Alaska Children's Services

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL/CLINICAL 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 Notice please contact our Privacy Officer:
Telephone: (907) 346-2101 ext 200
Mail : 4600 Abbott Road, Anchorage, AK 99507
OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION (PHI)

“Protected Health Information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services. We understand that your PHI is personal. We are committed to protecting your PHI and to sharing the minimum necessary required to accomplish the purpose. We create a record of the care and services you receive through Alaska Children’s Services. This notice applies to all of the Protected Health Information compiled about you while you are receiving services at Alaska Children’s Services.

This Notice of Privacy Practices describes how we 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 (see in the body of this Notice). It also describes your rights to access and control your protected health information.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. Whenever there is a material change to the uses and disclosures of protected health information, we will make this revised Notice available for your review.

I. Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information

When you come to Alaska Children’s Services, there are many forms that you will need to complete and data that you will provide. We are required to compile much of this information by our payers. Your protected health information may be used and disclosed by our agency, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing services to you.

Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of Alaska Children’s Services.

Following, are examples of the types of uses and disclosures of your protected health care information. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by Alaska Children’s Services.

A. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care services. We will share information that you provide with supervisors or our internal team members so that they can assist in determining the best course of care and services for you.

B. Payment: Your protected health information will be used, as needed, to obtain payment for the services that we provide. This may include certain activities that your health insurance plan or other payer may request before it approves or pays for the health care services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, or undertaking utilization review activities (review of your care on an ongoing basis). For example, obtaining approval for an admission may require that your relevant PHI be disclosed to the health plan/payer to obtain approval for the admission. We may also disclose your information to another provider involved in your care as part of ensuring your eligibility for services.

C. Healthcare Operations: We may use or disclose, as needed, your PHI for our own health care operations in order to provide quality care to all consumers, to assess staff training needs, or to ensure the efficiency of program operations. Health care operations include such activities as:

• Quality assessment and improvement activities,
• Employee review activities,
• Training programs including those in which students, trainees, or practitioners in health care learn under supervision,
• Accreditation, certification, licensing, or credentialing activities,
• Review and auditing, including compliance reviews, record reviews, legal services and maintaining compliance programs, or
• Business management and general administrative activities.

In certain situations, we may also disclose PHI to another provider or health plan for their health care operations.

D. Other Uses and Disclosures: As part of treatment, payment, and health care operations, we may also use or disclose your protected health information for the following purposes:

• To remind you of an appointment,
• To inform you of potential treatment alternatives or options,
• To inform you of health related benefits or services that may be of interest to you.

II. Other Permitted Uses and Disclosures

•Others Involved in Your Healthcare: We may use or disclose PHI to your guardian or personal representative or any other person that is legally responsible for your care. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

•Communication Barriers: We may use and disclose your PHI if we attempt to obtain an authorization from you but are unable to do so due to substantial communication barriers. These barriers would only be ones that we cannot overcome and that we determine, using professional judgment, that you intend to provide authorization to share information.

III. Other Required Uses and Disclosures
We may use or disclose your PHI in the following situations without your authorization. These situations include:

A. In Connection With Judicial and Administrative Proceedings: We may disclose your PHI in the course of any judicial or administrative proceedings in response to an order of a court or magistrate as expressly authorized by such order or in response to a signed authorization.

B. To a Designated Hospital for Emergency Services (Involuntary Commitment): We may disclose protected health information to assure continuity of care.

C. To Report Abuse, Neglect or Domestic Violence: We may notify government authorities if we believe that a student is the victim of abuse, neglect, or domestic violence. We will make this disclosure only when specifically required by law or when the student agrees to the disclosure.

D. Health Oversight Activities: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits; civil, administrative or criminal investigations, proceedings or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.

E. In a Medical or Psychological Emergency: We may disclose protected health information to direct medical service or mental health personnel if a medical or psychological emergency arises.

F. For Research Purposes: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information. At this time, Alaska Children’s Services does not maintain an institutional review board, and does not participate in research as defined in this manner.

G. When Legally Required: We will disclose your protected health information when we are required to do so by any Federal, State or local law.

H. Imminent Threat to Health or Safety: Consistent with applicable Federal and State laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

I. To Division of Mental Health and Developmental Disabilities in accordance with 7 ACC 71.400 – 7 ACC 71.449 (Required Data Submission). We will disclose protected health information to DMHDD for health oversight activities specifically identified in Alaska law.

J. For all other disclosures of your PHI we must obtain a written authorization for release of information from you. This authorization must include:

• Specific person to whom the information is being released
• Purpose of the release
• Date of the release -time frame
• Specific information or documents that are being released
• Opportunity to revoke consent.

IV. Your Rights Regarding Protected Health Information
Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.

A. Right to Inspect and Copy: You have the right to inspect and receive a copy of your PHI. We may have to charge you for copying. This means you may inspect and obtain a copy of PHI about you that is contained in a Designated Record Set. A “Designated Record Set” contains PHI in your clinical record and billing records that we use for making decisions about you. If we perceive that providing you access to your record constitutes a danger to self or a danger to others, we can use our professional judgment regarding access.

B. Right to Request Restrictions: You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your record not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

C. We are not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. 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.

D. Right to Request Confidential Communications: You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You must make this request in writing. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. We are not required to honor your request, but if we do not do so, we will explain in writing.

E. Right to Amend: You may have the right to amend your case record. This means you may request an amendment of the information in your record for as long as we maintain this information. This request must be in writing and provide a reason for the amendment. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, we will do so in writing. You have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact your provider if you request an amendment.

F. Right to an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. By law it excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame.

G. Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

V. Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint in writing, with Alaska Children’s Services by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.

You may contact our Privacy Officer at (907) 346-2101 for further information about the complaint process.

VI. Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current notice in all of our buildings. The notice will contain on the first page, in the top right-hand corner, the effective date. You will be offered a copy of the current notice when you visit our offices for services.

VII. Effective Date:
This Notice of Privacy Practices is effective 4/14/03.