Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW IDENTIFIABLE MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

This notice is effective as of April 14, 2003. This Notice of Privacy Practices for protected health information complies with Federal Regulation 164.520. If you have any questions about this notice, please contact the Privacy Officer at 315-476-7441, extension 127.

Our Commitment to Our Consumers
At the Arc of Onondaga, we understand that information about you and your family is personal. When you apply for any service that the Arc of Onondaga offers, you disclose information about yourself or members of your family. The collection, use, and disclosure of such information is regulated by law. Arc of Onondaga invites you to receive services from us knowing that we protect your personal information. This Notice of our Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations, and for other purposes. It also describes your rights to access and control your protected health information. Arc of Onondaga restricts access to personal information about you to those individuals who need to know that information in order to provide services to you or for agency operations. We also maintain physical, electronic, and procedural safeguards that comply with state and federal regulations to protect your personal information. We are required by law to maintain the privacy practices with respect to protected health information and abide by the terms of this Notice of Privacy Practices. You have the right to obtain a copy of this Notice.

Who Will Follow This Notice
All members of the Arc of Onondaga workforce, in any of our program or service areas, and in our administrative offices will follow this notice. This includes employees and persons the agency contracts with (contractors) who are authorized to enter information in your clinical record or need to review your record to provide services to you. Other members of our workforce include volunteers, trainees, and other persons whose conduct, in the performance of work for the agency, is under the direct control of the agency, whether or not they are paid by the agency.

What Information Is Protected:
“Protected Health Information” is information about you, including demographics that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services or payment for those services. This includes your name, address, birth date, social security number, your medical information, your individualized service plan and other information, including photographs and other images, about your care in our programs or services.

How Arc of Onondaga Uses and Discloses Medical Information
The following categories describe different ways that we may use and disclose protected health information. For each category of uses or disclosures, we will explain what we mean and try to give some example. Not every use or disclosure is described, but all of the ways we are permitted to use and disclose information without your permission will fall within one of these categories. Arc of Onondaga utilizes a Consent form, signed prior to or upon start of service delivery, for consent to obtain, release or exchange information for the purposes of treatment and/or payment and/or health care operations.

Uses and Disclosures Pursuant to Your Consent

Treatment – Arc of Onondaga may use your protected health information to provide you with treatment and services. We may disclose medical information about you to doctors, nurses, psychologists, social workers, qualified mental retardation professional (QMRPs), direct care personnel or other agency personnel who are involved in delivering services and providing care. For example, involved staff may discuss your health information to develop and carry out your individualized service plan. Agency staff may share your health information to coordinate different services you need, such as medical tests, transportation, etc. We may also need to disclose your health information to your service coordinator and other providers who are responsible for providing you with the services identified in your ISP or to obtain new services for you. Different departments of the agency also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, follow-up care and needs assessments. We also may disclose protected health information about you to people outside the agency who may be involved in your care and services, such as family members, advocates, employers or others we use to provide services that are part of your plan of services.
Payment – We may use and disclose protected health information about you so that the treatment and services you receive from the agency may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to provide the NYS Department of Health (Medicaid) with information about the services you received in our facility or through one of our HCBS waiver programs so they will pay us for the services. We may need to give your health plan information about clinic services you received at the agency so your health plan will pay us to reimburse you for the visits. In addition, we disclose your clinical information to receive prior approval for payment for services you may need. Also, we may disclose your clinical information to the US Social Security Administration or the Department of Health to determine your eligibility for coverage or your ability to pay for services.
Health Care Operations – We may use and disclose protected health information about you for agency operations. These uses and disclosures are necessary to operate programs, residences and services, and to make sure all consumers receive appropriate, quality care. For example, we may use health information for quality improvement to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to clinicians and other personnel for on-the-job training. We may also combine medical information about many consumers to decide what additional services the agency should offer, what services are not needed and whether certain new programs are effective. We may also disclose information to doctors, nurses, technicians, and other agency personnel for review and learning purposes. We may also combine the protected health information we have with protected health information from other agencies to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific consumers are.
Appointment Reminders – We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or services at the agency.
Health Oversight Activities – We may disclose protected health information to an oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government program, and compliance with civil rights laws.
Treatment Alternatives – We may use and disclose protected health information to tell you about or recommend possible treatment options, alternatives or other services that may be of interest to you.
Health-Related Benefits and Services – We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Fundraising/Marketing Activities – The agency may contact you in order to raise funds for the agency or for limited marketing activities, including a face-to-face encounter or a communication involving a promotional gift of nominal value.

Uses and Disclosures that may be made with your Consent, Authorization or Opportunity to Object

Directories/Rosters – We may include your name and address on agency rosters for emergency or administrative purposes, unless you object to this. Any objections should be put in writing.
Individuals Involved in Your Care or Payment for Your Care – We may release protected health information about you to a friend or family member who is involved in your care, unless you object. Any objections should be put in writing. We may also tell your family or friends your condition and that you are receiving services from us. In addition, we may disclose protected health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research – Under certain circumstances, we may use and disclose protected health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process.

Other Uses and Disclosures that Do Not Require Your Authorization
In addition to treatment, payment and health care operations, as well as the situations noted above, the Arc of Onondaga may use your protected health information for the following reasons:

As required by law – We may disclose protected health information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety – We may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Workers’ Compensation – We may release medical information about you for workers’ compensation or similar programs, as necessary to comply with workers compensation laws.
Public Health Risks – We may disclose medical information about you for public health activities, including prevention and control of disease, injury or disability, reporting births and deaths, reporting child abuse or neglect, reporting reactions to medication or problems with products, and to notify people who may have been exposed to a disease or are at risk of contracting or spreading a disease or condition
Domestic Violence/Adult Abuse or Neglect – We may disclose protected health information to the appropriate government authority if we believe a consumer has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law or regulation.
Lawsuits and Disputes – If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court or administrative order. We may also disclose protected health information about you 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 information requested.
Law Enforcement – We may release protected health information, in response to a court order, subpoena, warrant, summons or similar process, to report a possible crime, to identify a suspect or witness or missing person, to provide identifying data in connection with a criminal investigation, and to the district attorney in furtherance of a criminal investigation of abuse. We may also release information about the victim of a crime, about a death we believe may be the result of criminal conduct, or about criminal conduct at the agency.
Coroners, Medical Examiners and Funeral Directors – We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release protected health information about consumers of the agency to funeral directors as necessary to carry out their duties.
Inmates – If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care; to protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.

Authorization Required for All Other Uses and Disclosures
For all other types of uses and disclosures not described in this Notice, the Arc of Onondaga will use or disclose protected health information only with a written authorization signed by you that states who may receive the information, what information is to be shared, the purpose of the use or disclosure and an expiration for the authorization. If you cannot give permission due to an emergency, the Arc of Onondaga may release protected health information in your best interest. We must tell you as soon as possible after releasing the information.

You may revoke your authorization at any time. If you revoke your authorization in writing we will no longer use or disclose your protected health information for the reasons stated in your authorization. We cannot, however, take back disclosures we made before you revoked and we must retain protected health information that indicates the services we have provided to you.

Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you. When we use the word “you” in this notice we also mean your personal representative. Depending on your circumstances and in accordance with state law, this may be your legal guardian, your health care proxy, or your involved parent, spouse, or adult child.

Right to Inspect and Copy – You have the right to inspect and copy your protected health information. Usually, this includes medical and billing records. There may be limited exceptions to this right.

To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer. 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 your request to inspect and copy in certain very limited circumstances. If you are denied access to protected health information, you may request that the denial be reviewed. Another licensed health care professional, chosen by the Arc of Onondaga and who was not involved in denying your request, will review your request and the denial. We will comply with the outcome of the review.

Right to Amend – If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the agency.

To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing, or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that was not created by the Arc of Onondaga, is not part of the protected health information kept by or for the agency, is not part of the information which you would be permitted to inspect and copy, or is accurate and complete. Your written request will be maintained in the record.

Right to an Accounting of Disclosures – You have the right to request an accounting of disclosures. This list, however, does not include certain disclosures, such as those made for treatment, payment, health care operations, and disclosures made to you or made to others with your permission.

To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions – 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. You also have the right to request a limit on the protected health information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or a friend. For example, you could ask that we not use or disclose information about a clinic appointment you had.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure or both, and to whom you want the limits to apply to, for example, disclosures to your spouse.

Right to Request Confidential Communications – You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Changes to this Notice
Arc of Onondaga reserves the right to change this notice. We reserve the right to make changes to terms described in this notice and to make the new notice terms effective to all protected health information that the Arc of Onondaga maintains. We will promptly revise and distribute this notice whenever there is a material change to the uses or disclosures, the individuals’ rights, the agency’s legal duties or other privacy practices stated in this notice. Except when required by law, a material change to any term of the notice may not be implemented prior to the effective date of the notice in which such material change is reflected. We will send you a copy of the revised notice. The notice will contain on the first page, in the top right hand corner, the effective date.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer for the agency. To file a complaint with the agency, contact the Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
You may also submit a formal complaint to:
   Department of Health and Human Services
   Office of Civil Rights
   Hubert H. Humphrey Building
   200 Independence Avenue, S.W.
   Room 509H HHH Building
   Washington, DC 20201

If you have any questions or complaints, please contact:
Privacy Officer/Director of Quality Assurance
Arc of Onondaga
315-476-7441, extension 127