NOTICE OF PRIVACY PRACTICES

If you have any questions about this Privacy Notice, please contact our Privacy Officer at (617) 847-1950 or (800) 852-2844.

INTRODUCTION

This Notice of Privacy Practices describes how South Shore Mental Health may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your health information.

"Protected health information" (PHI) means health information, including identifying information about you, that we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care, and payment for your health care services.

We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are also required to comply with the terms of our current Notice of Privacy Practices.

HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Uses and Disclosures For Treatment, Payment, and Operation

• Treatment. We will use your health information to provide your health care and any related services. Your health information may be discussed for treatment planning purposes or supervision among our clinical staff that work at South Shore Mental Health. For example, your therapist may discuss your care with his/her supervisor. We will also use and disclose your health information to coordinate and manage your health care and related services. For example, we may need to disclose information to a case manager who is responsible for coordinating your care and health insurance. When required by law, we will obtain your written authorization prior to such disclosures.

• Payment. We may use or disclose your health information so that the treatment and services you receive are billed to, and payment is collected from, your health plan or other authorized payer. For example, we may disclose your health information as required by your health plan to approve services. These actions may include:
  • making a determination of eligibility or coverage for health insurance;
  • reviewing your services to determine if they were medically necessary;
  • reviewing your services to determine if they were appropriately authorized or certified in advance of your care; or
  • reviewing your services for purposes of utilization review, to ensure the appropriateness of your care, or to justify the charges for your care.

   

• Health Care Operations. We may use and disclose health information about you for our operations. These uses and disclosures are necessary to operate our agency and make sure that you receive quality care. These activities may include quality assessment and improvement, quality management, reviewing the performance or qualifications of our clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities.

  We may combine health information of many of our clients to decide what additional services we should offer, what services are no longer needed, and whether certain new treatments are effective. We may also combine our health information with health information from other providers to compare how we are doing and see where we can make improvements in our services. When we combine our health information with information of other providers, we will remove identifying information so others may use it to study health care or health care delivery without identifying specific clients.

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR CONSENT OR AUTHORIZATION, BUT YOU WILL HAVE AN OPPORTUNITY TO OBJECT UNDER CERTAIN CIRCUMSTANCES.

• Facility Directory. We do not maintain a facility directory at any of our outpatient programs. If asked, we will not confirm that you are our current or former client, verbally, in writing, or through any other means. Exceptions are listed below under "Persons Involved in Your Care."

• Persons Involved in Your Care. We may provide health information about you to someone who helps pay for your care as required for the purposes of collecting payment.

• Emergencies. If you are in an emergency situation, we may disclose your health information to a spouse, a family member, or a friend so that such person may assist in your care. In this case we will determine whether the disclosure is in your best interest, and if so, only disclose information that is directly relevant to the emergency.

• Unable to Make Health Care Decisions. If you are not in an emergency situation but are unable to make health care decisions, we will disclose your health information to:
  • your health care agent if we have received a valid health care proxy from you;
  • your guardian or medication monitor if one has been appointed by a court; or
  • if applicable, the state agency responsible for consenting to your care.

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT UNDER CERTAIN CIRCUMSTANCES.

• Emergencies. We may use and disclose your health information in an emergency treatment situation. For example, we may provide your health information to a paramedic who is transporting you in an ambulance. If a clinician is required by law to treat you and your treating clinician has attempted to obtain your Consent but is unable to do so, the treating clinician may nevertheless use or disclose your health information to treat you.

• As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.

• To Prevent a Serious Threat to Health or Safety. We may use and disclose health information 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 decrease the threat.

• Public Health Activities. We may disclose health information about you as necessary for public health activities including disclosures to:
  • report to public health authorities if required by law for the purpose of preventing or controlling disease, injury or disability;
  • report vital events such as birth or death;
  • conduct public health surveillance or investigations;
  • report child abuse or neglect;
  • report to the Food and Drug Administration (FDA) or to a person required by the FDA to report certain events including information about defective products or problems with medications;
  • notify consumers about FDA-initiated product recalls;
  • notify the appropriate government agency if we believe you have been a victim of abuse, neglect or domestic violence. We will only notify an agency if we obtain your agreement or if we are required or authorized by law to report such abuse, neglect or domestic violence.

   

• Health Oversight Activities. We may disclose health information about you to a health oversight agency for activities authorized by law. Oversight agencies include government agencies that oversee the health care system, government benefit programs such as Medicare or Medicaid, other government programs regulating health care and civil rights laws.

• Disclosures in Legal Proceedings. We may disclose health information about you to a court when a judge orders us to do so. We also may disclose health information about you in legal proceedings without your permission or a judge's order when:
  • your health information involves communications made during a court-ordered psychiatric examination;
  • you introduce your mental or emotional condition into evidence in support of your claim or defense in any proceeding and the judge approves our disclosure of your health information;
  • you sue any of our clinicians or staff for malpractice or initiate a complaint with a licensing board against any of our clinicians;
  • the legal proceeding involves child custody, adoption or dispensing with consent to adoption and the judge approves our disclosure of your health information;
  • one of our staff brings a proceeding, or is asked to testify in a proceeding, involving foster care of a child or commitment of a child to the custody of the Massachusetts Department of Social Services.

   

• Law Enforcement Activities. We may disclose health information to a law enforcement official for law enforcement purposes when:
  • the information is provided in response to an order of a court; or
  • we determine that the law enforcement purpose is to respond to a threat of an imminently dangerous activity by you against yourself or another person; or
  • the disclosure is otherwise required by law.

   

• Medical Examiners or Funeral Directors. We may provide health information about you to a medical examiner.

• National Security and Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law. We may also disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or so they may conduct special investigations.

• Workers' Compensation. We may disclose health information about you to comply with the Massachusetts Workers' Compensation Law. These disclosures will be made only when we have received a court order.

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITH YOUR PERMISSION.

Uses and disclosures of your health information not described previously in this Notice of Privacy Practices will only be made with your written permission, called an "authorization." You have the right to revoke an authorization at any time. If you revoke your authorization we will not make any further uses or disclosures of your health information under that authorization. The exception is if we have already taken an action relying upon the uses or disclosures you have previously authorized.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.

• Right to Inspect and Copy. You have the right to request an opportunity to inspect or copy your health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. You must sign an authorization form and submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a fee for the cost of copying, mailing and supplies associated with your request.

  We may deny your request to inspect or provide you with a copy of your health information in certain limited circumstances. For example, if it is judged not be in your best interest. Under Massachusetts law, if your request is denied, you may further request that the information be sent directly to another health care provider or your attorney.

• Right to Amend. For as long as we keep records about you, you have the right to request us to amend any health information used to make decisions about your care - whether they are decisions about your treatment or payment of your care. You must submit a request in writing to our Privacy Officer and tell us why you believe the information is incorrect or inaccurate.

  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend health information that:

  • was not created by us;
  • is not part of the health information we maintain to make decisions about your care;
  • is not part of the health information that you would be permitted to inspect or copy; or
  • is accurate and complete.

   

  If we deny your request to amend, we will send you a written notice of stating the basis for the denial, and offering you the opportunity to provide a written statement disagreeing with the denial. If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and our denial be attached to all future disclosures of the health information that is the subject of your request.

  If you choose to submit a written statement of disagreement, we have the right to prepare a written rebuttal to your statement of disagreement. In this case, we will attach the written request and the rebuttal, as well as the original request and denial, to all future disclosures of the health information that is the subject of your request.

• Right to an Accounting of Disclosures. You have the right to request that we provide you with an accounting (list) of disclosures we have made of your health information other than those we have made for purposes of treatment, payment, and health care operations and with a signed authorization.

  To request an accounting of disclosures, you must submit your request in writing to the Clinical Information Management Department. For your convenience, you may submit your request on a form called a "Request For Accounting," which you may obtain from our Clinical Information Management Department or our staff. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years and not include dates before April 14, 2003. The request must also include the client's name, date of birth, and how we can contact the client. Requests should be addressed to:

South Shore Mental Health
Clinical Information Management Department
500 Victory Road
Quincy, MA 02171

The first accounting you request within a twelve-month period will be free. For additional requests during the same 12 month period, we will charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.

• Right to Request Restrictions. You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations. You may also ask that any part, or all, of your health information not be disclosed to family members or friends who may be involved in your care.

  You may also ask that any part, or all, of your health information not be disclosed for notification purposes as described previously in the section "We May Use and Disclose Your Health Information Without Your Consent or Authorization, But You Will Have An Opportunity to Object Under Certain Circumstances" of this Notice of Privacy Practices.

  To request a restriction, you must either include it, with our approval, in the Consent for Use or Disclosure Form or request the restriction in writing addressed to the Privacy Officer. The Privacy Officer will ask you to complete a Request for Restriction Form, which you should complete and return to the Privacy Officer. We are not required to agree to a restriction that you may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.

• Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care only in a certain location or through a certain method. For example, you may request that we contact you only at work or by pager. To request such a confidential communication, you must make your request in writing to the Privacy Officer. We will attempt to accommodate all reasonable requests. You do not need to give us a reason for the request; but 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 obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy, contact our Privacy Officer.

• Updates. Updates to this notice will be made available on site and on the Internet.