HIPAA NOTICE OF PRIVACY PRACTICES AND CLIENT RIGHTS
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.
Metropolitan Family Services’ Responsibilities
At Metropolitan Family Services, we are committed to protecting the privacy and the confidentiality of your records. This notice has been prepared in response to federal regulations that enforce the Health Insurance Portability and Accountability Act of 1996 (HIPAA). We are required by applicable federal law to maintain and safeguard the privacy of your Protected Health Information (PHI). We are also required to give you notice of our legal duties and privacy practices with respect to your PHI. We must also notify you after a breach of unsecured PHI. We must abide by the terms provided in this notice while it is in effect. This notice takes effect October 22, 2013 and will remain in effect until we replace it.
Metropolitan Family Services reserves the right to change the terms of this notice and privacy practices at any time, provided such changes are permitted by applicable law. We reserve the right to make the new notice provisions effective for all PHI we maintain, including PHI we created or received before we made the changes. Before making a material change in our privacy practices, we will change this notice and make the new notice available to you as required by law.
Metropolitan Family Services provides service to any person or family regardless of age, gender, religion, disability, nationality, sexual orientation, race, ethnic or cultural group, who meets program requirements. We will make every effort to communicate with you in a familiar language and use communication technology to address difficulties in hearing and sight.
This notice describes how medical, mental health and social service information about you may be used and disclosed and how you can get access to this information. Please review it carefully. It will help you understand your rights as a recipient of services.
We maintain a policy of strict compliance with State and Federal confidentiality laws including the Illinois Domestic Violence Act, DCFS Title 89 Confidentiality Rules, HIPAA, and the Mental Health and Developmental Disabilities Act 740 ILCS 110. No protected health and service information will be released to or requested from other persons, organizations, agencies or other third parties without your informed written consent, except in response to a court order or as otherwise permitted or required by law, and/or to protect you and others from injury, abuse or neglect as provided below. Unless you give us written authorization, we cannot use or disclose your PHI for any reason including marketing and sale of your PHI except those described in this notice or as permitted by law. We will make disclosures of any psychotherapy notes we may have only if you provide us with written authorization or when disclosure is permitted or required by law. Other uses and disclosures not described in this notice will be made only with your written authorization or as permitted or required by law. You may withdraw your authorization in writing as provided by applicable law. Your withdrawal will not affect any use or disclosures allowed by your authorization while it was in effect.
You may contact us using the information at the end of this notice to receive explanations on how to submit a request or for additional information.
To Review and Copy Your Records
You have the right, with limited exceptions, to look at or get copies of your PHI kept in a designated record set. A “designated record set” includes medical, mental health and billing records, as well as any other records we use in providing services to you. You also have the right to receive an electronic copy of your PHI if it is maintained in an electronic designated record set. We will use the format you request unless we cannot practicably do so. You must make your request in writing to obtain access to your PHI and may obtain a request form from us. If we deny your request, we will provide you a written explanation and will tell you if the reasons for the denial can be reviewed and how to ask for such a review or if the denial cannot be reviewed. You are entitled to a copy of your records and may be charged a fee for copying, supplies for creating the copy, and mailing. You may request that your PHI be released to anyone you designate. Your request that we provide a copy of your PHI to a person you designate must be in writing, signed by you, clearly identify the designated person, and clearly identify where to send a copy of your PHI.
To Obtain an Accounting of the Information Released From Your Record
You have the right to receive a list of instances for the six (6)-year period, but not before April 14, 2003, in which we or our Business Associates disclosed your PHI for purposes other than treatment, payment, health care operations, or as authorized by you and for certain other activities. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. We will provide you with more information on the applicable fee at your request.
To Request Amendments to Your Record
You have the right, with limited exceptions, to request that we amend your PHI. This request must be made in writing to the Metropolitan Family Services Privacy Officer. Your request must explain why your PHI should be amended. We will provide you with a timely response. We may deny your request if you ask us to amend information that:
- Was not created by Metropolitan Family Services and the originator remains available.
- Is not a part of the information maintained by or for Metropolitan Family Services.
- Is accurate and complete.
- For certain other reasons as provided by law.
In cases where we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement. We will then add our response and your statement of disagreement to the information you wanted amended. We may also prepare a written rebuttal to your statement of disagreement and provide you a copy. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.
To Request Restrictions
You have the right to ask us to restrict or limit the PHI disclosed about you for delivery of services, payment or business operations. We are not required to agree to your request. If we do agree, we will comply with your request unless there is an emergency or we are otherwise required by law to disclose information.
To Request Confidential Communications
You have the right to request to receive communications of your PHI from us by alternative means or at alternative locations. For example, you may request that we only call you at work or by mail at a special address or post office box instead of your home address. Your request must be in writing. You do not have to explain the basis of your request, but you must specify how or where we are to contact you. We will accommodate all reasonable requests.
Breach Notification: You have the right to be notified when it has been determined that a breach of your unsecured PHI has occurred.
Right to Receive a Copy of the Notice: You may request a copy of this notice at any time by contacting the Privacy Officer. If you receive this notice on our web site or by electronic mail (email), you are also entitled to request and receive a paper copy of the notice upon request.
How We May Use Your Information
For Service Delivery
We will use your protected health and service information to provide, coordinate, or manage the services we will provide to you. The minimum amount of protected information necessary to accomplish treatment goals may be disclosed to supervisors, other treatment team members, consultants and administrators.
We may use and disclose your protected health and service information so that we can receive payment from you, your insurance company or other funding sources. The minimum amount of protected information will be disclosed to secure reimbursement for the services delivered to you.
For Business Operations
We may use your protected information to support our business activities and to improve the quality of our services. For example: we may use your records when evaluating the services you received. We may also disclose your PHI to health oversight and accrediting agencies and for activities authorized by law such as audits, investigations, inspections and licensure.
We are required to share PHI with State and Federal governmental entities to determine our compliance with federal and state laws related to health care.
Appointments and Communication
We may contact you at the phone number you provided with regard to appointments, treatment and/or other issues that relate to the services you are receiving.
Training and Fundraising
Protected information that does not contain your personal identifiers may be disclosed for training and fundraising purposes. We may contact you or disclose a limited amount of your PHI to a Business Associate or to an institutionally related foundation for the purpose of raising funds for our own benefit. If we do so, you have the right to opt out of receiving such fundraising communications. Your decision will have no impact on the payment for services.
There are some services provided at Metropolitan Family Services through a third party “business associate”. Examples include financial auditors, answering services, and psychiatrists. Whenever service delivery to you requires the use or disclosure of your protected information, Metropolitan Family Services will have a written contract that contains terms to protect the privacy of your service information.
For Reporting Child and Elder Abuse
Staff with reasonable cause to believe that a child may be subjected to abuse or neglect is required by law to report this to the Illinois Department of Children and Family Services. Staff with reasonable cause to believe that an older person, who is incapable of seeking assistance because of some dysfunction, has been subjected to abuse or neglect are required by law to report this to the Illinois Department on Aging or one of its elder abuse provider agencies.
For Reporting Risk of Harm to Clients and Others
Staff with reasonable cause to believe that a risk exists of serious, immediate, physical or emotional injury or death may inform law enforcement agencies and persons who may be affected by threatened action. Staff may also take steps to facilitate or secure the client’s hospitalization, if warranted. Criminal activity on our premises may require the sharing of information with law enforcement agencies.
For Continuous Quality Improvement
Continuous Quality Improvement (CQI) or “Peer Review” is another valuable process that Metropolitan Family Services uses to improve services. CQI activities may include the review of client records. Some of the findings may be published for use within and outside of Metropolitan Family Services but your name and other information that would identify you will not be used in any publications and reports.
Public Benefit: We may use or disclose your PHI as authorized by law for the following purposes deemed to be in the public interest or benefit:
- as required by law;
- for public health activities, including disease and vital statistic reporting, child abuse reporting, certain Food and Drug Administration (FDA) oversight purposes with respect to an FDA regulated product or activity, and to employers regarding work-related illness or injury required under the Occupational Safety and Health Act (OSHA) or other similar laws;
- to report adult abuse, neglect, or domestic violence;
- to health oversight agencies;
- in response to court and administrative orders and other lawful processes;
- to law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;
- to avert a serious threat to health or safety;
- to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities;
- to correctional institutions regarding inmates;
- as authorized by and to the extent necessary to comply with state worker’s compensation laws;
- in connection with certain research activities;
- to coroners, medical examiners, and funeral directors; and
- to an organ procurement organization
Use and Disclosure of Certain Types of Medical Information
For certain types of PHI, state laws may provide greater protection for your privacy. For example, use and/or disclosure of PHI including, but not limited to HIV/AIDS, genetic information, mental health information, alcohol and substance abuse information may need to be specifically authorized by you or required by law. In such instances, we will follow the provisions of Illinois law.
Client Complaint and Grievance
Your rights of grievance are protected in accordance with The Illinois Medical Patient Rights Act 410 ILCS 50 and HIPAA. We will not retaliate against you in any way if you file a complaint with us or with the U.S. Department of health and Human Services.
Confidentiality and Privacy Complaints
If you want to file a privacy or confidentiality complaint with Metropolitan Family Services or have any questions regarding your privacy rights or the information in this notice, please contact the Metropolitan Family Services Privacy Officer by mail or phone:
Metropolitan Family Services
Attn: Privacy Officer
1 N. Dearborn – 10th Floor
Chicago, IL. 60602
If you believe that Metropolitan Family Services has violated your privacy rights, you may file a complaint with the Office of Civil Rights, U.S. Department of Health and Human Services at the following address:
Office for Civil Rights
U.S. Department of Health and Human Services
233 North Michigan Ave, Suite 1300
Chicago, Illinois 60601
312-886-2359 or TDD at 312-353-5693
Client Grievance Procedures
Metropolitan Family Services provides internal procedures to address client complaints. We encourage you to express any concern about the services you receive to your service provider as soon as they arise. You can expect to have a satisfactory response from the provider of your service following a complaint and if not satisfied, a Supervisor is available to address your concerns. If you are still not satisfied after supervisory contact, you can expect the involvement of the following individuals willing to address your concern. Listed in rising authority they include Manager, Director, Executive Director, Director of Clinical Services, Chief Operating Officer and President who has final decision authority. You can expect a written response from Metropolitan Family Services regarding your grievance. Metropolitan Family Services maintains grievance records for qualitative review.
Fundamental Client Rights
Metropolitan Family Services will not discriminate against a service recipient or applicant for services because of race, disability, color, creed, religion, sex, age, national origin, ancestry, citizenship, veteran status, sexual orientation, or other related factors and legally protected characteristics.
- Clients have the right to be free from abuse, neglect and exploitation.
- Clients will have mental health services provided in the least restrictive setting.
- Clients have the right not to be denied, suspended or terminated from services or have services reduced by exercising any rights.
- Clients have the right to contact the public payer or insurer of payment regarding a grievance or complaint. An agency staff will assist clients to access appropriate resources and to facilitate contact.
- Individuals or guardians shall be permitted to purchase and use the services of private physicians and other mental health and developmental disabilities professionals of their choice.
- Clients have the right to accommodation for their disabilities as required by the Americans with Disabilities Act, section 504 of the Rehabilitation Act and the Human Rights Act [775 ILCS 5]
- Any restriction of your rights requires our written justification and a plan for reinstatement given to you as required under the Rights of Recipients of Mental Health and Developmental Disabilities Services [405 ILCS 5/Ch II].
Access to Advocacy and Rights Organizations
In order to safeguard your rights as a recipient of mental health and other services, staff is available to offer you assistance in contacting any of the following agencies regarding your concern about rights:
Equip for Equality
20 North Michigan Avenue, Suite 300
Chicago, IL 60602
(800) 537-2632 (Voice)
(800) 610-2779 (TTY)
Guardianship and Advocacy Commission
160 N La Salle Street
Chicago Illinois 60601
Illinois Department of Human Services
401 South Clinton Street
Chicago, Illinois 60607
Illinois Department of Children and Family Services
100 West Randolph St, 6th Floor
Chicago, Illinois 60601
Illinois Office of Inspector General – For Clients Funded By Medicaid Only
160 N. LaSalle
Chicago, IL. 60601
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775