NOTICE OF PRIVACY PRACTICES

Effective April 14, 2003

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

            The following is the Notice of Privacy Practices of Cognitive Solutions: Neuropsychological & LMSW Counseling Services, PLLC.  HIPAA (the Health Insurance Portability and Accountability Act of 1996) is a federal law that requires us to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy policies with respect to your protected health information. We are required by law to abide by the terms of this Notice of Privacy Practices.

Your Protected Health Information (PHI)

            Your “protected health information” (PHI) includes any individually identifiable health information that is created or received by us, other health care providers, and health insurance companies, in any form (written, oral, or electronic).  This includes data that relates to your physical or mental health, the provision of health care to you, or the payment for the provision of health care to you, including information such as your name, address, social security number, and other information that could be used to identify you as the individual patient who is associated with that health information.

Uses or Disclosures of Your Protected Health Information

            We may not “use” or “disclose” your PHI, except: (1) as the Privacy Rule permits or requires; or (2) if we obtain your written authorization to disclose your PHI.  We must obtain your written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.  In all cases, we are required to use, disclose, and request only the minimum amount of protected health information that is reasonably needed to accomplish the intended purpose of the use, disclosure, or request.  “Use” refers generally to activities within our office.  “Disclosure” refers generally to activities involving parties outside of our office. 

Circumstances in which the Privacy Rule permits or requires use or disclosure of your PHI:         

Required Disclosures:

(1)    When you specifically request access to, or an accounting of disclosures of, your PHI;

(2)    To the Department of Health and Human Services (DHHS) when it is undertaking a compliance investigation, review, or enforcement action.

(3)    As required by law, including: (a) disclosure regarding reports of child abuse or neglect, including reporting to social service or child protective service agencies; (b) to the extent necessary to protect you or others from a serious imminent risk of danger presented by you; (c) health oversight activities including audits, civil, administrative, or criminal investigations, inspections, licensure or disciplinary actions, or civil, administrative proceedings or actions, or other activities necessary for appropriate oversight of government benefit programs; (d) judicial and administrative proceedings in response to an order of a court or administrative tribunal, or in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided; (e) as authorized by, and to comply with, worker’s compensation laws; (f) as required by the Secretary of Health and Human Services to investigate or determine compliance with federal regulations.

Permitted Uses and Disclosures:

(1)   Treatment activities, including: (a) use within our office by our professional staff for the provision, coordination, or management of your health care at our office; (b) our office contacting you to provide appointment reminders; (c) consultation between providers regarding a patient and referral of a patient by one provider to another.

(2)   Payment activities, including: (a) disclosure to your health plans or plan administrators, or their appointed agents, to determine coverage, for their medical necessity reviews, for their appropriateness of care review, for their utilization review activities, and for adjudication of health benefit claims; (b) activities of our health care providers or our professional staff to obtain reimbursement or payment for health care delivered to you, including disclosures for billing for which we may utilize the services of outside billing companies and claims processing companies with which we have Business Associate Agreements that protect the privacy of your PHI.   

(4)    Health care operations, including: (a) use within our office for general administrative activities such as filing, typing, etc.; (b) use within our office for quality assessment and improvement activities; (c) disclosure to our attorney, accountant, bookkeeper and similar consultants to our health care operations, provided that we shall have entered into Business Associate Agreements with such consultants for the protection of your PHI.

Other Information About Uses and Disclosures of Your PHI:

(1)    You may revoke your authorization to use or disclose any PHI at any time, except to the extent that we have taken action in reliance on such authorization or if you provided the authorization as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy.

(2)    Special Handling of Psychotherapy Notes:  “Psychotherapy Notes” are defined as records of communications during individual or family counseling which may be maintained in addition to and separate from medical or health care records.  Psychotherapy Notes are only released with your specific written authorization except in limited instances, including: (a) to the United States Department of Health and Human Services in an investigation of our compliance with HIPAA; (b) to health oversight agencies for a lawful purpose related to oversight of our practice; (c) to the extent necessary to protect you or others from a serious imminent risk of danger presented by you; and (c) if you sue us or place a complaint, we may use Psychotherapy Notes in our defense.  Health insurers may not condition treatment, payment, enrollment, or eligibility for benefits on obtaining authorization to review, or on reviewing, Psychotherapy Notes.            

Your Rights With Respect to Your Protected Health Information

Under HIPAA, you have certain rights with respect to your PHI. The following is an overview of your rights and our duties with respect to enforcing those rights.

Right to Request Restrictions On Use or Disclosure of your Protected Health Information

You have the right to request restrictions on certain uses and disclosures of your PHI. While we are not required to agree to any requested restriction, if we agree to a restriction, we are bound not to use or disclose your protected health care information in violation of such restriction, except in certain emergency situations. We will not accept a request to restrict uses or disclosures that are otherwise required by law.  We require that all requests for restrictions be in writing and that you state a reason for the request.

Right to Inspect and Copy Your Protected Health Information

You have the right to access in order to inspect, and to obtain a copy of your PHI, except for: (a) Psychotherapy Notes or other personal notes and observations of the treating provider; (b) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; (c) health information maintained by us to the extent to which the provision of access to you would be prohibited by law; (d) when our health care professionals believe access could cause harm to you or another individual (in such situations, you have the right to have such denial reviewed by a licensed health care professional for a second opinion). Upon denial of a request for access or request for information, we will provide you with a written denial specifying the basis for denial, a statement of your rights, and a description of how you may file an appeal or complaint.

Right to Request Amendment of Your Protected Health Information

You have the right to request that we amend your PHI when that information is inaccurate or incomplete, for as long as your medical record is maintained by us. We require that you submit written requests and provide a reason to support the requested amendment.  We have the right to deny your request for amendment.  If we accept your request for amendment, we will make reasonable efforts to provide the amendment within a reasonable time to persons identified by you as having received your PHI prior to amendment and persons that we know have the PHI that is subject of the amendment and that may have relied, or could foreseeably rely, on such information to your detriment.

If we deny your request, we will provide you with a written denial stating the basis of the denial, your right to submit a written statement disagreeing with the denial, and a description of how you may file a complaint with us and/or the Security of the U.S. Department of Health and Human Services (DHHS). All requests for amendments shall be sent to our office at the mailing address below.

Right to Receive An Accounting Of Disclosures Of Your Protected Health Information

Beginning April 14, 2003, you have the right to receive a written accounting of all disclosures of your PHI for which you have not provided an authorization, that we have made within the six (6) year period immediately preceding the date on which the accounting is requested.  We require that you request an accounting in writing on a form that we will provide you.

The accounting of disclosures will include the date of each disclosure, the name and, if known the address of the entity or person who received the information, a brief description of the information disclosed, and a brief statement of the purpose and basis of the disclosure or, instead of such statement, a copy of your written authorization or written request for disclosure pertaining to such information. We are not required to provide accountings of disclosures for the following purposes: (a) treatment, payment, and healthcare operations; (b) disclosures pursuant to your authorization; (c) disclosures to you; (d) disclosures to other healthcare providers involved in you care; (e) for national security or intelligence purposes; (f) to correctional institutions or law enforcement officials for certain purposes regarding inmates or individuals in lawful custody; (g) with respect to disclosures occurring prior to 4/14/03; and (h) incident to otherwise permitted or required uses or disclosures.  We reserve the right to temporarily suspend your right to receive an accounting of disclosures to health oversight agencies or law enforcement officials, as required by law.  All requests for an accounting shall be sent to our Privacy Officer at the mailing address below.

Right to Receive Confidential Communication by Alternative Means and at Alternative Locations

We must permit you to request and must accommodate reasonable request by you to receive communications of PHI from us by alternative means or at alternative locations. We will ask how you wish us to communicate with you.

Complaints

            You may file a complaint with us and with the Secretary of DHHS if you believe that your privacy rights have been violated. Please submit any complaints to us in writing by mail to our Privacy Officer at the mailing address below. A complaint must name the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Notice of Privacy Practices. A complaint must be received by us or filed with the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission occurred. You will not be retaliated against for filing any complaint.

Amendments to this Notice of Privacy Practices

            We reserve the right to revise or amend this Notice of Privacy Practices at any time. These revisions or amendments may be made effective for all PHI we maintain even if created or received prior to the effective date of the revision or amendment. Upon your written request, we will provide you with notice of any revisions or amendments to this Notice of Privacy Practices, or changes in the law affecting this Notice of Privacy  Practices, by mail or electronically within 60 days of receipt of your request.

Ongoing Access to Notice of Privacy Practices

            We will provide you with a copy of the most recent version of this Notice of Privacy Practices at any time upon your request sent to our Privacy Officer at the mailing address below. For any other requests or for further information regarding the privacy of your PHI, and for information regarding the filing of a complaint, please contact us at the address or telephone number listed below.