This notice describes how medical information about you may be used and disclosed and how you can get access to this information.   PLEASE REVIEW THIS NOTICE CAREFULLY.
 
COMMITMENT TO YOUR PRIVACY – We will only release healthcare information about you in accordance with federal and state laws and ethics of the counseling profession.  “Protected health information” (PHI) includes any information which may identify you and relates to your past, present, or future physical or mental health or condition; the health care provided to you; and the past, present, or future payment for your health care.  “Electronic health information” (EPHI) includes PHI created, stored, or transmitted electronically.  This Notice of Privacy Practice describes the policies by which we may use and/or disclose your EPHI/PHI in accordance with applicable law.  Additionally, it describes your rights about gaining access and control of your EPHI/PHI.  We are required by law to protect the privacy of your EPHI/PHI and to provide notice of our legal duties and privacy practices concerning your EPHI/PHI.  We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the terms of this Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all EPHI/PHI that we maintain at that time.  We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request, or providing one to you at your next appointment.
 
USE OR DISCLOSURE FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The following categories describe the different ways in which we may use and disclose your EPHI/PHI:

• Treatment:  We may use or disclose your EPHI/PHI to provide, manage or coordinate your care or related services.  For example, we may use information about you to consult with other counselors and physicians, or refer you to another health care provider.
• Payment:  We may use or disclose your EPHI/PHI to verify insurance coverage and/or benefits with your insurance carrier, to process your claims, to bill and collect payment for services and items you have received. For example, we may contact your insurance carrier to verify your benefits eligibility or we may disclose your EPHI/PHI to obtain payment from a third party, such as a family member, who pays for your insurance. 
• Healthcare Operations:  We may use or disclose your EPHI/PHI to perform activities related to the performance and operation of our practice.   Examples may include, but are not limited to:  certification, compliance and licensing requirements; reminding you of appointments; providing you with information about treatment alternatives or other health related benefits and services; communicating with a family member, a relative, a close friend, or any other person you identify as having involvement in your care.

USES OR DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION
We may use or disclose your EPHI/PHI when it is required by state or federal law.  For example, but not limited to:

• Child Abuse:  If we have cause to believe that a child has been, or may be, abused, neglected, or sexually abused, we must make a report of such within 48 hours to the Texas Department of Protective and Regulatory Services, the Texas Youth Commission, or to any local or state law enforcement agency.
• Abuse of the Elderly and Disabled:  If we have cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, we must immediately report such to the Department of Protective and Regulatory Services.
• Regulatory Oversight:  If a complaint is filed against a counselor with a regulatory authority, they have the authority to subpoena confidential mental health information relevant to that complaint.
• Judicial or Administrative Proceedings:  We may use and disclose your EPHI/PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  In certain circumstances, we may also disclose your EPHI/PHI in response to a discovery request, subpoena, or other lawful process.
• Serious Threat to Health or Safety:  We may use or disclose your EPHI/PHI to medical or law enforcement personnel if you or others are in danger and the information is necessary to prevent physical harm. 
• Workers’ Compensation:  We may use or disclose your EPHI/PHI to your employer’s insurance carrier if you file a worker’s compensation claim.
• Law Enforcement:  We may use or disclose your EPHI/PHI for law enforcement purposes in order to comply with state and federal laws.
• The Secretary of Health and Human Services:  We are required to disclose your EPHI/PHI to the United States Department of Health and Human Services when requested in order to enforce the privacy laws.

 

• Counselor Incapacitation:  In the event your counselor is unable to provide ongoing services, your records will be transferred to another counselor who will be responsible for contacting you and providing an appropriate referral.  

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

• Authorization for Other Uses and Disclosures:   Other use and disclosure of your EPHI/PHI not specifically permitted by state and federal law will be made only with your written authorization, which may be revoked by you at any time in writing.  With some exceptions, we must obtain an authorization for use or disclosure of psychotherapy notes. “Psychotherapy notes” are notes made about our conversation regarding a private, group, joint, or family counseling session.
• Marketing Uses of PHI:  In general, PHI cannot be used or shared for marketing without your authorization.
• Highly Confidential Information:  Special privacy protections by state and federal regulations may apply for certain highly confidential information such as information about alcohol and drug abuse.
• Texas Law:  Certain provisions of Texas Law may be more stringent than HIPAA.  If such provisions are more stringent than HIPAA, Texas Law will take precedence.

CLIENT RIGHTS

• Right to Receive Confidential Information:  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 may not want a family member to know you are seeking or receiving counseling services.  Upon your request, we can send correspondence to an alternate address or leave messages through an alternate phone number.
• Electronic database storage systems:  We utilize an electronic database system to store some of your EPHI/PHI.  Should a breach in security occur, we will conduct an investigation following federal and state guidelines to determine if notification is required.  You will be notified within 60 days if notification is required.
• Inspection and Copies:  You have the right to inspect and obtain a copy of the EPHI/PHI that may be used to make decisions about you, including client medical records and billing records.  Some exceptions may apply.  Your right to inspect and copy EPHI/PHI may be restricted in certain circumstances; however, in some cases you may have this decision reviewed.  If you ask for a copy of any information, you may be charged a reasonable fee for the costs of copying, mailing, and supplies.
• Right to an Electronic Copy of PHI:  Massey Counseling creates, stores, and transmits some PHI electronically.  You have a right to obtain an electronic copy of your PHI within 15 days of your request.
• Right to Amend:  If you feel your health information is incorrect or incomplete, you may ask that we add information to amend the record.  We are not required to agree to the amendment.  We must notify you in writing of denial.  You may submit a statement of disagreement which will be added to your file.
• Right to an Accounting of Disclosures:  You have the right to request an accounting of certain disclosures made of your EPHI/PHI for purposes other than for treatment, payment, healthcare operations and certain other activities for six years prior to the request.  We will provide one free accounting per year.  You may be charged a reasonable fee for additional accounting requests.  
• Right to Request Restrictions:  You have the right to ask for restrictions on certain uses and disclosures of your health information.  We are not required to agree to your request.  If you pay for counseling services out of pocket, you have a right to have EPHI/PHI regarding such services held confidentially and not released to third parties (fully paid for by you with no reimbursement or additional payment by a third party).   
• Right to a Paper Copy:  You have the right to obtain a paper copy of this Notice of Privacy Practices from us upon request, even if you have agreed to receive the notice electronically.
• Right to receive Changes in Policy:  You have the right to receive any future policy changes secondary to changes in state and federal laws. 
• Right to Complain:  If you believe your privacy rights have been violated, please contact your counselor personally and discuss your concerns.  If you are not satisfied with the outcome, you may file a complaint with the U.S. Dept. of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201, (877) 696-6775 or on the Texas Attorney General’s website (www.oag.state.tx.us). An individual will not be retaliated against for filing such a complaint.

THIS NOTICE WAS PUBLISHED AND BECAME EFFECTIVE ON JUNE 1, 2013
THIS NOTICE WAS REVISED ON 9/12/2013