Apricity Behavioral Health, LLC
Notice of Privacy Practices
Effective: November 17, 2017
THIS NOTICE DESCRIBES HOW MENTAL, BEHAVIORAL, MEDICAL AND
OTHER HEALTH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
Apricity Behavioral Health,LLC (herein referred to as
"Apricity") provides outpatient behavioral health and other
counseling related services in a virtual environment with a
headquarters mailing address of 752 Steeplechase Rd.,
Landisville, PA 17538.
PURPOSE. We are required by law to maintain the
privacy of your health information. This Notice describes our
legal duties and privacy practices. This Notice tells you how we
may use and disclose your health information. This Notice also
describes your rights and how you may exercise your rights.
Apricity agrees to abide by the terms of this Notice.
Your Protected Health Information. We refer to your
mental, behavioral, medical and other health care information as
"protected health information" or "PHI". "PHI" is health
information we have collected in our records from you or received
from other health care providers, health plans, or the county. It
may include information about your past, present or future physical
or mental health or condition. For example, PHI in your records
could include your diagnosis, treatment plan, or evaluations. PHI
also includes information about payment for services.
Confidentiality of Your PHI. Your PHI is
confidential. We are required to maintain the confidentiality of
your PHI by the following federal and Pennsylvania laws.The
Health Insurance Portability and Accountability Act of
1996. The Department of Health and Human Services issued
the following regulations: "Standards for Privacy of Individually
Identifiable Health Information". We call these regulations the
"HIPAA Privacy Regulations". We may not use or disclose your PHI
except as required or permitted by the HIPAA Privacy Regulations.
The HIPAA Privacy Regulations require us to comply with
Pennsylvania laws that are more stringent and provide greater
protection for your PHI.
Pennsylvania Mental Health Confidentiality Laws. For
individuals who receive treatment and services in our mental
health programs, Pennsylvania laws may provide greater protection
for your PHI than the HIPAA Privacy Regulations. For example, we
are not permitted to disclose or release PHI in response to a
Pennsylvania subpoena. Also, any information acquired by a
licensed social worker in the course of your treatment is
privileged under Pennsylvania law and may not be released without
your authorization or court order. Finally, if mental health
records include information relating to drug or alcohol abuse or
dependency, we are required to comply with the Pennsylvania Drug
and Alcohol Abuse Control Act. We will comply with the
Pennsylvania laws that are more stringent than the HIPAA Privacy
Regulations and provide greater protection for your PHI.
Confidentiality of Drug and Alcohol Treatment
Records. For individuals who receive treatment and
services for drug or alcohol use, federal and Pennsylvania laws
may provide more protection for your PHI than the HIPAA Privacy
Regulations. We will comply with the federal and Pennsylvania
laws that are more stringent than the HIPAA Privacy Regulations
and provide greater protection for your PHI.
Confidentiality of HIV-Related
Information. Pennsylvania laws may provide greater
protection for PHI related to HIV as provided for in 35 P.S. 7601
ET. Seq. We will comply with Pennsylvania laws that are more
stringent than the HIPAA Privacy Regulations and provide greater
protection for your PHI.
Why this Notice is Important. The HIPAA Privacy
Regulations require that we provide you with this Notice. The
effective date of this Notice is November 17, 2017. We will post
a current copy of the Notice on our website. We reserve the right
to change the terms of this Notice at any time. The revised
Notice will be posted on our website, and available to you upon
request. The new Notice will be effective for all PHI that we
maintain at that time and for information we receive in the
future.
AUTHORIZATION TO DISCLOSE YOUR PHI
Except as described in this Notice, it is our practice to obtain
your authorization before we disclose your PHI to another person
or party. If you are receiving services in our mental health
program, Pennsylvania law states that you are entitled to inspect
the PHI before it is released. You may revoke an authorization,
at any time, in writing. If you revoke an authorization, we will
no longer use or disclose your PHI. However, we cannot undo any
disclosures we have already made.
HOW WE MAY USE OR DISCLOSE YOUR PHI WITHOUT YOUR
AUTHORIZATION
Uses and Disclosures for Treatment, Payment and Health Care
Operations. Unless prohibited by more stringent
Pennsylvania mental health, mental retardation, substance abuse or
other laws, the HIPAA Privacy Regulations permit us to use and
disclose your PHI for the following purposes in order to provide
your treatment.
For Treatment. It is necessary for us to use your PHI
to care for you. In order to help you, our clinicians and other
staff need to use your PHI. For example, we may need to share
your PHI with a case manager who is responsible for coordinating
your care. We may disclose your PHI to another health care
provider (e.g. primary care physician) for your treatment. When
you are referred to another provider we are permitted to provide
your PHI if it is necessary for the continuity of your care and
treatment.
For Payment. We will use and disclose your PHI to
obtain payment for our services. Before you receive services, we
may disclose PHI to your insurance company, health plan, county,
or other third party payer to permit them to: make a
determination of eligibility or coverage; review the medical
necessity of your services; review your coverage; or review the
appropriateness of care or our charges. We will also use your PHI
for billing, claims management, collection activities, and data
processing. For example, a bill may be sent to you or whoever
pays for your services. The bill may include PHI that identifies
you as well as your diagnosis, procedures, and supplies used in
the course of your treatment. We may also disclose PHI to another
provider for payment activities of the provider that receives the
PHI.
For Health Care Operations. We may use and disclose
your PHI within the company in order to carry out our health care
operations. For example, your PHI is used for: business
management and general administrative duties; quality assessment
and improvement activities; medical, legal, and accounting
reviews; business planning and development; licensing and
training. Our quality assurance team may use PHI in your record
to assess the care and outcomes in your case and others like it.
This information will then be used in an effort to improve the
quality and effectiveness of the services we provide. In
addition, we sometimes hire business associates to help in our
operations. We are permitted to share your PHI with a "business
associate" that performs or assists in various activities
involving PHI (e.g., billing, transcription services, and
auditors) for us. Whenever we engage a business associate we will
have a written contract that contains terms that will protect the
privacy of your PHI.
Other Uses and Disclosures. We may contact you to
provide appointment reminders, or information about treatment
alternatives or other health related benefits that may be of
interest to you.
USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR
AUTHORIZATION, BUT SUBJECT TO YOUR OPPORTUNITY TO AGREE OR
OBJECT
Your Opportunity to Agree or Object to Certain Uses and
Disclosures. It is our practice to obtain your written
authorization prior to disclosing PHI to another person or party.
However, as described in this section, it may be necessary to
disclose your PHI without your written authorization (exception:
no disclosure for Drug/Alcohol treatment). Under these
circumstances, the HIPAA Privacy Regulations permit us to use or
disclose PHI when you are present and have the capacity to make
health care decisions if, prior to the use or disclosure, we
obtain your agreement, provide you with an opportunity to object
(and you do not express an objection), or we can reasonably inter
from the circumstances, based upon our professional experience,
that you do not object. If you are not present or the opportunity
to obtain your agreement or objection cannot practicably be
obtained due to your incapacity or an emergency, then we may in
the exercise of professional judgment determine whether the
disclosure is in your best interests and, if so, disclose only
PHI that is directly relevant to that person's involvement in
your case.
Family Members and Others Involved in Your
Healthcare. Subject to your opportunity to agree or
object, we may share your PHI with a family member, other
relative, close personal friend, or any other person you identify
(your "personal representative"). The PHI shared with your
personal representative will be directly relevant to your
personal representative's involvement with your care or payment
for services. For example, your personal representative may act
on your behalf by picking up forms or medical supplies for you.
Notification. Subject to your opportunity to agree or
object, we may use or disclose PHI to notify, or assist in the
notification of (including identifying or locating), a personal
representative of your location, general condition, or death.
Disaster Relief. Subject to your opportunity to agree
or object, we may use or disclose your PHI to a public or private
entity (e.g. the American Red Cross) authorized by law or by its
charter to assist in disaster relief efforts. The purpose of such
use or disclosure of your PHI is to coordinate with a disaster
relief agency and/or your personal representative your location,
general condition, or death. Only specific information pertinent
to the relief effort and the emergency may be released without
your authorization.
Residential Facility Directories. If you are
receiving services in one of our residential facilities, you may
be entitled to receive telephone messages and visitors. We
maintain a limited directory of persons living at each
residential facility. Unless otherwise directed by you, with
regard to messages or visitors, we will indicate that you live at
and may be contacted at the facility.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE
MADE WITHOUT YOUR AUTHORIZATION
Introduction. Unless prohibited by more stringent
Pennsylvania mental health, mental retardation, substance abuse
laws or other laws, the HIPAA Privacy Regulations permit us to
use or disclose your PHI without your authorization or agreement
under the following circumstances.
As Required By Law. We will disclose PHI about you
when required to do so by federal or Pennsylvania law. Any use or
disclosure must comply with and be limited to the relevant
requirements of the law. For example, we are required to report
or disclose PHI related to child or elder abuse or neglect and
commitment proceedings authorized by the Pennsylvania Mental
Health Procedure Act of 1966.
Emergencies. We may use or disclose your PHI in an
emergency treatment situation when use and disclosure of the PHI
is necessary to prevent serious risk of bodily harm or death to
you.
Public Health Activities. If required by federal or
Pennsylvania law, we will disclose your PHI for public health
activities in order to: prevent disease, injury or disability;
report births and deaths; report child abuse or neglect; report
reactions to medications; notify a person who may be at risk for
contracting or spreading a disease or condition; or, notify
appropriate government authorities if we believe a patient has
been the victim of abuse, neglect or domestic violence, when
required to do so by law or with your agreement. Only specific
information required by law may be disclosed without your
authorization.
Health Oversight Activities. If required by law, we
may use or disclose PHI about you to a health oversight agency. A
Health Oversight agency includes government agencies such as
Medicare, Medicaid or county programs. Oversight activities
include audits, accreditation, investigations, inspections,
utilization review, and licensure of Pennsylvania Counseling
Services, Inc.
To Avert a Serious Threat to Health or Safety. The
HIPAA Privacy Regulations permit us to use and disclose PHI about
you when necessary to prevent a serious and imminent threat to
your health or safety or to the health or safety of the public or
another person. Under these circumstances, we will only disclose
health information to someone who is able to help prevent or
lessen the threat. However, if you are receiving mental health
services, more stringent Pennsylvania laws require our mental
health professionals to exercise reasonable care to warn another
person if you communicate a specific and immediate threat of
serious bodily injury against a specific person or readily
identifiable person.
Disclosures in Legal Proceedings. We are not
permitted by Pennsylvania law to disclose PHI regarding mental
health or drug and alcohol services in response to a Pennsylvania
subpoena, unless a court or administrative agency issues us an
order to release your PHI. If you are receiving services in our
mental health program, Pennsylvania law requires us to make a
good faith effort to notify you by certified mail at your last
known address that we disclosed your PHI pursuant a court order.
Law Enforcement Activities. We are not permitted by
Pennsylvania laws to disclose PHI regarding mental health or drug
and alcohol services to Law Enforcement agencies or officials
except pursuant to a court order or in special circumstances
required by law. For example, we may disclose the minimum
necessary PHI to report a death or criminal conduct on our
premises.
Special Situations. We are not permitted by
Pennsylvania laws to disclose PHI regarding mental health or drug
and alcohol services except pursuant to your authorization, a
court order or in special circumstances required by federal and
state laws. Subject to these more stringent federal or
Pennsylvania laws, the HIPAA Privacy Regulations permit us to
disclose PHI related to: Military and Veterans agencies; National
Security and Protective Services for the President and others;
inmates or if you are under the custody of a law enforcement
official; a coroner or medical examiner to identify a deceased
person or determine the cause of death; or to a funeral director
as necessary to carry out their duties.
YOUR RIGHTS REGARDING YOUR PHI
Right to Request Restrictions. You have the right
to request a limitation or a restriction on our use or disclosure
of your PHI for treatment, payment or healthcare operations. You
may also request that we limit the PHI we disclose to family
members, friends or a personal representative who may be involved
in your care. However, we are not required to agree to a
restriction. If we agree to the requested restriction, we may not
use or disclose your PHI in violation of that restriction unless it
is needed to provide emergency treatment. You may request a
restriction by making your request in writing, including: (a) what
PHI you want to limit; (b) whether you want us to limit our use,
disclosure or both; and (c) to whom you want the limits to apply.
Right to Request Confidential Communication. You have
the right to request that confidential communications from us be
sent to you in a certain way or at an alternative location. For
example, you can ask that we only contact you at your home or by
mail. We will accommodate reasonable requests. We may also
condition this accommodation by asking you for specific
information. We will not request an explanation from you as to
the basis for the request. Please make this request in writing
specifying how or where you wish to be contacted.
Right to Inspect and Copy. You have the right to
inspect and obtain a copy of your PHI that is contained in our
records. However, you may not inspect or copy the following
records: psychotherapy notes; or information compiled in
reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding. In addition you may be
denied access to your PHI if it was obtained from a person under
a promise of confidentiality; or disclosure is likely to endanger
the life and physical safety of you or another person. A decision
to deny access may be reviewed. To inspect and copy PHI, submit
your request in writing to our Privacy / Compliance Officer. If
you request a copy of the information, we may charge a fee for
the costs of copying, mailing, or other related costs.
Right to Amend. If you believe the PHI that we have
collected about you is incorrect, you have certain rights. If you
are receiving mental health services, you have the right to
submit a written statement qualifying or rebutting information in
our records that you believe is erroneous or misleading. This
statement will accompany any disclosure of your records. You also
have the right under the HIPAA Privacy Regulations to request an
amendment of the PHI maintained in our records. 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 PHI that: was not created by
us (unless the person or entity that created the information is
no longer available to make the amendment); the information is
not part of the record kept by us; the PHI is not subject to
inspection or copying; or the record is accurate and complete. If
we deny your request for amendment, you have the right to appeal
our decision and file a statement of disagreement with us. We may
prepare a rebuttal to your statement and will provide you with a
copy of any such rebuttal. Please contact our Privacy /
Compliance Officer if you have questions about submitting a
written statement or to request an amendment of your records.
Right to Receive an Accounting of Disclosures. You
have the right to request an "accounting of disclosures". This is
a list of the disclosures we have made of PHI about you. We are
not required to account for disclosures related to: treatment,
payment, or our health care operations; authorizations signed by
you; or disclosures to you, to family members or your personal
representative involved in your care, or for notification
purposes. You have the right to receive specific information
regarding these disclosures that occurred after November 17,
2017.
Right to a Paper Copy of this Notice. You have the
right to receive a paper copy of this Notice upon request. To
obtain a paper copy, contact Apricity at (717) 742-0501. You may
also obtain an electronic copy of this Notice at our
website:
http://www.apricitybehavioralhealth.com.
GRIEVANCE PROCEDURES; RIGHT TO FILE A COMPLAINT
If you are not pleased with your care or feel your PHI was not
kept confidential you may officially file a grievance with us.
Under the PCS grievance procedure, we will work with you to
address your questions, concerns and complaints. The HIPAA
Privacy Regulations also entitle you to file a complaint with the
U.S. Secretary of Health and Human Services. To file a complaint
with us or learn more about the grievance process, you may
contact Apricity by phone at (717) 742-0501, or by mail at
752 Steeplechase Rd. Landisville, PA 17538. A complaint problem
form will be provided to assist you. We will not retaliate
against you for filing a complaint.