I. What this Is?
This Notice describes the privacy practices of Opportunities for Inclusion, Inc. as required by HIPAA, the Health Insurance Portability and Accountability Act of 1996. The effective date for compliance with HIPAA is April 14, 2003
II. Our Privacy Obligations
Privacy is very important to us. Opportunities for Inclusion feels responsible for treating participants with respect and upholding their rights. Opportunities for Inclusion has taken many steps to make sure that any information that Opportunities for Inclusion has about a participant is shared only with people who have a need to know. Massachusetts Laws and Regulations and Opportunities for Inclusion Policies have required maintaining participant records in a confidential way for many years. The new HIPAA law requires that Opportunities for Inclusion provide you as a participant or participant's guardian/ family member with this Notice Of Privacy regarding Opportunities for Inclusion's legal duties and privacy practices concerning participant records and other information. When Opportunities for Inclusion uses or gives out information about a participant to someone other than his or her direct Opportunities for Inclusion program staff, Opportunities for Inclusion has made a disclosure of Protected Health Information or PHI. Opportunities for Inclusion is required to abide by the terms of this Notice or a new privacy notice if Opportunities for Inclusion makes changes.
III. Uses and Sharing of Information about an Opportunities for Inclusion Participant
When an individual is referred and accepted into Opportunities for Inclusion services, Opportunities for Inclusion establishes a participant record that contains information about that person. ISPs, Emergency Fact Sheets, attendance sheets, production sheets and incident reports are some of the types of information that Opportunities for Inclusion keeps in the Agency. Participants in the Day Habilitation programs also have a Medical Record.
A. There are generally 3 ways that Opportunities for Inclusion uses PHI. These are:
1. Services/Treatment - Opportunities for Inclusion of Waltham MA
Some staff train consumers using specialized materials and equipment, or they may dispense medication and monitor side effects.
Speech/Communication, Occupational, Physical, Behavioral and Music Therapists consulting with staff review PHI to develop and provide therapeutic activities such as programs of exercise, skills training in food preparation or plants and crafts, individualized communication books/devices and special relaxation or sensory opportunities.
Transporters, relief staff, recreation staff and volunteers use only the necessary PSI to assist or act in an emergency.
Opportunities for Inclusion uses limited PHI to obtain payment for services that Opportunities for Inclusion provides for example, to identify claims for payment from MassHealth, DDS, City of Waltham, MCB, or other Federal, state or local funding sources which pay the cost of some or all services, provided by Opportunities for Inclusion.
3. Program Operations
Opportunities for Inclusion may use PHI for operations including internal administration, planning and various activities that improve the quality and cost effectiveness of the service that Opportunities for Inclusion delivers.
A Case Record Review is done by someone other than the assigned case manager to make sure the right papers are included and that they are in the correct order for each consumer.
The Opportunities for Inclusion Human Rights Committee reviews incident reports, complaints/investigations and Behavior Plans with minimal identifying information (except to Professional members).
The Board of Directors reviews summary reports on program operations such as participants activities, outcome achievements and Satisfaction Surveys.
B. Disclosure to Relatives, Close Friends and Other Caregivers.
1. Opportunities for Inclusion may share PHI with a guardian, family member, staff at the residence, other caregivers who are involved with a consumer and to the DDS Service Coordinator (or other case manager) responsible for oversight of a participant's services.
2. In an emergency circumstance, Opportunities for Inclusion may decide that a disclosure of PHI is necessary and in the participant's best interest. Opportunities for Inclusion will disclose only information that is directly relevant to treatment or payment for treatment.
3. Opportunities for Inclusion may in a rare circumstance disclose PHI in order to notify or to assist persons who are helping a participant such as location, general condition or death.
C. Public Health Activities. Opportunities for Inclusion may disclose PHI:
1. To report health information to public health authorities when it is required.
2. To report suspected or observed abuse, or rape or sexual assault to the Disabled Person's Protection Commission (DPPC) and/or DDS.
3. To report information on faulty products and services to the U.S.D.A.
4. To report information to your insurer and/or the Massachusetts Industrial Accident Board as required under laws addressing work-related illnesses, exposure, injuries or workplace medical monitoring;
D. Health Oversight Activities.
Opportunities for Inclusion may disclose PHI to MassHealth, Division of Medical Assistance (DMA), Executive Office of Health and Human Services (EOHHS) or a governmental agency that oversees the services.
E. Court, Law Enforcement Officials, Government Agencies & Health/Safety.
Opportunities for Inclusion may disclose PHI to the police, law enforcement officials as required or permitted by law or in compliance with a court order, a grand jury or for an administrative subpoena.
Opportunities for Inclusion may inform PHI to the police or others to assist if a consumer is missing or lost.
IV. Disclosures Requiring Written Consent
A. Disclosures For Treatment, Payment and Operations.
With written consent, which will be requested annually, Opportunities for Inclusion may only disclose necessary PHI so another provider can treat, obtain payment for services provided, and conduct their operations such as:
Opportunities for Inclusion may disclose PHI to obtain first aid, treatment by a doctor or hospital emergency room with transportation by our staff or ambulance.
Opportunities for Inclusion may contact a residence or family member to let them know that a participant is sick, injured or seems to be having difficulty and to discuss this person's symptoms and what Opportunities for Inclusion should do to assist.
Opportunities for Inclusion will disclose only general, summary descriptive information about participants served by Opportunities for Inclusion to seek funds for services that Opportunities for Inclusion provides through general fundraising, proposals, tours and/or grant writing.
3. Opportunities for Inclusion Operations
Opportunities for Inclusion will disclose only the minimal necessary PHI for our operations:
Opportunities for Inclusion internal and external Quality Review, Accreditation (CARF), Licensing (DDS), Human Rights, Complaint and Auditing activities may involve program observation and reviews of records and services. These reviewers evaluate the quality and competence of our programs, staff and planning.
Opportunities for Inclusion provides Incident Reports and certain Behavior Plans to a DDS Peer Review Committee to meet Human Rights Requirements.
If a complaint is initiated, Opportunities for Inclusion shares PHI with the involved investigators consistent with Human Rights Training. This may involve the release of Highly Confidential Information to a sanctioned Professional.
V. Uses and Disclosures Requiring Written Authorization
A. Uses or Disclosure with Authorization.
Opportunities for Inclusion will not disclose PHI except as agreed to upon enrollment or consented to unless a participant or their guardian gives specific written authorization on an Opportunities for Inclusion authorization form.
1. Opportunities for Inclusion will obtain a specific authorization before sending PHI to any agency other than the one currently serving you.
2. Opportunities for Inclusion will not send confidential information from a consumer record to a doctor or a mental health clinician without specific authorization.
1. Opportunities for Inclusion will obtain specific written authorization prior to using identifying PHI on any Opportunities for Inclusion brochures, publicity or newspaper articles consistent with the Opportunities for Inclusion policy on Release of Information.
2. Without a Marketing Authorization, however, Opportunities for Inclusion will mail and distribute general Opportunities for Inclusion marketing materials; give participants, guardians or family members gifts of nominal value; and send participants and guardians/families newsletters and information on multiple topics related to the organization including Annual Reports, Fundraising appeals, and Recreation/Family Support Program Brochures.
VI. Individual Rights
A. Further Information & Complaints.
Opportunities for Inclusion distributes information about privacy, rights and complaints as part of Human Rights Policy. If anyone is concerned that Opportunities for Inclusion has violated privacy rights or disagrees with a decision that Opportunities for Inclusion has made about access to PHI, please contact the Director of Admin/Personnel who is our HIPAA Office Manager. A written complaint may be filed with the Office for Civil Rights of the U.S. Department of Health and Human Services. If unsatisfied with the Director of Admin/Personnel's response, a complainant will be referred to the Chief Executive Director. Opportunities for Inclusion will not retaliate against any person for filing a complaint.
B. Right to Request Additional Restrictions.
A participant or guardian may request restrictions on Opportunities for Inclusion's uses and disclosures of PHI: (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, relative, close friend or any other person identified by you) who are involved with your services or with payment related to your services, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. All requests for such restrictions must be made in writing. While Opportunities for Inclusion will consider all requests for additional restrictions carefully, Opportunities for Inclusion is not required to agree to a requested restriction. If you wish to request additional restrictions, please obtain a request form from our Office Manager and submit the completed form to the Office Manager. Opportunities for Inclusion will assist you with the written request for restriction if you ask. Opportunities for Inclusion will send you a written response.
C. Right to Receive Confidential Communications.
Any participant or his/her guardian may request to receive PHI by alternative means of communication or at alternative locations. For example: you may prefer to be called or mailed copies of information at an alternative phone number or address during certain times. Opportunities for Inclusion will consider all requests.
D. Right to Inspect and Copy Health Information.
A participant/ guardian may request access to a record file and billing records in order to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, Opportunities for Inclusion may deny you access to your records. If requesting access to records, please obtain a record request form from the Program Director and submit the completed form to the Director of Admin/Personnel. Opportunities for Inclusion may charge you $0.05. (five cents) for photocopying each page.
E. Right to Revoke Authorization.
A participant or his/her guardian may revoke any written authorization by delivering a written revocation statement to the Office Manager identified below.
F. Right to Amend Records.
A participant or his/her guardian has the right to request that Opportunities for Inclusion amend PHI maintained in a participant file or billing records. Please obtain an amendment request form from the Program Director and submit the completed form to the Director of Admin/Personnel. All requests for amendments must be in writing. Opportunities for Inclusion will amend PHI unless Opportunities for Inclusion believes that the information that would be amended is accurate and complete or other special circumstances apply.
G. Right to Receive An Accounting of Disclosures.
Upon written request, a participant, guardian/family member may obtain an accounting of certain disclosures of PHI made by us during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, Opportunities for Inclusion will charge you $.05 per page for the accounting statement.
VII. Effective Date and Duration of This Notice
A. Effective Date.
This Notice is effective on April 14, 2003.
B. Right to Change Terms of this Notice.
Opportunities for Inclusion may change the terms of this Notice at any time. If Opportunities for Inclusion changes this Notice, Opportunities for Inclusion may make the new notice terms effective for all PHI that Opportunities for Inclusion maintains, including any information created or received prior to issuing the new notice. If Opportunities for Inclusion changes this Notice, Opportunities for Inclusion will post the revised notice in waiting areas of Opportunities for Inclusion, Inc. and on the Internet site at www.OppsforInclusion.org. A revised notice may be obtained by contacting the Chief Executive Director.
VIII. Designated Office Manager
The Opportunities for Inclusion Director of Admin/Personnel is the HIPAA designated Office Manager and can be contacted at:
Director of Admin/Personnel Services
Opportunities for Inclusion, Inc.
56 Chestnut St.
Waltham, MA 02453
Email Address: firstname.lastname@example.org