reserve the right to change the terms of this notice at anytime. We reserve the right to make the revised notice effective for Protected Health Information we already have about you as well as any Protected Health Information we receive in the future. The effective date of this notice and any revised notice may be found in the bottom right hand corner. You will receive a copy of any revised notice.

For additional information regarding SKIP’s HIPAA Medical Information Privacy Policy or our general privacy policies, please contact Mary Mulvey at (212) 268-5999.