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The Next Step Network,
Inc. (NSN)
Effective Date: April 14, 2003
Reviewed 12-1-2004
NOTICE OF PRIVACY PRACTICES
THIS
NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION (PHI) ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Next Step Network, Inc. is committed to protecting your Protected
Health Information (PHI). We are required by law to:
► Maintain the privacy of your PHI;
► Give you
a notice of our legal duties and privacy practices with respect to your PHI; and
► Follow the terms of the notice
currently in effect.
What is this document?
This Notice of Privacy Practices describes how we may use and
disclose your PHI. It also describes your rights to access and control your PHI.
What does this notice cover?
This Notice of Privacy Practices applies to all of your PHI used to make decisions about your care that we generate or maintain,
including sensitive information such as mental health, communicable disease and drug and alcohol abuse information. Different
privacy practices may apply to your PHI that is created or kept by other people or entities.
Who does this notice
cover?
This Notice of Privacy Practices will be followed by:
►All NSN/Area Prevention Resource Center (APRC)
employees;
►Any treatment professional who provides services to you;
►Any member of a volunteer group
that provides help to consumers; and
►referral agencies/personnel.
What will you do with my PHI?
The following categories describe the ways that we may use and disclose your PHI. In order to assure compliance with Oklahoma
law, we will obtain your consent to the use and disclosure of your PHI. Not every use or disclosure in a category will be
listed. You will give us your consent by signing the Confidentiality Release form.
If you do not consent, we cannot
provide you with treatment. If you are concerned about a possible use or disclosure of any part of your PHI, you may request
a restriction. Your right to request a restriction is described in the section below.
Treatment. We will use your
PHI to provide you with substance abuse treatment and services.
Examples:
1. Your PHI may be disclosed to
personnel, on a “need to know” basis, who are involved with providing services at NSN
2. Different department
of NSN may also share PHI about you in order to coordinate specific services, such as treatment, referrals, and medical/dental/vision
care. We may disclose your PHI for the treatment activities of any other service providers.
Examples:
1. A
referral agency will receive your discharge information only, not you complete PHI from NSN. If additional information is
needed to provide you with quality services the referral agency can request additional PHI about you. The request will be
evaluated by the NSN’s Executive Director and will be authorized or denied, depending on the request.
Payment.
We may use PHI about you for our payment activities. Common payment activities include, but are not limited to:
►Determining
eligibility or coverage under a plan;
►Billing and collection activities; and
►Disclosures to consumer
reporting agencies.
Examples: (1) Your PHI may be released to an insurance company to obtain payment for services.
(2) We may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether
your plan will cover the treatment.
We may disclose PHI about you to another health care provider or covered entity
for its payment activities.
Operations. We may use your PHI for treatment operations. These uses are necessary
to run The Next Step Network, Inc. and to make sure consumers receive quality care. Common operation activities include, but
are not limited to:
►Conducting quality assessment and improvement activities;
►Reviewing the competence
of The Next Step Network Inc. professionals and staff;
►Training The Next Step Network Inc. employees;
►Arranging
for legal or auditing services;
►Business planning and development; and
►Communicating with consumers
about services.
Examples: (1) We may use your PHI to conduct internal audits to verify that billing is being conducted
properly. (2) We may use your PHI to contact you for the purposes of conducting consumer satisfaction surveys or to follow
up on the services we provided.
We may disclose PHI about you to another health care provider or covered entity
for its operation activities under certain circumstances.
Example: We may disclose your PHI to your health plan
for its utilization review analysis.
Business Associates. We may disclose your PHI to other entities that provide
a service to us or on our behalf that requires the release of client PHI. However, we only will make these disclosures if
we have received satisfactory assurance that the other entity will properly safeguard your PHI.
Example: We may
contract with another entity to provide transcription or billing services.
Treatment Alternatives. We may use and
disclose your PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. We may release PHI about you to a friend, family member
or legal guardian who has been authorized by you in a written release.
Appointment Reminders. We may use and disclose
PHI to contact you as a reminder that you have an appointment for services.
Health-Related Benefits and Services.
We may use and disclose PHI to tell you about health-related benefits or services that may be of interest to you.
Research. We may use and disclose PHI about you to researchers. In most circumstances, you must sign a separate form specifically
authorizing us to use and/or disclose your PHI for research. However, there are certain exceptions. Your PHI may be disclosed
without your authorization for research if the authorization requirement has been waived or altered by a special committee
that is charged with ensuring that the disclosure will not pose a great risk to your privacy or that measures are being taken
to protect your PHI. Your PHI also may be disclosed to researchers to prepare for research as long as certain conditions are
met. PHI regarding people who have died can be released without authorization under certain circumstances. Limited PHI may
be released to a researcher who has signed an agreement promising to protect the information released.
Can you
ever use and disclose my PHI without my consent? Yes. The following categories describe the ways that we may be required to
use and disclose your PHI without your consent. Not every use or disclosure in a category will be listed.
Required
by Law. We may disclose your PHI when required to do so by federal, state or local law.
Examples:
1. We may
release your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries
or illness.
2. We are required by law to report criminally inflicted injuries and cases of abuse and neglect. These
reports may include your PHI.
Public Safety. We may use and disclose PHI 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 would only
be to someone able to help prevent the threat.
Public Health. We may disclose PHI about you for public health activities
intended to:
►Prevent or control disease, injury or disability;
►Report abuse, neglect or violence as
required by law;
►Report reactions to medications or problems with products;
►Notify people of recalls
of products they may be using; or
►Notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition.
Health Oversight Activities. We may disclose PHI to a health 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 programs, and
compliance with civil rights laws.
Example: We may be required to disclose client PHI to the Oklahoma State Department
of Mental Health and Substance Abuse Services to maintain our treatment license.
Lawsuits and Disputes: If you
are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. In limited
circumstances, we may disclose PHI about you in response to a subpoena or discovery request, but only if efforts have been
made to inform you about the request or to obtain an order protecting the information requesting.
Law Enforcement.
We may release PHI if asked to do so by law enforcement official:
►In response to a court order, warrant, summons,
or other 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 a criminal conduct;
►About criminal conduct at The Next Step Network, Inc.;
and
►In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description
or location of the person who committed the crime.
Coroners and Medical Examiners. We may release PHI to
a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of
death.
National Security and Intelligence Activities. We may release PHI about you to authorized federal officials
for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services
for the President and Others. We may disclose PHI about you to authorized federal officials so they may provide protection
to the President, other authorized persons or foreign heads of state or conduct special investigations.
Military/Veterans.
We may disclose your PHI as required by military command authorities, if you are a member of the armed forces.
Inmates.
If you are an inmate of a correctional facility or under the custody of law enforcement official or agency, we may release
your PHI to the correctional facility or law enforcement official or agency. This release may be necessary to: (1) enable
the correctional facility to provide you with health care; or (2) protect the health and safety of you and/or other people.
What if you want to use and/or disclose my PHI for a purpose not described in this Notice?
We must obtain a separate,
specific authorization from you to use and/or disclose your PHI for any purpose not covered by this notice or the laws that
apply to us. In other words, the consent you already provided will not be enough to use and/or disclose your information for
any purpose that is not described in this Notice.
If you provide us with authorization to use or disclose your
PHI you may revoke the authorization, in writing, at any time. If you revoke your authorization, we will not use or disclose
your PHI for the reasons covered by your authorization. However, your revocation will not apply to disclosures already made
by us in reliance on your authorization.
What are my rights regarding my PHI?
You have the right to inspect
and copy PHI used to make decisions about your care. This right does not apply to a very narrow category of PHI referred to
as “psychotherapy notes”.
If you request a copy of your PHI, we may charge a fee of 25 cents a page.
We may deny your request to inspect and/or copy your PHI in certain circumstances. If you are denied access, you may request
that the denial be reviewed. A licensed treatment professional will review your request and denial. The person conducting
the review will not be the person who denied your original request. We will comply with the outcome of the review.
Right to Amend. If you feel that PHI that we created is incorrect or incomplete, you may submit a request for an amendment
for as long as we maintain the information. You must provide a reason that supports your amendment 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 to amend information that:
►We did not create, unless the person or entity
that created the information is not available to make the amendment;
►Is not part of the PHI that we maintain;
►Is not part of the information that you would be permitted to inspect and copy; or
Right to an Accounting
of Disclosures. You have the right to request one free “accounting of disclosures’ every 12 months. This is a
list of certain disclosures we made of your PHI. There are several categories of disclosures that we are not required to list
in the accounting. For example, we do not have to keep track of disclosures made for treatment, payment or health care operations
or for those disclosures that are authorized. Your request must state a time period, which may not be longer than 6 years
and may not include dates before April 14, 2003.
If you request more than 1 accounting in a 12-month period, 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 PHI we use or disclose about you unless our use and/or disclosure is required
by law. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care
or the payment for your care, like a family member of friend. For example, you may want to pay cash for certain services instead
of having information submitted to your insurance company for payment. We are not required to agree with your request. If
we agree, we will comply unless the information is needed to provide emergency treatment to you.
In your request
you must indicate:
►the type of restriction you want and the information you want restricted; and
►To
whom you want the limits to apply, for example, your spouse.
Right to Request Confidential Communications. You
have the right to request that we communicate with you about The Next Step Network, Inc. matters in a certain way or at a
certain location.
Example: You can ask that we only contact you at work or by mail.
We will accommodate
all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy
of this Notice. You have the right to a paper copy of this notice. Copies of this notice always will be available from the
Corporate Compliance Officer.
Can you change this notice?
We reserve the right to change this notice. We reserve
the right to make the revised or changed notice effective for PHI we already have about you as well as any information we
receive in the future. Copies of the current notice will be posted at The Next Step Network and will be available for you
to pick up on each visit to The Next Step Network, Inc.
What if I have questions or need to report a problem?
If you believe your privacy rights have been violated, you may file a complaint with us or with the Oklahoma Department
of Mental Health and Substance Abuse Services.
To file a complaint with us, or if you would like more information
about our privacy practices, contact our Privacy Official at (580) 338-7259. The Privacy Official’s mailing address
is:
The Next Step Network, Inc.
Attn: Privacy Officer
P.O. Box 1739
Guymon, OK 73942
To
file a complaint with the Oklahoma Department of Mental Health and Substance Abuse Services, you must submit the co9mplaint
within 180 days of when you knew or should have known of the circumstance that led to the complaint. The complaint must be
submitted in writing.
Oklahoma Department of Mental Health and Substance Abuse Services
Office of Consumer
Advocacy
900 East Main Street
P.O. Box 151
Norman, OK 73070
866-699-6605
(405) 573-6605
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