Privacy Policy

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Alpha House, Inc.
HIPAA Policy on Notice of Privacy Practices

 

Adopted:        March 24, 2003
Effective:        April 14, 2003

Policy:

It is the policy of Alpha House, Inc. to provide our residents/clients with written notice of our privacy practices, including among other things a statement of each resident/client’s rights as set out by the HIPAA Privacy Regulations.  The written Notice of Privacy Practices adopted by Alpha House, Inc. shall be distributed to each resident/client or their legal representative pursuant to the guidelines set forth below:

  1. Each resident client and/or their legal representative shall be provided a copy of the most current Notice of Privacy practices at the time of their initial intake into the program, unless impracticable in the case of emergency treatment.  In case of a telephone intake, it shall be the responsibility of the HIPPA coordinator or residential counselor to provide this notice and take further steps described below, at the first opportunity available.
  2. Each resident client or their legal representative shall be asked to sign an Acknowledgement of Receipt of Notice of Privacy Practices to acknowledge that they received a copy this notice.  If the resident client or legal representative is unwilling or unable to acknowledge receipt in this way, the HIPPA coordinator or residential counselor shall document his/her effort to obtain this acknowledgement and the refusal or the reason the resident client or legal representative did not sign the acknowledgement on the acknowledgement form with the date and the HIPPA coordinator’s or residential counselor’s signature.
  3. The acknowledgement form or evidence of refusal or inability to sign shall be immediately placed in the resident’s/client’s chart as evidence indicating the provision of the Notice of Privacy Practices.
  4. At each treatment episode of each resident/client after April 14, 2003, when pulling the file for quality monitoring, the HIPPA coordinator or residential counselor shall check for the existence of the Notice of Privacy Practices.  If there no indication of the provision of the Notice of Privacy Practices exists within the file, it shall be the responsibility of the HIPPA coordinator or residential counselor to provide a copy of the Notice of Privacy Practices and attempt to obtain the written acknowledgement of receipt of the notice, under the guidelines set forth above.
  5. The Notice of Privacy Practices shall also be posted in the reception area, as well as within the Alpha House, Inc. website.

See Alpha House, Inc., Client Information Handbook for evidence of HIPAA Notice of Privacy Compliance.

Alpha House, Inc.
Notice of Privacy Practices

 

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

WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION.  We will protect the privacy of the health information that we maintain that identifies you, whether it deals with the provision of health care to your or the payment for health care.  We must provide you with this Notice about our privacy practices.  It explains how, when and why we may use and disclose your health information.  With some exceptions, we will avoid using or disclosing any more of your health information than is necessary to accomplish the purpose of the use or disclosure.  We are legally required to follow the privacy practices that are described in this Notice, which is currently in effect.

However, we reserve the right to change the terms of this Notice and our privacy practices at any time.  Any changes will apply to any of your health information that we already have. Before we make an important change to our policies, we will promptly change this Notice and post a new Notice in our reception area and on our web site at www.alphahouseinc.org.  You may also request, at any time, a copy of our Notice of Privacy Practices that is in effect at any given time, from the HIPAA Coordinator or Residential Counselor.  You may view and obtain an electronic copy of this Notice on our web site at www.Alphahouseinc.org.

We would like to take this opportunity to answer some common questions concerning our privacy Practices:

QUESTION: HOW WILL ALPHA HOUSE, INC. USE AND DISCLOSE MY PROTECTED HEALTH INFORMATION?

Answer:  We use and disclose health information for many different reasons.  For some of these uses or disclosures, we need your specific authorization.  Below, we describe the different categories of our uses ad disclosures and give you some examples of each.

A. Uses and Disclosures Relating to Treatment, Payment or Healthcare Operations.

  1. For Treatment: As a drug and alcohol facility, we cannot disclose information regarding your treatment without your specific written authorization.  Information may be released without specific authorization under certain conditions.  These conditions are a “Good Cause” court order, medical personnel in an emergency medical situation, where an individual’s life                         Revised 6-08
    is in danger and/or requires medical services.  Please be aware that any incident of suspected child abuse or neglect is not covered by Federal Confidentiality Laws.  If such a situation exists, Alpha House, Inc. would be responsible for the welfare of the child and would have to report circumstances to proper authorities.
  1. Obtain Payment for Treatment:  As a drug and alcohol facility, we cannot disclose information regarding your treatment without specific written authorization.  For example, in order to bill or collect payment, we will request your specific written authorization.
  2. For Health Care Operations: We may, at times, need to use and disclose your health information to operate our agency.  However, as a drug and alcohol facility, we cannot disclose information regarding your treatment without specific written authorization.  Even with signed consent, the agency is restricted to the information that can be released:

1)     Whether the client is in treatment
2)     Client’s prognosis
3)     Type of treatment
4)     Description of client’s progress
5)     Whether the client has relapsed into drug abuse and the frequency of relapse.

Occasionally we have visitors touring our facility; no individual identifiable information will be disclosed.

B. Certain Other Uses and Disclosures are Permitted by Federal Law. We may use and disclose your health information without your authorization for the following reasons:

  1. When a Disclosure is required by Federal, State or Local Law, in Judicial or Administrative Proceedings or by Law Enforcement.  For example, we may disclose your protected health information if we are ordered by a court, or if a law requires that we report that sort of information to a government agency or law enforcement authorities, such as suspected child abuse or gunshot wounds.
  2. For Public Health Activities.  Under the law, we need to report information about certain diseases, and about any deaths, to government agencies that collect that information.  With the possible exception of information concerning mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status (for which we will need your specific authorization), we also are permitted to provide some health information to the coroner or a funeral director, if necessary, after a client’s death.
  3. For Health Oversight Activities.  For example, we may need to provide your health information if requested to do so by the County and/or the State when they oversee the program in which you receive care.  They may be permitted to review records on site as part of an Audit & Evaluation but information can’t be released without resident/client consent
  4. For Organ Donation.  If one of our clients wished to make an eye, organ or tissue donation after their death, we may disclose with specific written authorization.
  5. For Research Purposes.  In certain limited circumstances (for example, where approved by an appropriate Privacy Board or Institutional Review Board under federal law), we will ask for specific written authorization.
  6. To Avoid Harm.  If one of our counselors, physicians or other staff believes that it is necessary to protect you, or to protect another person or the public as a whole, with a court order, we may provide protected health information to the police or others who may be able to prevent or lessen the possible harm.

42CFR 2.63 (a1.2.3) revised 10-03

  1. For Specific Government Functions.    For substance abuse treatment information an informed valid consent is always required.  Even with signed consent, the agency is restricted to the information that can be released:

1)      Whether the client is in treatment

2)      Client’s prognosis

3)      Type of treatment

4)      Description of client’s progress

5)      Whether the client has relapsed into drug abuse and the frequency of relapse. 42CFR 2.12 (c1,2) revised 10-03

  1. For Workers’ Compensation.  We may provide your health information as described under the workers’ compensation law, if your condition was the result of a workplace injury for which you are seeking workers’ compensation and with client’s written consent. (Revised 10-04)
  2. Appointment Reminders and Health-Related Benefits or Services.  Unless you tell us that you would prefer not to receive them, we may use or disclose your information to provide you with the appointment reminders and treatments that may help you.
  3. Fundraising Activities.  For example, if Alpha House chooses to raise funds to support one or more of our programs or facilities, or some other charitable cause or community health education program, we, with specific written authorization, will use the specific information that we have about you to contact you.  If you do not wish to be contacted as part of any fundraising activities, please contact the HIPPA coordinator or residential counselor.
  4. Disclosures to Family, Friends or Others Involved in Your Care.  With written authorization, we may provide a limited amount of your health information to a family member, friend or other person known to be involved in your care or in the payment for your care, unless you tell us not to.  For example, if a family member comes to your intake appointment and you allow them to come into the counseling office with you, we will not disclose otherwise protected health information to them during the appointment.   (This information will not contain information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status, without your specific written authorization.) (Revised 10-04)
  5. Disclosures to Notify a Family Member, Friend, or Other Selected Person.  When you first started in our program, we asked that you provide us with an emergency contact person in case something should happen to you while you are at our facility.  With specific written authorization, we will disclose certain limited health information about you (your general condition, location, etc.) to your emergency contact or another available family member, should you need to be admitted to the hospital, for example.  (This information will not contain information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status, without your specific written authorization.)
  6. Disclosures from our Agency Director.  If you reside with us, Alpha House, as a drug and alcohol facility cannot disclose information regarding your name and location to be able to direct visitors to call you without specific written authorization.C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
  1. Other Uses and Disclosures Require Your Prior Written Authorization.  In situations other than those categories of uses and disclosures mentioned above, or those disclosures permitted under federal law, we will ask for your written authorization before using or disclosing any of your protected health information.  In addition, we need to ask for your specific written authorization to disclose information concerning your mental health, drug and alcohol abuse and/or treatment, or to disclose your HIV status.

If you choose to sign an authorization to disclose any of your health information, you can later revoke it to stop further uses and disclosures to the extent that we haven’t already taken action relying on the authorization, so long as it is revoked in writing or upon verbal revocation that has been documented and witnessed by authorized agency staff.   (Revised 10-03)

QUESTION:  WHAT RIGHTS DO I HAVE CONCERNING MY PROTECTED HEALTH INFORMATION?

Answer:  You have the following rights with respect to your protected health information:

A. The Right to Request Limits on Uses and Disclosures of Your Health

  1.   You have the right to ask us to limit how we use and disclose your health information. We will consider your request, but, as a drug and alcohol provider, we must have your specific written authorization to disclose information and/or request limits.  In agreement to your request, we will put the limits in writing and will abide by them, except in the case of an emergency.  Please note that you are not permitted to limit the uses and disclosures that we are required or allowed by law to make.

B. The Right to Choose How We Send Health Information to You or How We Contact You.  You have the right to ask that we contact you at an alternate address or telephone number (for example, sending information to your work address instead of your home address).  We must agree to your request so long as we can easily do so.

C. The Right to See or to Get a Copy of Your Protected Health Information.  In most cases, you have the right to look at or get a copy of your health information that we have, but you must make the request in writing.  A request form is available with the HIPPA coordinator or residential counselor.  We will respond to you within 30 days after receiving your written request.  If we do not have the health information that you are requesting, but we know who does, we will tell you how to get it.  In certain situations, we may limit the amount or temporarily remove portions of the record prior to inspection by the resident if it is determined that the information may be detrimental if presented to the resident/client. . If we do, we will tell you, in writing, our reasons for these limitations. These reasons shall be documented and kept on file.  The HIPAA coordinator or Residential counselor identifies the information that should be removed and presents that data to the Executive Director (ED).  The ED reviews the information, removes it and places it in a temporary file prior to the resident’s/clients inspection.  After review the information is then placed back into the original file.  The documentation stating the reason for temporary removal is maintained with the HIPAA Coordinator and ED.  You may have a right to appeal the decision limiting access to his/her record to the HIPAA Coordinator or ED.  The appeal is reviewed within five (5) days and a decision will be rendered to the resident/client.  Further appeal shall be brought to the Single County Authority of Allegheny County (SCA) Department of Human Services Bureau of Drug and Alcohol services. All residents/clients will be given the grievance and appeal process for Allegheny County and the signature page will be kept on file.

D. The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made.  You have the right to receive a list of the release of information that you signed authorizing certain types of disclosures that we have made of your health information.  This list would not include uses or disclosures for treatment, payment or healthcare operations, disclosures to your family for notification purposes or due to their involvement in your care.  This list also would not include any disclosures made for national security purposes, disclosures to corrections or law enforcement authorities if you were in custody at the time, or disclosures made prior to April 14, 2003.  You may not request an accounting for more than a six (6) year period.

To make such a request, we require that you do so in writing; a request form is available upon asking with the HIPPA coordinator or residential counselor.  We will respond to you within 60 days of receiving your request.  The list that you may receive will include the date of the disclosure, the person or organization that received the information (with their address, if available), a brief description of the information disclosed, and a brief reason for the disclosure.  We will provide such a list to you at no charge; but, if you make more than one request in the same calendar year, you will be charged $35 for each additional request that year.

E. The Right to Ask to Correct or Update Your Health Information.  If you believe that there is a mistake in your health information or that a piece of important information is missing, you have a right to ask that we make an appropriate change to your information.  You must make the request in writing, with the reason for your request, on a request form that is available with the HIPPA coordinator or residential counselor.  We will respond within 60 days of receiving your request.  If we approve your request, we will make the change to you health information, tell you when we have done so, and will tell others that need to know about the change.

We may deny your request if the protected health information: (1) is correct and complete; () was not created by us; (3) is not allowed to be disclosed to you; or (4) is not part of our records.  Our written denial will state the reasons that your request was denied and explain your right to file a written statement of disagreement with the denial.  If you do not wish to do so, you may ask that we include a copy of your request form, and our denial form, with all future disclosures of that health information.

F. The Right To Get a Paper Copy of This Notice.  You have the right to request a paper copy of this Notice.

QUESTION: HOW DO I COMPLAIN OR ASK QUESTIONS ABOUT ALPHA HOUSE, INC. PRIVACY PRACTICES?

Answer:  If you have any questions about anything discussed in this Notice or about any of our privacy practices, or if you have any concerns, or complaints, please contact our HIPPA coordinator at 412-363-4220.  You also have the right to file a written complaint with the Secretary of the U.S. Department of Health and Human Services.  We may not take any retaliatory action against you if you lodge any type of complaint.

QUESTION: WHEN DOES THIS NOTICE TAKE EFFECT?

Answer: This Notice takes effect on April 14, 2003

Procedure:
All residents/client’s will receive a notice of privacy practices of Alpha House, Inc. in the client handbook information.  All residents/client’s will sign for and indicate acceptance and/or refusal of having received the client handbook

Alpha House Inc.
Receipt of Client Information Handbook

&Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy
I have reviewed and been given a copy of the Client Information Handbook of Alpha House Inc. that also contains a copy of the Alpha House, Inc. Notice of Privacy in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

 

SIGNED;  ________________________________      DATE: _____________

                                    Resident/Client

WITNESS:  _______________________________      DATE:  _____________

                        Alpha House HIPAA Coordinator/

                                    Residential Counselor        

THE SIGNATURE/ MARK BELOW SHALL INDICATE MY REFUSAL AND/OR ACKNOWLEDGEMENT OF MY INABILITY TO SIGN THE ALPHA HOUSE INC. CLIENT INFORMATION HANDBOOK AND THE NOTICE OF PRIVACY PRACTICES.

 

 

SIGNED;  ________________________________      DATE: _____________

Resident/Client

 

 

 

WITNESS:  _______________________________      DATE:  _____________

Alpha House HIPAA Coordinator/

Residential Counselor

Alpha House, Inc.

HIPAA Policy on Verification of Identity

 

Adopted:        March 28, 2003

Effective:        April 14, 2003

 

Policy:

 

It is the policy of Alpha House, Inc. to ensure the security and privacy of each resident/client’s health information by protecting such information from unauthorized disclosure.

 

The Alpha House staff member processing a client health information request of any sort shall take appropriate steps to verify the identity and/or authority of any requestor of resident/client health or billing information (including demographic information) by any person not known to the staff member, or by any person whose authority to obtain such information is not certain.  Alpha House staff members should refer to the guidelines for verifying identity and /or authority set forth below:

 

  1. Information authorized by the client, or by the client’s legal representative, to be disclosed, may only be disclosed to the person or business entity specifically name on the signed Authorization form.
  2. Where the identity of the requestor is unknown to the staff member, the staff member should request proof of identification form the requestor.  If the requestor is a staff member or agent of an unknown business entity, including but not limited to health care providers and/or law forms authorized by the resident/client to receive such information it is sufficient for the Alpha House staff member to mail the requested information to the business’ address, as listed in the telephone directory.
  3. If the signature upon an authorization form does not appear to be that of the resident/client or the resident/client’s legal representative, the resident/client or the resident/client’s legal representative should be contacted by telephone or mail for confirmation.
  4. Where an Authorization has been signed by the legal representative of the resident/client, the staff member processing the request should verify that a copy of the legal representative’s authority ( as indicated in the chart below) has been attached to the Authorization and it is maintained in the resident/clients file

 

Guardian of an incapacitated resident/client                     Guardianship Order

 

Legal Guardian of Minor (Non-Parent)                               Guardianship Order

(The above doesn’t apply; Alpha House, Inc. is an adult facility) revised 10-03

 

Attorney-in-Fact of Resident/Client                         Power of Attorney

 

Executor/Executrix of Deceased                             Letters of Testamentary or

Resident/client’s Estate                                           Short Certificate

(Copy of Will not sufficient)

 

Administrator/Administratrix of                                Letters of Administration

Deceased resident/client’s Estate                          Short Certificate

 

  1. The Staff member processing a health information request is responsible for assuring that any documentation, statements or representations are obtained form the requestor if required as a condition of the disclosure pursuant to the applicable Authorization, or by State or Federal law.
  2. Wherever, possible all warrants, court orders, or other legal process issued by a judge, grand jury or administrative judge, and any subpoenas of an unusual nature, shall be reviewed by the HIPAA Coordinator prior to processing.
  3. If reasonable under the circumstance, Alpha House will rely upon ay of the following as verification of the identity of a public official or person acting on behalf of a public official:

(a)    An agency identification badge, official credentials, or other proof of government status;

(b)    A written request on the appropriate government letterhead;

(c)     A written statement on the appropriate government letterhead that the person to whom the disclosure is to be made is acting under the government’s authority; or

(d)    A contract for services, memorandum of understanding, or purchase order that establishes that the person is acting on behalf of a public official

Such verification shall be charted and/or a copy of such verification shall be placed in the chart with documentation of the request.

 

  1.   All health information request of any sort (including requests for demographic or billing information) shall be documented in the resident/client’s chart.

Procedure:

Verification of Information request will be conducted by the HIPAA Coordinator and/or Residential Counselor, and/or Outpatient Director for Outpatient services.  Procedures for verification will follow the policy as set forth, with evidence documented in the residents/client’s chart.

 Alpha House, Inc.
Policy for Release of Certain Disclosures

 The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made.  (Has stated in the Notice of Privacy, “The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made).

You have the right to receive a list of the release of information that you signed authorizing certain types of disclosures that we have made of your health information.  This list would not include uses or disclosures for treatment, payment or healthcare operations, disclosures to your family for notification purposes or due to their involvement in your care.  This list also would not include any disclosures made for national security purposes, disclosures to corrections or law enforcement authorities if you were in custody at the time, or disclosures made prior to April 14, 2003.  You may not request an accounting for more than a six (6) year period.

To make such a request, we require that you do so in writing; a request form is available upon asking with the HIPPA coordinator or residential counselor.  We will respond to you within 60 days of receiving your request.  The list that you may receive will include the date of the disclosure, the person or organization that received the information (with their address, if available), a brief description of the information disclosed, and a brief reason for the disclosure.  We will provide such a list to you at no charge; but, if you make more than one request in the same calendar year, you will be charged $35 for each additional request that year

Following this policy is the Client Request for an Accounting of the Disclosures of Health Information.   (List of the Release Disclosure Notice to only, not the actual information released)

Procedure:

Resident/client makes the request in writing. Alpha House will respond to the request
within 60 days.  The list will contain the information cited above and will be provided at no charge; but, if you make more than one request in the same calendar year, you will be charged $35 for each additional request that year

This policy is effective April 14, 2003 and thereafter.

Alpha House, Inc.
Policy on the

“Minimum Necessary” Criteria for Use & Disclosure of Health Information

It is the policy of Alpha House to ensure that its workforce members only request, use and/or disclose the minimum amount of a residents/client’s individually identifiable health information that is necessary to achieve the intended purpose of the permitted use or disclosure.  This policy does not apply to:

  • Disclosures to, or requests or use by, a health care provider for purposes of treatment without specific written authorization by the resident/client.
  • Disclosures to the resident/client, the residents/clients legal representative, or anyone designated to receive such information without specific written authorization by the resident/client or the resident/client’s legal representative; or
  • Disclosures required to be made to the Pennsylvania Department of Health, Drug & Alcohol licensing without specific written authorization by the resident/client or the resident/client’s legal representative.
  1. The following categories of information shall be deemed the “minimum necessary” to be requested, used and/or disclosed for the following types of routine and recurring requests, uses and/or disclosures:

Examples:

(a) Disclosures to State & County:  Only documentation of treatment under contract(progress notes, consultationreports,… relating to particular course of treatment) required under contract for purposes of payment and only in compliance with PA. DOH licensing standards under Drug & Alcohol licensing standards.

(b)  Electronic Billing to Insurers:  Only standard data required byPA DOH, Division of Drug &Alcohol licensing standards.

  1. For all other requests, uses and/or disclosures of individually identifiable health information by any member of the Alpha House workforce, the following criteria shall be applied prior to making such a request, use or disclosure:
    • There must be a determination that the information to be used or disclosed does not include any information beyond that which is specifically requested, in terms of scope of time, type of information, and does not exceed the 4PA Code 255.5.
    • There must be a determination that the information to be used or disclosed does not include any information beyond what a reasonable person would believe is needed for the stated purpose; and does not exceed the 4PA Code  255.5.
    • There must be a determination that the amount and type of information to be requested, used or disclosed cannot be reduced or limited any further without adversely affecting the ability to use the information for its stated purpose and that the type of information requested, used or disclosed does not exceed the 4PA Code 255.5.
  1. Each member of the Alpha House, Inc. workforce may only access the minimum information that is necessary to perform that workforce member’s particular job functions, as defined by the individual workforce member’s job description.
  2. At no time shall any workforce member review any portion of any resident/client’s chart or billing information that is not required by his/her specific job duties.

This policy is effective April 14, 2003 and thereafter.

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