COMMUNITY HEALTH CARE, INC
COMMUNITY SUBSTANCE ABUSE CENTERS, INC.
MERRIMACK RIVER MEDICAL SERVICES, INC.
COMMUNITY SUBSTANCE ABUSE CENTERS
NOTICE OF PRIVACY PRACTICES
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.
If you have any questions about this Privacy Notice, please contact the Privacy Officer at 617-889-8779.
This Notice of Privacy Practices describes how CSAC may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice of Privacy Practices also describes your rights regarding your health information that CSAC maintains and a brief description of how you may exercise your rights. This Notice of Privacy Practices further states the obligations CSAC has to protect your protected health information.
"Protected health information" means health information (including identifying information about you) that CSAC has collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care and payment for your health care services.
CSAC is required by law to maintain the privacy of your protected health information and to provide you with a notice of its legal duties and privacy practices with respect to your protected health information. CSAC is also required to comply with the terms of its current Notice of Privacy Practices.
II.How CSAC Will Use and Disclose Your Health Information
CSAC will use and disclose your protected health information as described in each category listed below. For each category, CSAC will explain what CSAC means in general, but it does not describe all specific uses or disclosures of health information.
A. Uses and Disclosures That May Be Made With Your Written Consent
1. For Treatment. Once you have signed CSAC's Consent to Use and Disclose Health Information, CSAC will use and disclosure your health information to provide your health care and any related services. CSAC will also use and disclose your health information to coordinate and manage your health care and related services. For example, CSAC may need to disclose information to a case manager who is responsible for coordinating your care. However, when CSAC makes disclosures to a third party (other than your health plan) for coordination or management of your health care, CSAC will usually obtain your written authorization prior to the disclosure. A third party is a person or entity who is not affiliated with CSAC's organization. CSAC may also disclose your health information among CSAC's clinicians and other staff (including clinicians other than your therapist or principal clinician), who work at CSAC. For example, CSAC's staff may discuss your care at a case conference. In addition, with your authorization, CSAC will disclose your health information to another health care provider (e.g., your primary care physician or a laboratory) working outside of CSAC.
2. For Payment. Once you have signed CSAC's Consent to Use and Disclose Health Information, CSAC may use or disclose your health information so that the treatment and services you receive are billed to, and payment is collected from, your health plan or other third party payer. By way of example, CSAC may disclose your health information to permit your health plan to take certain actions before your health plan approves or pays for your services. These actions may include:
For example, your health plan may ask CSAC to share your health information in order to determine if the plan will approve additional visits to your therapist.
3. For Health Care Operations. Once you have signed CSAC’s Consent to Use and Disclose Health Information, CSAC may use and disclose health information about you for CSAC's operations. These uses and disclosures are to enable CSAC to operate its organization and audit the quality of care that you receive. These activities may include, by way of example, quality assessment and improvement, reviewing the performance or qualifications of CSAC's clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities.
CSAC may combine health information of many of CSAC's consumer/patients to decide what additional services CSAC should offer, what services are no longer needed and whether certain new treatments are effective. CSAC may also combine CSAC's health information with health information from other providers to compare CSAC's performance with others and to see where CSAC can make improvements in CSAC's services. When CSAC combine CSAC's health information with information of other providers, CSAC will "de-identify" the health information by removing identifying information so others may use it to study health care or health care delivery without identifying the specific consumer/patients.
CSAC may also use and disclose your health information to contact you to remind you of your appointment. Finally, CSAC may use and disclose your health information to inform you about possible treatment options or alternatives that may be of interest to you.
4. Health-Related Benefits and Services. CSAC may use and disclose health information to tell you about health-related benefits or services that may be of interest to you. If you do not want CSAC to provide you with information about health-related benefits or services, you must notify the Privacy Officer in writing. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. Please state clearly that you do not want to receive materials about health-related benefits or services.
B. Uses and Disclosures That May be Made Without Your Consent or Authorization, But For Which You Will Have an Opportunity to Object.
1. CSAC does not maintain a facility directory at any of CSAC's outpatient units. If asked, CSAC will not confirm orally, in writing or through any other medium that you are CSAC's current or former consumer/patient, except as listed below under "Person's Involved in an Individual's Care."
2. Persons Involved in Your Care. CSAC may provide health information about you to someone who helps pay for your care. CSAC may use or disclose your health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. CSAC may also use or disclose your health information to an entity assisting in disaster relief efforts and to coordinate uses and disclosures for this purpose to family or other individuals involved in your health care.
In limited circumstances, CSAC may disclose health information about you to a friend or family member who is involved in your care. If you are physically present and have the capacity to make health care decisions, your health information may only be disclosed with your agreement to persons you designate to be involved in your care.
But, if you are in an emergency situation, CSAC may disclose your health information to a spouse, a family member, or a friend so that such person may assist in your care. In this case CSAC will determine, in its professional judgment, whether the disclosure is in your best interest and, if so, only disclose information that is directly relevant to participation in your care.
And, if you are not in an emergency situation but are unable to make health care decisions, CSAC will disclose your health information to:
C. Uses and Disclosures That May be Made Without Your Consent, Authorization or Opportunity to Object.
1. Emergencies. CSAC may use and disclose your health information in an emergency treatment situation. By way of example, CSAC may provide your health information to a paramedic who is transporting you in an ambulance. CSAC will attempt to obtain your Consent as soon as reasonably practicable after your emergency treatment. If a clinician is required by law to treat you and your treating clinician has attempted to obtain your Consent but is unable to do so, the treating clinician may nevertheless use or disclose your health information to treat you.
2. Communication Barriers. CSAC may use and disclose your health information if one of CSAC's clinicians attempts to obtain Consent from you, but is unable to do so due to substantial communication barriers. However, CSAC will only use or disclose your health information if the clinician determines in his/her professional judgment that, absent the communication barriers, you likely would have consented to use or disclose information under the circumstances.
3. Research. CSAC may disclose your health information to researchers when their research has been approved by an Institutional Review Board or a similar privacy board that has reviewed the research proposal and established protocols to protect the privacy of your health information.
4. As Required By Law. CSAC will disclose health information about you when required to do so by federal, state or local law.
5. To Avert a Serious Threat to Health or Safety. CSAC may use and disclose health information about you when necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person. Under these circumstances, CSAC will only disclose health information to someone who is able to help prevent or lessen the threat.
6. Organ and Tissue Donation. If you are an organ donor, CSAC may release your health information to an organ procurement organization or to an entity that conducts organ, eye or tissue transplantation, or serves as an organ donation bank, as necessary to facilitate organ, eye or tissue donation and transplantation.
7. Public Health Activities. CSAC may disclose health information about you as necessary for public health activities including, by way of example, disclosures to:
8. Health Oversight Activities. CSAC may disclose health information about you to a health oversight agency for activities authorized by law. Oversight agencies include government agencies that oversee the health care system, government benefit programs such as Medicare or Medicaid, other government programs regulating health care, and civil rights laws.
9. Disclosures in Legal Proceedings. CSAC may disclose health information about you to a court when a judge orders CSAC to do so. CSAC also may disclose health information about you in legal proceedings without your permission or without a judge's order when:
10. Law Enforcement Activities. CSAC may disclose health information to a law enforcement Officer for law enforcement purposes when:
CSAC may also disclose health information about you, if you are a victim of a crime, without a court order or without being required to do so by law. However, CSAC will do so only if the disclosure has been requested by a law enforcement Officer and you agree to the disclosure or, in the case of your incapacity, the following occurs:
11. Medical Examiners or Funeral Directors. CSAC may provide health information about you to a medical examiner. Medical examiners are appointed by law to assist in identifying deceased persons and to determine the cause of death in certain circumstances. CSAC may also disclose health information about you to funeral directors as necessary to carry out their duties.
12. Military and Veterans. If you a member of the armed forces, CSAC may disclose your health information as required by military command authorities. CSAC may also disclose your health information for the purpose of determining your eligibility for benefits provided by the Department of Veterans Affairs. Finally, if you are a member of a foreign military service, CSAC may disclose your health information to that foreign military authority.
13. National Security and Protective Services for the President and Others. CSAC may disclose medical information about you to authorized federal Officers for intelligence, counter-intelligence, and other national security activities authorized by law. CSAC may also disclose health information about you to authorized federal Officers so they may provide protection to the President, other authorized persons or foreign heads of state or so they may conduct special investigations.
14. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement Officer, CSAC may disclose health information about you to the correctional institution or law enforcement Officer.
15. Workers' Compensation. CSAC may disclose health information about you to comply with the Massachusetts Workers' Compensation Law. These disclosures will usually be made only when CSAC have received a court order or, sometimes, when CSAC have received a subpoena for the information.
III. Uses and Disclosures of Your Health Information with Your Permission.
Uses and disclosures not described in Section II of this Notice of Privacy Practices will generally only be made with your written permission, called an "authorization." You have the right to revoke an authorization at any time. If you revoke your authorization CSAC will not make any further uses or disclosures of your health information under that authorization, other than actions relying upon the uses or disclosures you have previously authorized.
IV. Your Rights Regarding Your Health Information.
A. Right to Inspect and Copy.
You have the right to request an opportunity to inspect or copy health information used to make decisions about your care - whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records.
You must submit your request to inspect or copy your health information in writing to the Privacy Officer. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. If you request a copy of the information, CSAC may charge a fee for the cost of copying, mailing and supplies associated with your request. For those who wish to remain anonymous and prefer a confidential method for raising concerns, a post office box exists for filing a report confidentially. Mailed correspondence should be addressed to Matt Davis, Post Office Box 771, Londonderry, NH 03053.
CSAC may deny your request to inspect or copy your health information in certain limited circumstances. In some cases, you will have the right to have the denial reviewed by a licensed health care professional not directly involved in the original decision to deny your request. CSAC will inform you in writing if the denial of your request may be reviewed and how you request a review. If you have a right to a review and request the review, once the review is completed, CSAC will honor the decision made by the licensed health care professional reviewer.
B. Right to Amend.
For as long as CSAC keep records about you, you have the right to request CSAC to amend any health information used to make decisions about your care - whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records.
To request an amendment, you must submit a written request to the Privacy Officer. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. In your request state clearly the reason(s) why you believe the information is incorrect or inaccurate.
CSAC may deny your request for an amendment if it is not in writing or does not include a reason to support the request. CSAC may also deny your request if you ask CSAC to amend health information that:
If CSAC denies your request to amend your health information, CSAC will send you a written notice of the denial stating the basis for the denial and offering you the opportunity to provide a written statement disagreeing with the denial. If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and CSAC's denial be attached to all future disclosures of the health information that is the subject of your request.
If you choose to submit a written statement of disagreement, CSAC has the right to prepare a written rebuttal to your statement of disagreement. In this case, CSAC will attach the written request and the rebuttal (as well as the original request and denial) to all future disclosures of the health information that is the subject of your request.
C. Right to an Accounting of Disclosures.
You have the right to request that CSAC provide you with an accounting of disclosures of your health information CSAC has made. An accounting is a list of disclosures. But this list will not include certain disclosures of your health information, by way of example, CSAC will not include disclosures made for purposes of treatment, payment, and health care operations.
To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. For your convenience, you may submit your request on a form called a "Request For Accounting," which you may obtain from the CSAC Privacy Officer. The request should state the time period for which you wish to receive an accounting. This time period cannot be longer than six years and cannot include dates before April 14, 2003.
The first accounting you request within a 12 month period will be free. For additional requests during the same 12 month period, CSAC will charge you for the costs of providing the accounting. CSAC will notify you of the amount CSAC will charge and you may choose to withdraw or modify your request before CSAC incur any costs.
D. Right to Request Restrictions.
You have the right to request a restriction on the health information CSAC uses or discloses about you for treatment, payment or health care operations. You may also ask that any part (or all) of your health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in Section II(B)(2) of this Notice of Privacy Practices.
To request a restriction, you must either include it (with CSAC's approval) in the Consent for Use or Disclosure Form or request the restriction in writing addressed to the Privacy Officer. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. The Privacy Officer will ask you to fill out a Request for Restriction Form, which you should complete and return to the Privacy Officer.
CSAC is not required to agree to a restriction that you may request. If CSAC agrees, to a restriction that you request, CSAC will honor the restriction, unless the restricted health information is needed to provide you with emergency treatment.
E. Right to Request Confidential Communications.
You have the right to request that CSAC communicate with you about your health care only in a certain location or through a certain method. For example, you may request that CSAC contact you only at work or by e-mail.
To request such a confidential communication, you must make your request in writing addressed to the Privacy Officer. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. CSAC will accommodate all reasonable requests. You do not need to give CSAC a reason for the request; but your request must specify how or where you wish to be contacted.
F. Right to a Paper Copy of this Notice.
You have the right to obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy, make a request in writing addressed to the Privacy Officer. The Privacy Officer is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150.
V. Confidentiality of Substance Abuse Records
For individuals who have received treatment, diagnosis or referral for treatment from CSAC's drug or alcohol abuse programs, the confidentiality of drug or alcohol abuse records is protected by federal law and regulations. As a general rule, CSAC may not tell a person outside the programs that you attend any of these programs, or disclose any information identifying you as an alcohol or drug abuser, unless:
A violation by CSAC of the federal law and regulations governing drug or alcohol abuse is a crime. Suspected violations may be reported to the Unites States Attorney in the district where the violation occurs.
Federal law and regulations governing confidentiality of drug or alcohol abuse permit CSAC to report suspected child abuse or neglect under state law to appropriate state or local authorities.
Please see 42 U.S.C. § 290dd-2 for federal law and 42 C.F.R., Part 2 for federal regulations governing confidentiality of alcohol and drug abuse patient records.
If you believe your privacy rights have been violated, you may file a complaint with CSAC or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with CSAC, contact CSAC's Complaint Officer addressed to Human Resources, 125 North Elm Street, Westfield, MA 01085. All complaints must be submitted in writing.
The Privacy Officer, who can be contacted is Norma Reppucci, 201 Crescent Avenue, Chelsea, MA 02150. The Privacy Officer will assist you with writing your complaint, if you request such assistance. For those who wish to remain anonymous and prefer a confidential method for raising concerns, a post office box exists for filing a report confidentially. Mailed correspondence should be addressed to Matt Davis, Post Office Box 771, Londonderry, NH 03053.
CSAC will not retaliate against you for filing a complaint.
VII. Changes to this Notice
CSAC reserve the right to change the terms of CSAC's Notice of Privacy Practices. CSAC also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information CSAC already has about you as well as any health information CSAC receives in the future. CSAC will post a copy of the current Notice of Privacy Practices at CSAC's main office and at each site where CSAC provides care. You may also obtain a copy of the current Notice of Privacy Practices by accessing CSAC's website at www.csachelp.com or by calling CSAC at any office location and requesting that a copy be sent to you in the mail or by asking for one any time you are at CSAC's offices.