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Community Youth Services NOTICE OF PRIVACY PRACTICES This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully. CONTENTS I. OUR COMMITMENT TO PROTECTING INFORMATION ABOUT YOU It is the policy of Community Youth Services to take a protective role regarding the disclosure of information about our program participants. CYS will ensure that information about participants remains confidential as required by state law and general professional standards. During the intake process, participants will be clearly informed if the services they will receive will involve multiple professionals with a need-to-know who will exchange information to enhance services and make them more efficient. In the event that a participant is functionally illiterate or are particularly vulnerable as a result of mental disability, CYS will exercise special care in helping them understand the release of information process. In addition, CYS will include their parent or guardian or other adult acting on their behalf. A federal regulation, known as the “HIPAA Privacy Rule,” requires that certain health care providers deliver detailed notice in writing of their privacy practices. The terms “We” and “Our” refer to Community Youth Services and the term “you” and “your” and “participant” refer to you as a specific Community Youth Services program participant. Community Youth Services provides certain aspects of mental health counseling services and therapeutic residential care that are covered under the HIPPA Privacy Rule. In addition to the social workers whom it employs, Community Youth Services contracts with psychiatrists and mental health professionals who provide individual and family services at their private offices or in the community. Community Youth Services also maintains affiliations with pharmacies to provide access to prescription drugs and supplies. These relationships are an integral part of the services Community Youth Services provides and are considered an Organized Health Care Arrangement as defined by the HIPAA Privacy Rule. While not all of the services we provide fall under the HIPPA regulations, CYS provides privacy protection for all participants, based on state law, professional ethics and contracted agreements. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a participant, or where there is a reasonable basis to believe the information can be used to identify a participant. This information is called “protected health information” or “PHI.” This Notice describes your rights as a health plan participant and our obligations regarding the use and disclosure of PHI. We are required by law to:
In some situations, federal and state laws provide special protections for specific kinds of PHI and require authorization from you before we can disclose that specially protected PHI. Examples of PHI that are specially protected include PHI involving mental health, HIV/AIDS, reproductive health, or treatment for substance abuse. We may refuse to disclose the specially protected PHI or we may contact you for the necessary authorization. We reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you. If and when a significant change is made to this Notice, we will make the revised Notice available upon request as of the effective date of the revision. We also will promptly make the revised Notice available at our service delivery sites and by posting prominently in such sites following the effective date of any revision. The revised Notice will also be available to you with the new notice by mail within 60 days of the change. II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU Generally, the program providing mental health or therapeutic residential care may not say to a person outside the program that a person attends or participates in the program, or disclose any information identifying a participant without the participant’s consent. However, there are many legally recognized people and situations where information may be disclosed without the participant’s authorization, including, but not limited to:
For children in care who are under the custody of the State Department of Social and Health Services, their state social worker and/or Guardian Ad Litem are authorized to obtain and release appropriate information on their behalf; Parents and guardians can request information about their children, under age 18, unless the youth has restricted their parent’s access, and as permitted by law; Verbal disclosures to family members, foster parents or other individuals with whom the participant is known to have a close personal relationship, unless the Participant instructs CYS in writing NOT to make disclosures. If you do not object after an opportunity to do so, or if you are incapacitated or it is an emergency situation, we may disclose to your family member, close friend, or any other person identified by you, PHI about you that is directly relevant to that person's involvement in your care or payment for your care. We may also use and disclose PHI necessary to notify these persons of your location, general condition, or death. However, under Washington State Law a teenage minor nearly always must consent to use or disclosure of PHI related to his or her mental health, chemical dependency, HIV/AIDS, or sexual health. Therefore, Community Youth Services may require the child's authorization before releasing PHI to anyone, including his or her parents. We may use or disclose participant information when required by a court order, administrative agency order, subpoenas, discovery requests, or other lawful process, when efforts have been made to advise you of the disclosure or to obtain an order protecting the information requested. We may use and disclose confidential information in performing business activities. For example, we may use and disclose information about you in reviewing and improving the quality, efficiency and cost of our operations. This may include our quality assurance process, a peer review, administrative, financial, educational, and planning processes and research services on behalf of CYS (research if done, does not include identifying information); We may use and disclose PHI so that we can bill and collect payment for the treatment and services provided to you. We may use and disclose PHI for billing, claims management, and collection activities. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owed to us. Foster parents have access to all relevant and legally permissible information concerning the child to be placed or currently in their care; We may disclose information to CPS agents with proper identification in relation to a child abuse investigation; Persons being victimized by a minor participant as relates to a legal case; or relatives of a minor to help in apprehending said minor following their disappearance or failure to return from leave; Specialized government functions, disaster relief efforts and/or national security; (for example, the Red Cross, use of a participant’s social security number to confirm male applicants to the CareerTrek program have registered for the draft, as required by law, etc.) may require the release of your PHI. CYS may use your PHI to contact you to provide reminders or information about treatment alternatives or other health-related benefits and services that may be of use to you. We may use your PHI to contact you to request your participation in our fundraising or community outreach and education efforts. Duty to warn – the participant’s right to privacy in confidentiality is over-shadowed if a CYS staff or provider has accurate, foreseeable knowledge that harm could come to a third party because of the Participant. A warning could be given to either the potential victim or the police; When CYS’s need to protect staff, the participant, or other people from the behavior of the participant outweighs the participant’s right to privacy; Protected health information (PHI) which is routinely used for treatment, payment and operations. All other requests for PHI may be used with management approval only if it is stripped of all identifying information; We may use and disclose PHI about you to coordinate or manage your services. For example, we may use or disclose PHI about you when you need a prescription or other health care services. In addition, we may use and disclose PHI about you when referring you to another provider for treatment. For example, we may send a report about you to another treatment provider that we refer you to so that the treatment provider may treat you. We also may share protected health information with each other, as necessary to carry out the integrated delivery of treatment under the Organized Health Care Arrangement. We may disclose PHI to the extent necessary to comply with laws that provide benefits for work-related injuries or illness. Foster parents, as relevant to the placement of the child-in-care; We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death or to funeral directors, as authorized by law, so that they may carry out their jobs. In case of participant death, upon receipt of a copy of the death certificate, information may be released to the surviving family members in the order of consent per Washington “hierarchy in decision making” law:
We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We may use and disclose PHI to authorized persons to carry out certain activities related to public health. We may disclose PHI to a health oversight agency to monitor the health care system, government health care programs, and compliance with certain laws. For example, we may disclose PHI about you to report child abuse or neglect or to report reactions to medications or problems with products or devices regulated by the federal Food and Drug Administration (FDA) Other Uses and Disclosures: All other uses and disclosures of your PHI will be made only with your written permission (an “authorization”). If you have given us written permission to use or disclose your PHI, you may later take back (“revoke”) your written permission at any time. If you revoke your permission, it will apply only after we receive your written revocation and will not apply to any situation in which we have already acted based on your permission. III. YOUR RIGHTS REGARDING PROTECTED HEALTH AND OTHER INFORMATION ABOUT YOU Under federal law, you have rights regarding PHI about you. You can exercise any of the specific rights identified below for PHI about you that we hold by using the appropriate form available from our Privacy Official, whose contact information is listed below. The following information will not be shared with participants or collateral contacts:
A youth, age 13 or over has the right to deny a parent access to mental health information and when over 14, information on sexually transmitted diseases and at age 15, medical information. If a parent submits a request for a release of information, the youth must be asked prior to release, to give permission. When a participant has explicitly requested specific information be held confidential, or requests a specific person or system be denied information on the participant. CYS may not always agree to comply with this request and will inform the participant if the request is denied. Right to Request Restrictions: You have the right to request additional restrictions on use of your PHI for treatment, payment and health care operations or disclosure of your PHI to individuals involved in your care. We are not required to agree to your request. The Program Director, may request approval from the Clinical Director or the Chief Operating Officer to revoke or deny the participant requested restriction if the exchange is legally and ethically necessary or required as a part of the program’s operations. Notification of revocation will be provided to the participant in writing and will include an explanation. Right to Receive Confidential Communications: If you tell us that disclosure of your PHI could endanger you, you have the right to request in writing that we communicate your PHI to you in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. We are required to meet only reasonable requests. Right to allow others to access your PHI: You or your parent (in certain situations described above) have the right to release your confidential information to other service providers and family members by submitting a request to release information in writing. Right to Inspect and Copy: You can request the opportunity to inspect and receive a copy of your PHI in certain records that we maintain. We may charge you reasonable fees for the cost of providing a copy. Right to Amend: You have the right to request that we amend your PHI if you give us an appropriate reason for the request. Right to Receive an Accounting of Disclosures: You have the right to request an “accounting” of certain disclosures that we have made of your PHI. This is a list of disclosures made by us after August 1, 2007, during a specified period of up to six years, other than disclosures made for treatment, payment, and operations; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative; for certain notification purposes (including national security, intelligence, and law enforcement purposes); of a “limited data set” in compliance with our policies and procedures for this kind of data; or incidental to otherwise permitted or required uses and disclosures. We may charge you for our reasonable costs of providing copies. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred. Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice at any time. IV. REQUESTS TO REVIEW CONFIDENTIAL PARTICIPANT INFORMATION Current and former participants will have access to their files, when legally mandated. Any request from a previous or current participant to review a case file or release participant information must be received in writing. To be valid, the authorization may be a letter, another entity’s form, or CYS’s Consent for Release of Confidential Information Form. Requests for information must include:
CYS will respond to a participant’s written authorization as promptly as possible. CYS will respond within:
If unusual circumstances delay CYS’s response, the participant must be informed in writing before the mandatory response period ends with reasons for the delay and when the information will be provided. Distributing Participant Information: CYS will fax or mail requested information. If faxed, the receiving party must have a fax machine that is in a secure environment and directly to the person requesting the information. A cover sheet stating that confidential information is being faxed must be included with the documents. Original Authorizations to Release Information will be retained in the participant record for the life of the file. On the bottom of the form, the date, a description of the pages sent, total number of pages and who released the information will be included. CYS may charge a reasonable fee for release of copies, not to exceed the actual overhead copying expenses. Participants will be informed of any charges prior to beginning the copy process. For closed records maintained at off-site secure storage, fees will includes the cost of copying, retrieving and re-filing the record. Copies will be held until receipt of payment. Out of Home Care programs may provide a courtesy copy of a person’s medical information, prescriptions and other health records of the participant’s record / family on discharge from the program free of charge. CYS staff may release information verbally, with written authorization from the participant. This will be documented in a case file. If there is currently not a case file, such as in outreach services, a case file will be created. Process for Participant File Review: Any case file review must be done in the presence of the Community Youth Services staff member who is familiar with the case. If a program participant wants to insert information into the file to clarify information or challenge information, he/she may do so. The program participant’s statement will be entered and clearly identified as such. If staff chooses to add a statement or comment regarding the client's statement, they may do so, but only with the knowledge of the client. If any information in the file may be psychologically damaging to the client it may be withheld. Likewise if another agency has provided information, it will be withheld. The Program Director will review and approve any information that will be withheld. This will be documented in the case file. In addition, information regarding other individuals, including family members may be withheld. By law, information that may be psychologically damaging to either the parent or the client may be withheld. The participant may enlist a qualified masters level professional to review their record on their behalf, provided the professional signs a statement that information determined to be harmful will be withheld. Violation of the Federal law and regulations by a program 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 a patient, either at the program or against any person who works for the program. Threats to commit a crime also are not protected. If you believe your privacy rights have been violated, you may file a complaint with us. To file a complaint with our office, please contact our Privacy Official. We will not retaliate or take action against you for filing a complaint. You may also file a complaint directly with the Secretary of the United States Department of Health and Human Services. VI. PRIVACY OPERATIONS OFFICIAL CONTACT INFORMATION If you have questions, you may contact our Privacy Official at the following addresses and phone numbers: Privacy Official: Wendy Tanner Phone: (360) 943-0780, ext. 115 This notice was published and first became effective on August 1, 2007.
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