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Privacy Statement
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If
you have any questions about this Privacy Notice, please
contact a Privacy Officer at 413-746-0051 or 781-933-0700.
I.
Introduction
This
Notice of Privacy Practices describes how CSAC 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
of Privacy Practices also describes your rights regarding
your health information that CSAC maintains and a brief
description of how you may exercise your rights. This
Notice of Privacy Practices further states the obligations
CSAC has to protect your protected health information.
“Protected
health information” means health information (including
identifying information about you) that CSAC has 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.
CSAC
is required by law to maintain the privacy of your protected
health information and to provide you with a notice of its
legal duties and privacy practices with respect to your
protected health information. CSAC is also required
to comply with the terms of its current Notice of Privacy
Practices.
II.
How CSAC Will Use and Disclose Your Health Information
CSAC
will use and disclose your protected health information
as described in each category listed below. For each
category, CSAC will explain what CSAC means in general,
but it does not describe
all specific uses or disclosures of health information.
A.
Uses and Disclosures That May Be Made With Your Written
Consent
1.
For Treatment. Once you have signed CSAC’s Consent
to Use and Disclose Health Information, CSAC will use and
disclosure your health information to provide your health
care and any related services. CSAC will also use
and disclose your health information to coordinate and manage
your health care and related services. For example,
CSAC may need to disclose information to a case manager
who is responsible for coordinating your care. However,
when CSAC makes disclosures to a third party (other than
your health plan) for coordination or management of your
health care, CSAC will usually obtain your written authorization
prior to the disclosure. A third party is a person
or entity who is not affiliated with CSAC’s organization.
CSAC may also disclose your health information among CSAC’s
clinicians and other staff (including clinicians other than
your therapist or principal clinician), who work at CSAC.
For example, CSAC’s staff may discuss your care at a case
conference. In addition, with your authorization,
CSAC will disclose your health information to another health
care provider (e.g., your primary care physician or a laboratory)
working outside of CSAC.
2.
For Payment. Once you have signed CSAC’s
Consent to Use and Disclose Health Information, CSAC 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 third party payer.
By way of example, CSAC may disclose your health information
to permit your health plan to take certain actions before
your health plan approves or pays for your 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.
For
example, your health plan may ask CSAC to share your health
information in order to determine if the plan will approve
additional visits to your therapist.
3.
For Health Care Operations. Once you have
signed CSAC’s Consent to Use and Disclose Health Information,
CSAC may use and disclose health information about you for
CSAC’s operations. These uses and disclosures are to enable
CSAC to operate its organization and audit the quality of
care that you receive. These activities may include,
by way of example, quality assessment and improvement, reviewing
the performance or qualifications of CSAC’s clinicians,
training students in clinical activities, licensing, accreditation,
business planning and development, and general administrative
activities.
CSAC may combine health information of many of CSAC’s consumer/patients
to decide what additional services CSAC should offer, what
services are no longer needed and whether certain new treatments
are effective. CSAC may also combine CSAC’s health
information with health information from other providers
to compare CSAC’s performance with others and to see where
CSAC can make improvements in CSAC’s services. When
CSAC combine CSAC’s health information with information
of other providers, CSAC will “de-identify” the health information
by removing identifying information so others may use it
to study health care or health care delivery without identifying
the specific consumer/patients.
CSAC may also use and disclose your health information to
contact you to remind you of your appointment. Finally,
CSAC may use and disclose your health information to inform
you about possible treatment options or alternatives that
may be of interest to you.
4.
Health-Related Benefits and Services. CSAC
may use and disclose health information to tell you about
health-related benefits or services that may be of interest
to you. If you do not want CSAC to provide you with
information about health-related benefits or services, you
must notify a Privacy Officer in writing. The Privacy
Officers are Vincent Tobin, 628 Center Street, Chicopee,
MA 01013 and Norma Reppucci, 444 Washington Street, Woburn,
MA 01801. Please state clearly that you do not want to receive
materials about health-related benefits or services.
B. Uses
and Disclosures That May be Made Without Your Consent or
Authorization, But For Which You Will Have an Opportunity
to Object.
1. CSAC does not maintain a facility directory at
any of CSAC’s outpatient units. If asked, CSAC will
not confirm orally, in writing or through any other medium
that you are CSAC’s current or former consumer/patient,
except as listed below under “Person’s Involved in
an Individual’s Care.”
2.
Persons Involved in Your Care. CSAC may provide
health information about you to someone who helps pay for
your care. CSAC may use or disclose your health information
to notify or assist in notifying a family member, personal
representative or any other person that is responsible for
your care of your location, general condition or death.
CSAC may also use or disclose your health information to
an entity assisting in disaster relief efforts and to coordinate
uses and disclosures for this purpose to family or other
individuals involved in your health care.
In limited circumstances, CSAC may disclose health information
about you to a friend or family member who is involved in
your care. If you are physically present and have
the capacity to make health care decisions, your health
information may only be disclosed with your agreement to
persons you designate to be involved in your care.
But, if you are in an emergency situation, CSAC 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 CSAC will determine, in its professional judgment,
whether the disclosure is in your best interest and, if
so, only disclose information that is directly relevant
to participation in your care.
And, if you are not in an emergency situation but are unable
to make health care decisions, CSAC will disclose your health
information to:
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your health care agent if
CSAC has received a valid health care proxy from you,
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your guardian or medication
monitor if one has been appointed by a court, or
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if applicable, the state
agency responsible for consenting to your care.
C. Uses
and Disclosures That May be Made Without Your Consent, Authorization
or Opportunity to Object.
1.
Emergencies. CSAC may use and disclose your
health information in an emergency treatment situation.
By way of example, CSAC may provide your health information
to a paramedic who is transporting you in an ambulance.
CSAC will attempt to obtain your Consent as soon as reasonably
practicable after your emergency treatment. 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.
2.
Communication Barriers. CSAC may use and disclose
your health information if one of CSAC’s clinicians attempts
to obtain Consent from you, but is unable to do so due to
substantial communication barriers. However, CSAC
will only use or disclose your health information if the
clinician determines in his/her professional judgment that,
absent the communication barriers, you likely would have
consented to use or disclose information under the circumstances.
3.
Research. CSAC may disclose your health information
to researchers when their research has been approved by
an Institutional Review Board or a similar privacy board
that has reviewed the research proposal and established
protocols to protect the privacy of your health information.
4.
As Required By Law. CSAC will disclose health
information about you when required to do so by federal,
state or local law.
5.
To Avert a Serious Threat to Health or Safety.
CSAC 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, CSAC
will only disclose health information to someone who is
able to help prevent or lessen the threat.
6.
Organ and Tissue Donation. If you are an organ
donor, CSAC may release your health information to an organ
procurement organization or to an entity that conducts organ,
eye or tissue transplantation, or serves as an organ donation
bank, as necessary to facilitate organ, eye or tissue donation
and transplantation.
7.
Public Health Activities. CSAC may disclose
health information about you as necessary for public health
activities including, by way of example, disclosures to:
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report to public health
authorities for the purpose of preventing or controlling
disease, injury or disability;
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report vital events such
as birth or death;
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conduct public health surveillance
or investigations;
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report child abuse or neglect;
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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;
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notify consumers about FDA-initiated
product recalls;
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notify a person who may
have been exposed to a communicable disease or who is
at risk of contracting or spreading a disease or condition;
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notify the appropriate government
agency if CSAC believe you have been a victim of abuse,
neglect or domestic violence. CSAC will only notify
an agency if CSAC obtains your agreement or if CSAC
are required or authorized by law to report such abuse,
neglect or domestic violence.
8.
Health Oversight Activities. CSAC 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.
9.
Disclosures in Legal Proceedings. CSAC may
disclose health information about you to a court when a
judge orders CSAC to do so. CSAC also may disclose
health information about you in legal proceedings without
your permission or without a judge’s order when:
-
you are a party to a legal
proceeding and CSAC receive a subpoena for your health
information. Normally, CSAC will not provide this
information in response to a subpoena without your authorization
if the request is for substance abuse records or for
information relating to AIDS or HIV status;
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your health information
involves communications made during a court-ordered
psychiatric examination;
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you introduce your mental
or emotional condition in evidence in support of your
claim or defense in any proceeding and a judge approves
CSAC’s disclosure of your health information;
-
you sue any of CSAC’s clinicians
or staff for malpractice or initiate a complaint with
a licensing board against any of CSAC’s clinicians;
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the legal proceeding involves
child custody, adoption or dispensing with consent to
adoption and a judge approves CSAC’s disclosure of your
health information;
-
one of CSAC’s social workers
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.
10.
Law Enforcement Activities. CSAC may disclose
health information to a law enforcement Officer for law
enforcement purposes when:
-
you agree to the disclosure;
or
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when the information is
provided in response to an order of a court; or
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CSAC 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.
CSAC
may also disclose health information about you, if you are
a victim of a crime, without a court order or without being
required to do so by law. However, CSAC will do so
only if the disclosure has been requested by a law enforcement
Officer and you agree to the disclosure or, in the case
of your incapacity, the following occurs:
-
the law enforcement Officer
represents to CSAC that (i) you are not the subject
of the investigation and (ii) an immediate law enforcement
activity to meet a serious danger to you or others depends
upon the disclosure; and
-
CSAC determines, in its
professional judgment that the disclosure is in your
best interest.
11.
Medical Examiners or Funeral Directors. CSAC
may provide health information about you to a medical examiner.
Medical examiners are appointed by law to assist in identifying
deceased persons and to determine the cause of death in
certain circumstances. CSAC may also disclose health
information about you to funeral directors as necessary
to carry out their duties.
12.
Military and Veterans. If you a member of
the armed forces, CSAC may disclose your health information
as required by military command authorities. CSAC
may also disclose your health information for the purpose
of determining your eligibility for benefits provided by
the Department of Veterans Affairs. Finally, if you
are a member of a foreign military service, CSAC may disclose
your health information to that foreign military authority.
13.
National Security and Protective Services for the President
and Others. CSAC may disclose medical information
about you to authorized federal Officers for intelligence,
counter-intelligence, and other national security activities
authorized by law. CSAC may also disclose health information
about you to authorized federal Officers so they may provide
protection to the President, other authorized persons or
foreign heads of state or so they may conduct special investigations.
14.
Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement Officer,
CSAC may disclose health information about you to the correctional
institution or law enforcement Officer.
15.
Workers’ Compensation. CSAC may disclose health
information about you to comply with the Massachusetts Workers’
Compensation Law. These disclosures will usually be
made only when CSAC have received a court order or, sometimes,
when CSAC have received a subpoena for the information.
III.
Uses and Disclosures of Your Health Information with
Your Permission.
Uses
and disclosures not described in Section II of this Notice
of Privacy Practices will generally 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 CSAC will not make any
further uses or disclosures of your health information under
that authorization, other than actions relying upon the
uses or disclosures you have previously authorized.
IV. Your
Rights Regarding Your Health Information.
A.
Right to Inspect and Copy.
You
have the right to request an opportunity to inspect or copy
health information used to make decisions about your care
– whether they are decisions about your treatment or payment
of your care. Usually, this would include clinical
and billing records.
You
must submit your request to inspect or copy your health
information in writing to a Privacy Officer. The Privacy
Officers are Vincent Tobin, 628 Center Street, Chicopee,
MA 01013 and Norma Reppucci, 444 Washington Street, Woburn,
MA 01801. If you request a copy of the information,
CSAC may charge a fee for the cost of copying, mailing and
supplies associated with your request.
CSAC
may deny your request to inspect or copy your health information
in certain limited circumstances. In some cases, you
will have the right to have the denial reviewed by a licensed
health care professional not directly involved in the original
decision to deny your request. CSAC will inform you
in writing if the denial of your request may be reviewed
and how you request a review. If you have a right
to a review and request the review, once the review is completed,
CSAC will honor the decision made by the licensed health
care professional reviewer.
B.
Right to Amend.
For
as long as CSAC keep records about you, you have the right
to request CSAC to amend any health information used to
make decisions about your care – whether they
are decisions about your treatment or payment of your care.
Usually, this would include clinical and billing records.
To
request an amendment, you must submit a written request
to a Privacy Officer. The Privacy Officers are Vincent
Tobin, 628 Center Street, Chicopee, MA 01013 and Norma Reppucci,
444 Washington Street, Woburn, MA 01801. In your request
state clearly the reason(s) why you believe the information
is incorrect or inaccurate.
CSAC
may deny your request for an amendment if it is not in writing
or does not include a reason to support the request.
CSAC may also deny your request if you ask CSAC to amend
health information that:
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was not created by CSAC,
unless the person or entity that created the health
information is no longer available to make the amendment;
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is not part of the health
information CSAC maintains to make decisions about your
care;
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is not part of the health
information that you would be permitted to inspect or
copy; or
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is accurate and complete.
If
CSAC denies your request to amend your health information,
CSAC will send you a written notice of the denial 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 CSAC’s 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,
CSAC has the right to prepare a written rebuttal to your
statement of disagreement. In this case, CSAC 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.
C.
Right to an Accounting of Disclosures.
You
have the right to request that CSAC provide you with an
accounting of disclosures of your health information CSAC
has made. An accounting is a list of disclosures.
But this list will not
include certain disclosures of your health information,
by way of example, CSAC will not
include disclosures made for purposes of treatment,
payment, and health care operations.
To
request an accounting of disclosures, you must submit your
request in writing to a Privacy Officer. The Privacy
Officers are Vincent Tobin, 628 Center Street, Chicopee,
MA 01013 and Norma Reppucci, 444 Washington Street, Woburn,
MA 01801. For your convenience, you may submit
your request on a form called a “Request For Accounting,”
which you may obtain from a CSAC Privacy Officer.
The request should state the time period for which you wish
to receive an accounting. This time period cannot
be longer than six years and cannot include dates before
April 14, 2003.
The
first accounting you request within a 12 month period will
be free. For additional requests during the same 12
month period, CSAC will charge you for the costs of providing
the accounting. CSAC will notify you of the amount
CSAC will charge and you may choose to withdraw or modify
your request before CSAC incur any costs.
D.
Right to Request Restrictions.
You
have the right to request a restriction on the health information
CSAC uses or discloses 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 or for notification purposes as described in Section
II(B)(2) of this Notice of Privacy Practices.
To
request a restriction, you must either include it (with
CSAC’s approval) in the Consent for Use or Disclosure Form
or request the restriction in writing addressed to a Privacy
Officer. The Privacy Officers are Vincent Tobin, 628
Center Street, Chicopee, MA 01013 and Norma Reppucci, 444
Washington Street, Woburn, MA 01801. The Privacy Officer
will ask you to fill out a Request for Restriction Form,
which you should complete and return to the Privacy Officer.
CSAC
is not required
to agree to a restriction that you may request. If
CSAC agrees, to a restriction that you request, CSAC will
honor the restriction, unless the restricted health information
is needed to provide you with emergency treatment.
E.
Right to Request Confidential Communications.
You
have the right to request that CSAC communicate with you
about your health care only in a certain location or through
a certain method. For example, you may request that
CSAC contact you only at work or by e-mail.
To
request such a confidential communication, you must make
your request in writing addressed to a Privacy Officer.
The Privacy Officers are Vincent Tobin, 628 Center Street,
Chicopee, MA 01013 and Norma Reppucci, 444 Washington Street,
Woburn, MA 01801. CSAC will accommodate all reasonable
requests. You do not need to give CSAC a reason for
the request; but your request must specify how or where
you wish to be contacted.
F.
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, make a request in writing addressed to a Privacy Officer.
The Privacy Officers are Vincent Tobin, 628 Center Street,
Chicopee, MA 01013 and Norma Reppucci, 444 Washington Street,
Woburn, MA 01801.
V.
Confidentiality of Substance Abuse Records
For individuals
who have received treatment, diagnosis or referral for treatment
from CSAC’s drug or alcohol abuse programs, the confidentiality
of drug or alcohol abuse records is protected by federal
law and regulations. As a general rule, CSAC may not
tell a person outside the programs that you attend any of
these programs, or disclose any information identifying
you as an alcohol or drug abuser, unless:
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you authorize the disclosure
in writing; or
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the disclosure is permitted
by a court order; or
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the disclosure is made to
medical personnel in a medical emergency or to qualified
personnel for research, audit or program evaluation
purposes; or
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you threaten to commit a
crime either at the drug abuse or alcohol program or
against any person who works for CSAC’s drug abuse or
alcohol programs.
A violation
by CSAC of the federal law and regulations governing drug
or alcohol abuse is a crime. Suspected violations
may be reported to the Unites States Attorney in the district
where the violation occurs.
Federal law
and regulations governing confidentiality of drug or alcohol
abuse permit CSAC to report suspected child abuse or neglect
under state law to appropriate state or local authorities.
Please see
42 U.S.C. § 290dd-2 for federal law and 42 C.F.R., Part
2 for federal regulations governing confidentiality of alcohol
and drug abuse patient records.
VI.
Complaints
If you believe
your privacy rights have been violated, you may file a complaint
with CSAC or with the Secretary of the U.S. Department of
Health and Human Services. To file a complaint with
CSAC, contact CSAC’s Complaint Officer addressed to Robert
Potter, 444 Washington Street, Woburn, MA 01801. All
complaints must be submitted in writing.
A Privacy
Officer, who can be contacted either is Vincent Tobin, 628
Center Street, Chicopee, MA 01013 or Norma Reppucci, 444
Washington Street, Woburn, MA 01801 A Privacy
Officer will assist you with writing your complaint, if
you request such assistance.
CSAC will
not retaliate
against you for filing a complaint.
VII.
Changes to this Notice
CSAC
reserve the right to change the terms of CSAC’s Notice of
Privacy Practices. CSAC also reserve the right to
make the revised or changed Notice of Privacy Practices
effective for all health information CSAC already has about
you as well as any health information CSAC receives in the
future. CSAC will post a copy of the current Notice
of Privacy Practices at CSAC’s main office and at each site
where CSAC provides care. You may also obtain a copy
of the current Notice of Privacy Practices by accessing
CSAC’s website at
www.csacmethadone.com
or by calling CSAC at any office location and requesting
that a copy be sent to you in the mail or by asking for
one any time you are at CSAC’s offices.
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