NOTICE OF PRIVACY PRACTICES
THE CENTER FOR AUTISM TREATMENT, INC.
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.
In this document, “we” refers to The Center for Autism Treatment, Inc., also referred to as “The Center.” “You” or “yours” refers to individual participants in The Center. We are required by federal law to protect the privacy of your individual health information (referred to in this notice as “Protected Health Information”). We are also required to provide you with this notice regarding our legal duties and privacy practices with respect to your protected health information, and to abide by the terms of this notice, as it may be updated from time to time.
The Center provides health, dental and/or vision benefits to you as described in your summary plan description(s). The Center receives and maintains Protected Health Information about you in the course of providing these health benefits to you. The Center hires business associates, to help it provide these benefits to you. These business associates also receive and maintain Protected Health Information about you in the course of assisting The Center. The Center is sponsored by The Center for Autism Treatment, Inc. (the “Plan Sponsor”).
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2004. The Center is required to follow the terms of this notice until it is replaced. The Center reserves the right to change the terms of this notice at any time. If The Center makes changes to this notice, The Center will revise it and send a new notice to all participants covered by The Center at that time. The Center reserves the right to make the new changes apply to all Protected Health Information about you maintained by The Center before and after the effective date of the new notice.
Purposes for which The Center May Use or Disclose Medical Information About You Without Your Consent or Authorization
The Center may use and disclose Protected Health Information about you for the following purposes:
· Health Care Providers’ Treatment Purposes. We may use or disclose your Protected Health Information to facilitate or assist with treatment or services rendered by providers on your behalf. For example, The Center may disclose Protected Health Information about you to your doctor, at the doctor’s request, for your treatment.
· Payment. We may use or disclose your Protected Health Information to determine eligibility for health and/or dental benefits, to facilitate payment for the treatment or services you receive from various providers, to determine benefit responsibility under The Center or to coordinate Plan coverage. For example, The Center may use or disclose Protected Health Information about you to pay claims for covered health care services or to provide eligibility information to your doctor when you receive treatment.
· Health Care Operations. We may use and disclose your Protected Health Information for other Plan operations that may be necessary to maintain or operate The Center. For example, The Center may use or disclose Protected Health Information about you for underwriting, premium rating, legal services, audit services or other activities relating to the creation, management, renewal or replacement of a contract of health insurance.
· Health Services. We may use and disclose your Protected Health Information in order to promote or improve health care services for your benefit. For example, The Center may use Protected Health Information about you to contact you to give you information about treatment alternatives or other health-related benefits and services that may be of interest to you.
· As Required By Law. We will use and disclose your Protected Health Information when required by federal, state or local law. For example, The Center must allow the U.S. Department of Health and Human Services to audit Plan records. The Center may also disclose Protected Health Information about you as authorized by and to the extent necessary to comply with workers’ compensation or other similar laws.
· To Business Associates. The Center may disclose Protected Health Information about you to third parties (called business associates) that The Center hires for assistance. Each business associate of The Center must agree in writing to ensure the continuing confidentiality and security of Protected Health Information about you in conformance with the Health Insurance and Portability Accountability Act of 1996 (“HIPAA”).
· To Plan Sponsor. The Center may disclose to The Center Sponsor, in summary form, claims history and other similar information. Such summary information does not disclose your name or other identifying characteristics. The Center may also disclose to The Center Sponsor the fact that you are enrolled in, or disenrolled from The Center. The Center may disclose Protected Health Information about you to The Center Sponsor for Plan administrative functions that The Center Sponsor provides to The Center if The Center Sponsor agrees in writing to ensure the continuing confidentiality and security of the Protected Health Information.
· The Center Sponsor must also agree not to use or disclose Protected Health Information about you for employment-related actions or for any other benefit or benefit plans of The Center Sponsor.
The Center may also use and disclose Protected Health Information as follows:
· To avert a serious threat to your health or safety or the health or safety of others.
· To comply with legal proceedings, such as a court or administrative order, subpoena, warrant, summons or request under certain circumstances.
· To law enforcement officials for certain law enforcement purposes:
o to identify or locate a suspect, fugitive, material witness or missing person, provided that the Protected Health Information is limited in nature;
o in response to a request about an individual who is or is suspected to be a victim of a crime if we are unable to obtain the individual’s agreement under certain circumstances; and
o in the event we believe that a crime occurred on our premises.
· To public health authorities or other appropriate government authorities for public health purposes or activities.
· To a government authority if The Center or Plan Sponsor reasonably believes an individual is a victim of abuse, neglect or domestic violence.
· To a governmental agency authorized to oversee the health care system or government programs.
· To a coroner, medical examiner, or funeral director about a deceased person.
· To your personal representatives appointed by you or designated by applicable law.
· For research purposes, as long as certain privacy-related standards are satisfied in conformance with HIPAA.
· To an organ procurement organization in limited circumstances.
· For specialized government functions (e.g., military and veterans activities, national security and intelligence, federal protective services, medical suitability determinations, correctional institutions and other law enforcement custodial situations).
· We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care. In addition, we may use or disclose the Protected Health Information to notify a member of your family, your personal representative, another person responsible for your care, or certain disaster relief agencies of your location, general condition, or death. If you are incapacitated, there is an emergency, or you otherwise do not have the opportunity to agree to or object to this use or disclosure, we will do what in our judgment is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your health care.
Authorizations: Uses and Disclosures with Your Permission
The Center will not use or disclose Protected Health Information about you for any other purposes unless you give The Center your written authorization to do so. If you give The Center written authorization to use or disclose Protected Health Information about you for a purpose that is not described in this notice, then, in most cases, you may revoke it in writing at any time.
Your revocation will be effective for all Protected Health Information about you The Center maintains, except for information The Center has already released based on your authorization.
Your Rights
You may make a written request to The Center to do one or more of the following concerning Protected Health Information about you that The Center maintains:
· To put additional restrictions on The Center’s use and disclosure of Protected Health Information about you. The Center does not have to agree to your request except in certain limited circumstances (see “New Rights Effective February 17, 2010,” below).
· To receive communications from The Center by alternative means or at a different location than The Center is currently doing. The Center does not have to agree to your request unless such alternative means are necessary to avoid endangering you and your request continues to allow The Center to collect premiums and pay claims. Your request must be in writing and must specify the alternative means or location.
· To see and get copies of Protected Health Information about you. In limited cases, The Center does not have to agree to your request. In particular, we may not comply with your request if the information was not created by us (unless the creator of the information is no longer available to make the requested amendment), not available to you for inspection or copying or if is already accurate and complete.
· To amend Protected Health Information about you that is retained in a designated record set. In some cases, The Center does not have to agree to your request for amendment.
· To receive a list of disclosures of Protected Health Information about you that The Center and its business associates made for certain purposes for the last 6 years (but not for disclosures before April 14, 2004). Please note, however, that certain disclosures may not be included in such an accounting, such as disclosures made for treatment, payment or health care operation purposes or disclosures that are incidental.
· To send you a paper copy of this notice if you received this notice by e-mail or on the Internet. In some cases, The Center may charge you a nominal, cost-based fee to carry out your request.
New Rights Effective February 17, 2010
You have the right to opt-out of receiving any communications from The Center or its affiliates regarding fundraising for The Center’s activities relating to improving the quality of health care or improving community health. If you choose to opt-out of receiving such communications, we ask that you fill out our Fundraising Opt-Out Form and give or send the form to:
The Center for Autism Treatment, Inc
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
We will keep your request on file. You may choose to change your decision at any time.
You have the right to access certain health information from your Electronic Health Record, to the extent that The Center maintains such a record. You also have a right to receive a copy of that information in an electronic format and to tell us to send a copy of that information directly to a person or organization that you designate. However, this information will not include psychotherapy notes, information related to a legal proceeding and information related to the Clinical Laboratory Improvements Amendments of 1988.
If you wish to access and receive a copy of your health information from your Electronic Health Record, you must provide us with clear and specific directions on our Electronic Health Record Request Form. We may impose a fee to cover our labor costs in responding to your request for electronic copies of your health information.
You have the right to request a restriction on disclosing your health information to a health plan or insurer when you pay for a health care item or service out-of-pocket in full, provided there are no other legal requirements for such disclosure. We must abide by this request. If you wish to request such a restriction, please fill out our Restriction on Disclosures Form and give or send it to:
The Center for Autism Treatment, Inc
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
If you want to exercise any of these rights described in this notice, please contact the Privacy Office at the location indicated below. The Center will give you the necessary information and forms for you to complete and return to us.
Complaints
If you believe your privacy rights have been violated, you may complain to us in writing by contacting the Privacy Officer at the location indicated below under “Contacting Us” or to the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Contacting Us
To request additional copies of this notice or to receive more information about our privacy practices or your rights, please contact our Privacy Officer at:
The Center for Autism Treatment, Inc
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
Conclusion
Use and disclosure of Protected Health Information by The Center is regulated, in part, by a federal law known as HIPAA. You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. This Notice attempts to summarize the Privacy Standards. The Privacy Standards will supersede any discrepancy between the information in this Notice and the Privacy Standards.
Amendment to Notice of Privacy Practices
THE CENTER FOR AUTISM TREATMENT, INC.
On February 17, 2009, President Obama signed into law additional health information privacy and security protections. This document amends The Center for Autism Treatment Inc.’s Notice of Privacy Practices (the “Notice”) by adding new rights to the Notice. The rights listed in the Notice are still in effect. This amendment merely adds to them. Unless specified otherwise below, these new rights take effect on February 17, 2010. Please contact
The Center for Autism Treatment, Inc.
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
Tamara S. Kasper, Director
if you have any questions or concerns about these new rights.
New Right With Regard To Fundraising Communications[1]
You have the right to opt-out of receiving any communications from The Center or its affiliates regarding fundraising The Center’s activities relating to improving the quality of health care or improving community health. If you choose to opt-out of receiving such communications, we ask that you fill out our Fundraising Opt-Out Form and give or send the form to:
The Center for Autism Treatment, Inc.
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
We will keep your request on file. You may choose to change your decision at any time.
Right of Access to Electronic Health Record[2]
You have the right to access certain health information from your Electronic Health Record, to the extent that The Center maintains such a record. You also have a right to receive a copy of that information in an electronic format and to tell us to send a copy of that information directly to a person or organization that you designate. However, this information will not include psychotherapy notes, information related to a legal proceeding and information related to the Clinical Laboratory Improvements Amendments of 1988.
If you wish to access and receive a copy of your health information from your Electronic Health Record, you must provide us with clear and specific directions on our Electronic Health Record Request Form. We may impose a fee to cover our labor costs in responding to your request for electronic copies of your health information.
Restrictions on Disclosures[3]
You have the right to request a restriction on disclosing your health information to a health plan or insurer when you pay for a health care item or service out-of-pocket in full, provided there are no other legal requirements for such disclosure. We must abide by this request. If you wish to request such a restriction, please fill out our Restriction on Disclosures Form and give or send it to
The Center for Autism Treatment, Inc
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
Accounting of Disclosures[4]
You may have the right to request an accounting of disclosures of your protected health information that The Center makes relating to your treatment, payment for services rendered to you and health care operations of The Center, as long as those disclosures were made through an Electronic Health Record. The accounting of such disclosures will be for the three years prior to the date of your request. Once The Center knows the exact date of when this new right takes effect, it will send an additional notice to you alerting you to the effective date.
Once this right takes effect, you may make such requests for accounting of disclosures by filling out our Accounting of Disclosures from EHR Request Form and give or send it to
The Center for Autism Treatment, Inc
388 Woodside Drive, Ste. 1
Cedarburg, WI 53012
[1] HITECH § 13406(b).
[2] HITECH § 13405(e).