Choices Coordinated Care Solutions

Notice of Privacy Practices

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

Choices Coordinated Care Solutions and its affiliated entities (collectively “Choices”) use health information about you for treatment, to obtain payment for treatment, to evaluate the quality of care you receive, and for other administrative and operational purposes, as described in this Notice.  Your health information is contained in records that are the physical property and responsibility of Choices.  This Notice describes the use and disclosure of protected health information (PHI) by employees, staff, personnel, volunteers and other professionals authorized to enter information into your record. 

Your Rights

You have the following rights with respect to protected health information about you:

Right to Copy of Notice of HIPAA Privacy Practices.  You have the right to a paper copy of this Notice at any time.  To obtain a copy of our current Notice of HIPAA Privacy Practices, please contact the Choices Privacy Officer at the address or phone number listed below.

Right to Inspect and Copy.  You have the right to inspect and/or obtain a copy of health information that may be used to make decisions about your care.  This includes medical and billing records but does not include psychotherapy notes.  Your request must be in writing to the Choices Privacy Officer at the address listed below.  If you request a copy of your health information, we may charge you a reasonable fee to cover the costs associated with copying and mailing the information.  If you request an electronic copy of your PHI that we maintain electronically, we will provide an electronic copy, and will do so in the electronic form or format you requested if the PHI is readily producible in that form or format. In certain very limited circumstances, we may deny your request to inspect and copy your health information.  If you are denied access to your medical information, we will document our reasons in writing and explain any right to have the denial reviewed.  For more information about this right see 45 C.F.R. § 164.524.

Right to Amend.  If you feel that medical 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 facility.  To request an amendment, your request must be made in writing and submitted to the Choices Privacy Officer at the address listed below.  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 us, unless the person or entity that created the information is no longer available to make the amendment.
  • is not part of the medical information kept by or for Choices.
  • is not part of the information which you would be permitted to inspect and copy; or
  • is accurate and complete.

If your request for an amendment is denied, we will explain our reasons in writing.  You have the right to submit a statement explaining why you disagree with our decision to deny your amendment request.  We will share your statement when we disclose health information about you. 

Right to an Accounting of Disclosures.  You have the right to request an accounting or detailed listing of certain disclosures of your health information during the past six (6) years.  Your request must be in writing to the Choices Privacy Officer at the address listed below.  If you request an accounting more often than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting.  

Right to Request Restrictions.  You have the right to request a restriction or limitation on the health information about you that we use or disclose.  Your request must be in writing to the Choices Privacy Officer at the address listed below.  If you have paid in full for a service and have requested we not share PHI related to that service with a health plan, we must agree to the request. For any other request to limit how we use or disclose your PHI, we will consider your request, but are not required to agree to the restriction.  If we agree to your request for a restriction, we will comply with it unless the information is needed for emergency treatment. 

Right to Request Alternative Method of Contact.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  Your request must be in writing to the Choices Privacy Officer at the address listed below.  We will agree to the request to the extent that it is reasonable for us to do so.  For example, you may request an alternative address for billing purposes. 

Right to Receive Notice of Breach.  We are required by law to notify you following a breach of your unsecured PHI. We will give you written notice in the event we learn of any unauthorized use of your PHI that has not otherwise been properly secured as required by HIPAA. We will notify you without unreasonable delay but no later than sixty (60) days after the breach has been discovered.

Choices’ Obligations

We understand that medical information about you and your health is personal.  We are committed to protecting your personal health information.  We create a record of the care and services you receive at Choices.  We need this record to provide you with quality care and to comply with certain legal requirements.  This Notice applies to all of the records of your care generated by Choices.  By law, we are required to:

  • maintain the privacy of protected health information;
  • provide you with this Notice of our legal duties and privacy practices with respect to your health information;
  • abide by the terms of the Notice of HIPAA Privacy Practices currently in effect.

Uses or Disclosure of Your Protected Health Information

We access, use and disclose PHI for a variety of reasons.  This section offers descriptions and examples of our potential uses and disclosures of your PHI. Not every potential use or disclosure will be listed in this Notice; however, all of the ways we are permitted to use and disclose information fall within one of the categories below.  Other uses and disclosures not described in this Notice will be made only with your authorization.

Treatment.  We may use and disclose health information about you to provide health care services.  To this end, we may communicate with other health care providers, such as a psychiatrist, pediatrician or other ancillary medical provider, regarding your treatment.  This information is necessary for Choices to determine what treatment you should receive. 

Payment.  We may use and disclose health information about you to others for purposes of receiving payment for treatment and services that you receive.  For example, we may release portions of your PHI to Medicare/Medicaid, a private insurer or group health plan to get paid for services that we delivered to you.  We may release your PHI to the state Medicaid agency to determine your eligibility for publicly funded services.

Health Care Operations.  We may use and disclose health information about you for administrative and operational purposes.  Members of the Performance and Quality Improvement Team may use health information about you to assess the care and outcomes in your case and others like it.  The results will be used internally to continually improve the quality of care for all Choices clients.  For example, we may combine outcome data from many clients to evaluate the need for new products, services or treatments.  We may disclose information to health care professionals, students and other personnel for review and training purposes.  We may also combine health information we have with other sources to see where we can make improvements.  We may also use and disclose medical information to evaluate the performance of our staff and your satisfaction with our services.

Business Associates.  We provide some services through contracts with business associates, such as consultants, cloud service providers, and vendors.  When such services are contracted, we may disclose health information about you to our business associates so that they can perform the tasks that we have assigned to them.  To protect your health information, we require the business associate to appropriately safeguard health information about you.

Alternative Treatments.  We may use health information about you to provide you with information about alternative treatments or other health-related benefits and services that may be of interest to you.

Appointment Reminders.  We may use health information about you to provide appointment reminders.  We may contact you by mail, e-mail, or telephone. We may use the telephone number(s) you provide us to leave voice messages or send text messages.

Required by Law.  We may disclose PHI when a law requires or allows us to do so. For example, we may report information about suspected abuse and/or neglect, relating to suspected criminal activity, for FDA-regulated products or activities, or in response to a court order.  We must also disclose PHI to authorities monitoring compliance with these privacy requirements.

Law Enforcement.  We may disclose health information about you to a law enforcement official in circumstances such as:

  • in response to a court order, subpoena, warrant, summons or similar process;
  • to identify or locate a suspect, fugitive, material witness or missing person;
  • about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
  • about a death we believe may be the result of criminal conduct;
  • about criminal conduct in the facility; and
  • in emergency circumstances to report a crime; the location of a crime or victims; or the identity, description or location of the person who committed the crime.

Public Health.  We may use health information about you for public health activities or for other health oversight activities.  These activities generally include the following:

  • to prevent or control disease, injury or disability;
  • to report births or deaths;
  • to report reactions to medications or problems with products;
  • to notify people of recalls of products that they may be using; and
  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

Research.  We may use or disclose health information about you for research purposes under certain circumstances.  For example, we may disclose health information to a research organization if an institutional review board or privacy board has reviewed and approved the research proposal, after establishing protocols to ensure the privacy of your health information.

To Avert a Threat to Health or Safety.  In order to avoid a serious and imminent threat to the health or safety of an individual or the public, we may disclose PHI to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.

Uses and Disclosures Requiring You to Have an Opportunity to Object.  In the following situations, we may use or disclose your PHI if we tell you about the use or disclosure in advance and you have the opportunity to agree to, prohibit, or restrict the use or disclosure, and you do not object.  However, if there is an emergency situation and you cannot be given the opportunity to agree or object, we may use or disclose your PHI if it is consistent with any prior expressed wishes and the use or disclosure is determined to be in your best interests; provided that you must be informed and given an opportunity to object to further uses or disclosures for patient directory purposes as soon as you are able to do so.

  • To families, friends or others involved in your care: We may share with your family, your friends or others involved in your care information directly related to their involvement in your care or payment for your care.  We may also share PHI with these people to notify them about your location, general condition, or your death.
  • Disaster relief: In the event of a disaster, we may release your PHI to a public or private relief agency, for purposes of notifying your family and friends of your location, condition or death.

Relating to Decedents.  We may use or disclose health information relating to an individual’s death to medical examiners, coroners, funeral directors, or organ procurement agencies to allow them to perform their lawful duties.  If you are an organ or tissue donor, we may use or disclose health information about you to organizations that help with organ, eye and tissue donation and transplantation.

De-Identified PHI.  We may de-identify your health information as permitted by law. We may use or disclose to others the de-identified information for any purpose, without your further authorization or consent, including but not limited to research studies and health care/health operations improvement activities.

Government Functions.  We may use or disclose health information about you for specialized government functions, such as protection of public officials, national security and intelligence activities, or reporting to various branches of the armed services.

Workers Compensation.  We may use or disclose health information about you to comply with laws and regulations related to workers compensation.

Correctional Institutions.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose health information about you.  Such information will be disclosed to the correctional institution or law enforcement official when necessary for the institution to provide you with health care and to protect the health and safety of others.

Fundraising.  We or our Foundations may contact you to raise money for Choices and its operations unless you tell us not to contact you for this purpose. You have the right to opt out of receiving fundraising communications from us and we will tell you how to opt out in every fundraising communication.

Effective Date, Restrictions and Changes to This Notice

This Notice, pursuant to the Health Insurance Portability and Accountability Act (HIPAA), Has been in effect since April 14, 2003.  Choices reserves the right to change the terms of this Notice.  We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.  We will provide you with a revised Notice in person or by mail.  We will post a copy of the current notice in the Choices waiting area. 

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Choices Privacy Officer or with the Secretary of the Department of Health and Human Services.  To file a complaint with Choices, contact the Privacy Officer at the address or phone number listed below.  You will not be penalized or retaliated against for filing a complaint.

Contact Information

If you have any questions, requests or concerns about your Choices-related health information rights or our use and disclosure of health information, please contact:  Privacy Officer, Choices Coordinated Care Solutions, 7941 Castleway Drive, Indianapolis, Indiana 46250.  Phone:  317-726-2121.

 

 

 

42 CFR Part 2 Notice of Privacy Practices

 

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 carefully.

Our Privacy Policy

Kaleidoscope Recovery Services, Choices Coordinated Care Solutions its facilities and subsidiaries, and all associates are committed to providing you with quality behavioral healthcare services. An important part of that commitment is protecting your health information according to applicable law. This notice (“Notice of Privacy Practices”) describes your rights and our duties under Federal Law. Protected health information (“PHI”) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition; the provision of healthcare services; or the past, present, or future payment for the provision of healthcare services to you.

Our Duties

We are required by law to maintain the privacy of your PHI; provide you with notice of our legal duties and privacy practices with respect to your PHI; and to notify you following a breach of unsecured PHI related to you. We are required to abide by the terms of this Notice of Privacy Practices. This Notice of Privacy Practices is effective as of the date listed on the first page of this Notice of Privacy Practices. This Notice of Privacy Practices will remain in effect until it is revised. We are required to modify this Notice of Privacy Practices when there are material changes to your rights, our duties, or other practices contained herein.

We reserve the right to change our privacy policy and practices and the terms of this Notice of Privacy Practices, consistent with applicable law and our current business processes, at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. Notification of revisions of this Notice of Privacy Practices will be provided as follows:

  1. Upon request;
  2. Electronically via our website or via other electronic means; and
  3. As posted in our place of business.

In addition to the above, we have a duty to respond to your requests (e.g. those corresponding to your rights) in a timely and appropriate manner. We support and value your right to privacy and are committed to maintaining reasonable and appropriate safeguards for your PHI.

Confidentiality of Alcohol and Drug Abuse Records

The confidentiality of alcohol and drug abuse patient records maintained by us is protected by Federal law and regulations. Generally, we may not say to a person outside the treatment center that you are a patient of the treatment center, or disclose any information identifying you as an alcohol or drug abuser unless:

  1. You consent in writing (as discussed below in “Authorization to Use or Disclose PHI”);
  2. The disclosure is allowed by a court order (as discussed below in “Uses and Disclosures”); or
  3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation (as discussed below in “Uses and Disclosures”).

Violation of the Federal law and regulations by the treatment center is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.

Federal law and regulations do not protect any information about a crime committed by you either at the treatment center or against any person who works for the treatment center or about any threat to commit such a crime (as discussed below in “Uses and Disclosures”).

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities (as discussed below in “Uses and Disclosures”).

See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR part 2 for Federal regulations.

Uses and Disclosures

Uses and disclosures of your PHI may be permitted, required, or authorized. The following categories describe various ways that we use and disclose PHI.

Among Kaleidoscope Center Personnel. We may use or disclose information between or among personnel having a need for the information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment of alcohol or drug abuse, provided such communication is: (i) Within the treatment center; or (ii) Between the treatment center and Choices Coordinated Care Center staff. For example, our staff, including doctors, nurses, and clinicians, will use your PHI to provide your treatment care. Your PHI may be used in connection with billing statements we send you and in connection with tracking charges and credits to your account. Your PHI will be used to check for eligibility for insurance coverage and prepare claims for your insurance company where appropriate. We may use and disclose your PHI in order to conduct our healthcare business and to perform functions associated with our business activities, including accreditation and licensing.

Secretary of Health and Human Services. We are required to disclose PHI to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA Privacy Rules.

Business Associates. We may disclose your PHI to Business Associates that are contracted by us to perform services on our behalf which may involve receipt, use or disclose of your PHI. All of our Business Associates must agree to: (i) Protect the privacy of your PHI; (ii) Use and disclose the information only for the purposes for which the Business Associate was engaged; (iii) Be bound by 42 CFR Part 2; and (iv) if necessary, resist in judicial proceedings any efforts to obtain access to patient records except as permitted by law.

Crimes on Premises. We may disclose to law enforcement officers information that is directly related to the commission of a crime on the premises or against our personnel or to a threat to commit such a crime.

Reports of Suspected Child Abuse and Neglect. We may disclose information required to report under state law incidents of suspected child abuse and neglect to the appropriate state or local authorities. However, we may not disclose the original patient records, including for civil or criminal proceedings which may arise out of the report of suspected child abuse and neglect, without consent.

Court Order. We may disclose information required by a court order, provided certain regulatory requirements are met.

Emergency Situations. We may disclose information to medical personnel for the purpose of treating you in an emergency.

Research. We may use and disclose your information for research if certain requirements are met, such as approval by an Institutional Review Board.

Audit and Evaluation Activities. We may disclose your information to persons conducting certain audit and evaluation activities, provided the person agrees to certain restrictions on disclosure of information.

Reporting of Death. We may disclose your information related to cause of death to a public health authority that is authorized to receive such information.

 

Authorization to Use or Disclose PHI

Other than as stated above, we will not use or disclose your PHI other than with your written authorization. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your PHI for marketing purposes, or sell your PHI unless you have signed an authorization. If you or your representative authorize us to use or disclose your PHI, you may revoke that authorization in writing at any time to stop future uses or disclosures. We will honor oral revocations upon authenticating your identity until a written revocation is obtained. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.

Patient/Client Rights

The following are the rights that you have regarding PHI that we maintain about you. Information regarding how to exercise those rights is also provided. Protecting your PHI is an important part of the services we provide you. We want to ensure that you have access to your PHI when you need it and that you clearly understand your rights as described below.

Right to Notice

You have the right to adequate notice of the uses and disclosures of your PHI, and our duties and responsibilities regarding same, as provided for herein. You have the right to request both a paper and electronic copy of this Notice. You may ask us to provide a copy of this Notice at any time. You may obtain this Notice on our website at www.americanaddictioncenters.org or from facility staff or our Privacy Officer.

Right of Access to Inspect and Copy

You have the right to access, inspect and obtain a copy of your PHI for as long as we maintain it as required by law. This right may be restricted only in certain limited circumstances as dictated by applicable law. All requests for access to your PHI must be made in writing. Under a limited set of circumstances, we may deny your request. Any denial of a request to access will be communicated to you in writing. If you are denied access to your PHI, you may request that the denial be reviewed. Another licensed health care professional chosen by American Addiction Centers will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the decision made by the designated professional. If you are further denied, you have a right to have a denial reviewed by a licensed third-party healthcare professional (i.e. one not affiliated with us). We will comply with the decision made by the designated professional.

We may charge a reasonable, cost-based fee for the copying and/or mailing process of your request. As to PHI which may be maintained in electronic form and format, you may request a copy to which you are otherwise entitled in that electronic form and format if it is readily producible, but if not, then in any readable form and format as we may agree (e.g. PDF). Your request may also include transmittal directions to another individual or entity.

Right to Amend

If you believe the PHI we have about you is incorrect or incomplete, you have the right to request that we amend your PHI for as long as it is maintained by us. The request must be made in writing and you must provide a reason to support the requested amendment. Under certain circumstances we may deny your request to amend, including but not limited to, when the PHI: 1. Was not created by us; 2. Is excluded from access and inspection under applicable law; or 3. Is accurate and complete. If we deny amendment, we will provide the rationale for denial to you in writing. You may write a statement of disagreement if your request is denied. This statement will be maintained as part of your PHI and will be included with any disclosure. If we accept the amendment we will work with you to identify other healthcare stakeholders that require notification and provide the notification.

Right to Request an Accounting of Disclosures

We are required to create and maintain an accounting (list) of certain disclosures we make of your PHI. You have the right to request a copy of such an accounting during a time period specified by applicable law prior to the date on which the accounting is requested (up to six years). You must make any request for an accounting in writing. We are not required by law to record certain types of disclosures (such as disclosures made pursuant to an authorization signed by you), and a listing of these disclosures will not be provided. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. We will notify you of the fee to be charged (if any) at the time of the request.

Right to Request Restrictions

You have the right to request restrictions or limitations on how we use and disclose your PHI for treatment, payment, and operations. We are not required to agree to restrictions for treatment, payment, and healthcare operations except in limited circumstances as described below. This request must be in writing. If we do agree to the restriction, we will comply with restriction going forward, unless you take affirmative steps to revoke it or we believe, in our professional judgment, that an emergency warrants circumventing the restriction in order to provide the appropriate care or unless the use or disclosure is otherwise permitted by law. In rare circumstances, we reserve the right to terminate a restriction that we have previously agreed to, but only after providing you notice of termination.

 

Out-of-Pocket Payments

If you have paid out-of-pocket (or in other words, you or someone besides your health plan has paid for your care) in full for a specific item or service, you have the right to request that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or healthcare operations, and we are required by law to honor that request unless affirmatively terminated by you in writing and when the disclosures are not required by law. This request must be made in writing.

Right to Confidential Communications

You have the right to request that we communicate with you about your PHI and health matters by alternative means or alternative locations. Your request must be made in writing and must specify the alternative means or location. We will accommodate all reasonable requests consistent with our duty to ensure that your PHI is appropriately protected.

Right to Notification of a Breach

You have the right to be notified in the event that we (or one of our Business Associates) discover a breach involving unsecured PHI.

Right to Voice Concerns

You have the right to file a complaint in writing with us or with the U.S. Department of Health and Human Services if you believe we have violated your privacy rights. Any complaints to us should be made in writing to our Privacy Official at the address listed below We will not retaliate against you for filing a complaint.

Questions, Requests for Information, and Complaints

For questions, requests for information, more information about our privacy policy or concerns, please contact us. Our company Chief Compliance Officer can be contacted at:

Kelly Kochell Compliance and Privacy Officer
Kelly Kochell
7941 Castleway Drive
Indianapolis IN 46158

Kkochell@ChoicesCCS.org


Confidential Online Compliance Reporting: 

TrustAccount@choicesccs.org

We support your right to privacy of your Protected Health Information. You will not be retaliated against in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

If you believe your rights have been violated and would like to submit a complaint directly to the U.S. Department of Health & Human Services, then you may submit a formal written complaint to the following address:

U.S. Department of Health & Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775
OCRMail@hhs.gov
www.hhs.gov