Privacy Information

 

ALLIED COMMUNITY RESOURCES, INC. 

Notice of Privacy Practices

Effective Date: April 14, 2003     Revised: September 12, 2013

THIS NOTICE DESCRIBES HOW CONFIDENTIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

Purpose of the Notice of Privacy Practices

This Notice of Privacy Practices (the “Notice”) is meant to inform you of the uses and disclosures of protected health information that we as the fiduciary agent for your state program may make. It also describes your rights to access and control your protected health information and certain obligations we have regarding the use and disclosure of your protected health information.

Your “protected health information” is information about you created and received by us, including demographic information, that may reasonably identify you and that relates to your past, present or future physical or mental health or condition, or payment for the provision of your health care.

We are required by law to:

·        Maintain the privacy of your protected health information.

·        Notify you, and in certain circumstances the media and/or appropriate state and federal agencies, of a breach of your unsecured protected health information. A “breach” is an impermissible use or disclosure of unsecured protected health information when our risk assessment shows a high probability that your protected health information has been accessed or compromised by an unauthorized individual or entity.

·        Provide you with this Notice of our legal duties and privacy practices with respect to your protected health information.

·        Abide by the terms of the Notice that are currently in effect.

We may change our notice at any time.  The new revised Notice will apply to all of your protected health information maintained by us.  You will not automatically receive a revised notice, but the notice will be available on our website.

How We May Use or Disclose Your Protected Health Information

Allied Community Resources, Inc. will ask new participants to sign a consent form that allows Allied Community Resources, Inc. to use and disclose your protected health information as required for payment operations and if applicable for service provision.  New participants will also be asked to acknowledge receipt of this Notice. 

The following categories describe some of the different ways that we may use or disclose your protected health information.  Even if not specifically listed below, Allied Community Resources, Inc. may use and disclose your protected health information as permitted or required by law or as authorized by you.  We will make reasonable efforts to limit access to your protected health information to those persons or classes of persons in our workforce who need access to carry out their duties.  In addition, if information release is required, we will make reasonable efforts to limit the protected health information to the minimum amount necessary to accomplish the intended purpose unless otherwise required by law.

·        For Payment - We may use and disclose your protected health information so that we can bill and receive payment for the treatment and related services you receive.  For billing and payment purposes, we may disclose your health information to your payment source, including insurance or managed care company, Medicare, Medicaid, or another third party payor.  For example, we may need to give information about the treatment you received such as type, dates of services and provider name, so Medicaid will pay us or reimburse us for your treatment or for the payroll of your household employees. We may also contact the state program sponsor to confirm your coverage or eligibility.

·        For Health Care Operations - We may use and disclose your health information as necessary for operations of Allied Community Resources, Inc., such as quality assurance and improvement activities, reviewing or auditing the accuracy of operational systems or records, and general administrative activities of Allied Community Resources, Inc.  (e.g. federal, state and outside CPA audits of Allied’s accounts). Additionally, we may use your protected health information to contact you for appointment reminders.

·        Business Associates - There may be some services provided by our business associates, such as billing, transcription, legal or accounting services.  We may disclose your protected health information to our business associate so that they can perform the job we have asked them to do.  To protect your health information, we require our business associates to enter into a written contract that requires them to appropriately safeguard your information. Our business associates are mandated to comply with the same HIPAA regulations as Allied Community Resources, Inc. and are subject to the same federal and state penalties for failure to do so.

·        Individuals Involved in Your Care or Payment of Your Care - With your permission, we may disclose your protected health information to a family member, a relative, a close friend or any other person you identify.  In addition, we may disclose your protected health information to a public or private entity authorized by law to assist in a disaster relief effort.  If you are unable to agree or object to such a disclosure, we may disclose such information if we determine that it is in your best interest based on our professional judgment or if we reasonably infer that you would not object.

·        Public Health Activities - We may disclose your protected health information to a public health authority that is authorized by law to collect or receive such information, such as for the purpose of reporting allegations of abuse or neglect.

·        Health Oversight Activities - We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, accreditation, licensure and disciplinary actions.

·        Judicial and Administrative Proceedings - If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to your authorization or a court or administrative order.  We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process if such disclosure is permitted by law. 

·        Law Enforcement - We may disclose your protected health information for certain law enforcement purposes if permitted or required by law, for example, to report suspicions of fraud, gunshot wounds; to report emergencies or suspicious deaths; to comply with a court order, warrant, or similar legal process; or to answer certain requests for information concerning crimes.

·        Research Purposes - Your protected health information may be used or disclosed for research purposes. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with the patients’ need for privacy of their medical information. Before we use or disclose protected health information for research, the project will have to be approved through this research approval process, but we may, however, disclose protected health information about you to people preparing to conduct a research project, so long as the medical information they review does not leave our facility.

·        To Avert a Serious Threat to Health or Safety - We may use and disclose your protected health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person.  Any disclosure, however, would be to someone able to help prevent the threat. 

·        Military and National Security - If required by law, if you are a member of the armed forces, we may use and disclose your protected health information as required by military command authorities or by the Department of Veterans Affairs. If required by law, we may disclose your protected health information to authorized federal officials for the conduct of lawful intelligence, counter- intelligence, and other national security activities authorized by law. If required by law, we may disclose your protected health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

·        Workers’ Compensation - We may use or disclose your protected health information as permitted by laws relating to workers’ compensation or related programs.

·        Other Uses of Medical Information - We may use or disclose your protected health information as permitted by laws relating to the Internal Revenue Service, Department of Revenue Services or related programs as it pertains to our fiscal intermediary and payment services.

·        Required by Law - We will disclose your protected health information when required to do so by federal, state or local law.

Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and HIV-Related Information

For disclosures concerning protected health information relating to care for psychiatric conditions, substance abuse or HIV‑related testing and treatment, special restrictions may apply.  For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special authorization or a court orders the disclosure.

 ·        Substance Abuse Treatment Information - If you are treated in a specialized substance abuse program, the confidentiality of alcohol and drug abuse client records is protected by federal law and regulation. Generally, we may not say to a person outside the program that you attend the program, or disclose any information identifying you as an alcohol or drug abuser, unless:

1. You consent in writing;

2. The disclosure is allowed by court order; or

3. The disclosure is made to medical personal in a medical emergency or to qualified personnel for payment, research, audit, or programevaluation.

·        HIV- Related Iformation - We may disclose HIV‑related information as permitted or required by applicable state law. 

·        Minors - We will comply with applicable state law when using or disclosing protected health information of minors. 

         Alabama: For example, if you are an unemancipated minor in Alabama consenting to a health care service related to HIV/AIDS, venereal disease, pregnancy or alcohol/drug dependence, you may have the authority to consent to the use and disclosure of your health information unless you have requested that another person be treated as your personal representative.  Note that your health care provider, using his or her professional judgment, may also decide to release your records to your parents or other legal guardians with or without your consent.

     Connecticut: For example, if you are an unemancipated minor in Connecticut consenting to a health care service related to HIV/AIDS, venereal disease, abortion, outpatient mental health treatment or alcohol/drug dependence, you may have the authority to consent to the use and disclosure of your health information unless you have requested that another person be treated as your personal representative.

When We May Not Use or Disclose Your Protected Health Information

Except as described in this Notice, or as permitted by applicable state or Federal law, we will not use or disclose your protected health information without your written authorization.

·        Marketing - We may not disclose any of your protected health information for marketing purposes without your written authorization if we will receive direct or indirect financial remuneration not reasonably related to the costs incurred for making the communication.

·        Psychotherapy Notes - An express written authorization or court order is required for any use or disclosure of psychotherapy notes except to carry out certain treatment, payment, or health care operations and for use by Allied Community Resources, Inc. for training programs or for defense in a legal action.

·        Sale of Protected Health Information - We will not sell your protected health information to third parties without your written authorization. The sale of health information, however, does not include a disclosure for public health purposes, for research purposes where Allied Community Resources, Inc. will only receive payment for our cost to prepare and transmit the protected health information, for treatment and payment purposes, for the sale, transfer, merger or consolidation of Allied Community Resources, Inc., for a business associate or its subcontractor to perform certain functions on our behalf, or for other purposes required or permitted by law.

Your written authorization will specify particular uses or disclosures that you choose to allow.  Under certain limited circumstances, Allied Community Resources, Inc. cannot provide services without your authorization, such as IRS, DRS, DOL/DIR and payroll related requirements.  If you do authorize us to use or disclose your protected health information for reasons other than treatment, payment or health care operations, you may revoke your authorization in writing at any time by contacting Allied Community Resources, Inc.’s Privacy Officer.  If you revoke your authorization, we will no longer use or disclose your protected health information for the purposes covered by the authorization, except where we have already relied on the authorization.

Your Health Information Rights and Access to Your Protected Health Information

You have the following rights with respect to your protected health information.  The following briefly describes how you may exercise these rights.

·        Right to Request Restrictions of Your Protected Health Information - You have the right to request certain restrictions or limitations on the protected health information we use or disclose about you.  You may request a restriction or revise a restriction on the use or disclosure of your protected health information by providing a written request stating the specific restriction requested.  You can obtain a Request for Restriction form from Allied.  You may require a restriction on disclosure of your protected health information to a health plan (other than a federal health care program that requires Allied to submit information) and Allied must agree (unless otherwise required by law) to your request, if it is for purposes of payment or other health care operations (but not treatment) if you paid out of pocket, in full, for the item or service to which the protected health information pertains. Otherwise, we are not required to agree to your requested restriction.  If or when we agree to accept your requested restriction, we will comply with your request except as needed to provide you with emergency treatment.  If restricted protected health information is disclosed to a health care provider for emergency treatment, we will request that such health care provider not further use or disclose the information.  In addition, you and Allied may terminate the restriction (other than a restriction to a health plan for purposes of payment) if the other party is notified in writing of the termination.  Unless you agree, the termination of the restriction is only effective with respect to protected health information created or received after we have informed you of the termination.

·        Right to Receive Confidential Communications - You have the right to request a reasonable accommodation regarding how you receive communications of protected health information.  You have the right to request an alternative means of communication or an alternative location where you would like to receive communications.  You may submit a request in writing to Allied Community Resources, Inc. requesting confidential communications.  You can obtain a Request for Confidential Communications form from Allied Community Resources, Inc.

·        Right to Access, Inspect and Copy Your Protected Health Information - You have the right to access, inspect and obtain a copy of your protected health information that is used to make decisions about your care for as long as the protected health information is maintained by Allied Community Resources, Inc.  To access, inspect and copy your protected health information that may be used to make decisions about you, you must submit your request in writing to Customer Service at Allied Community Resources, Inc. In your request you have the right to specify your preferred method of receiving the protected health information, such as mail, fax or electronically.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.  We may deny, in whole or in part, your request to access, inspect and copy your protected health information under certain limited circumstances.  If we deny your request, we will provide you with a written explanation of the reason for the denial.  You may have the right to have this denial reviewed by an independent professional designated by us to act as a reviewing official.  This individual will not have participated in the original decision to deny your request.  You may also have the right to request a review of our denial of access through a court of law.  All requirements, court costs and attorney’s fees associated with a review of denial by a court are your responsibility.  You should seek legal advice if you are interested in pursuing such rights.

·        Right to Amend Your Protected Health Information - You have the right to request an amendment to your protected health information for as long as the information is maintained by or for Allied Community Resources, Inc. Your request must be made in writing to Customer Service at Allied Community Resources, Inc. and must state the reason for the requested amendment.  You can obtain a Request for Amendment form from Allied Community Resources, Inc.  If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.  We may rebut your statement of disagreement.  If you do not wish to submit a written statement disagreeing with the denial, you may request that your request for amendment and its denial be included with any future disclosure of your relevant information.

·        Right to Receive An Accounting of Disclosures of Protected Health Information - You have the right to request an accounting of certain disclosures of your protected health information by Allied Community Resources, Inc. or by others on our behalf.  To request an accounting of disclosures, you must submit a request in writing to Customer Service, stating a time period that is within six (6) years from the date of your request.  The first accounting provided within a twelve-month period will be free.  We may charge you a reasonable, cost-based fee for each future request for an accounting within a single twelve-month period.  However, you will be given the opportunity to withdraw or modify your request for an accounting of disclosures in order to avoid or reduce the fee. Please note that, at times, companies we work with (called “business associates”) may have access to your protected health information. When you request an accounting of disclosures from Allied Community Resources, Inc., we may provide you with the accounting of disclosures or the names and contact information of our business associates, so that you may then contact them directly for an accounting of disclosures made by them.

·        Right to Request Transmission of Your Protected Health Information in Electronic Format - You may direct us to transmit an electronic copy of your protected health information that we maintain in electronic format to an individual or entity you designate. To request the transmission of your electronic health information, you must submit the request to Allied Community Resources, Inc. in writing.

·        Right to Obtain A Paper Copy of Notice - You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically.  You may request a copy of this Notice at any time by contacting Customer Service at Allied Community Resources, Inc.  In addition, you may obtain a copy of this Notice on our web site.

·        Right to Complain - You may file a complaint with us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our Privacy Officer.  You will not be penalized or experience retaliation for filing a complaint and we will make every reasonable effort to resolve your complaint with you.

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 If you have any questions about this Notice or would like further information concerning your privacy rights, please contact:

 Allied Community Resources, Inc.
Karen L. Hansen, Privacy Officer
6 Craftsman Road, East Windsor CT 06088
(860) 627-9500 ext. 126