THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Ashley Addiction Treatment is committed to protecting the confidentiality of information about you as a Ashley patient. Protecting the confidentiality of your information, also known as protected health information (PHI), is specifically required by Federal law and regulations, including the Federal confidentiality provisions for alcohol and substance abuse records (42 U.S.C. § 290dd-2, 42 C.F.R. Part 2), the general Federal privacy and security law known as the Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 and 164), and State privacy laws. Ashley Addiction Treatment is required by law to provide you with this Notice of Privacy Practices and to abide by its terms. A violation of the applicable laws or regulations may be a crime. If you suspect a violation you may file a report as set forth under “Complaints” below. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will make available a revised Notice of Privacy Practices by posting a copy on our website www.AshleyTreatment.org, sending a copy to you in the mail upon request or providing one to you upon request.
How We May Use and Disclose Health Information About You:
Listed below are examples of the uses and disclosures that Ashley Addiction Treatment may make of your protected health information. In a number of cases, we will get your consent (authorization) for a use or disclosure of PHI. These examples are not meant to be exhaustive. Rather, they describe types of uses and disclosures that may be made.
- Uses and Disclosures for Treatment, Payment and Health Care Operations For Treatment. Your PHI may be used and disclosed by your physician, counselor, program staff and others outside of our program that are involved in your care for the purpose of providing, coordinating or managing your health care treatment and any related services with your written authorization. This includes coordination or management of your health care with a third party, consultation with other health care providers or referral to another provider for health care treatment. For example, your protected health information may be provided to the state agency that referred you to our program to ensure that you are participating in treatment. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of the program, becomes involved in your care. When applicable, we may disclose your PHI for treatment purposes without your authorization to third parties known as BAs (see discussion below).
- To Obtain Payment for Services. Ashley Addiction Treatment will use and disclose your PHI to obtain payment for your health care services unless you request otherwise. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity or undertaking utilization review activities. When applicable, we may disclose your PHI for payment purposes without your authorization to third parties known as BAs (see discussion below).
- For Healthcare Operations. We may use your PHI, as needed, within Ashley Addiction Treatment in order to support the business activities of our program including, but not limited to, quality assessment activities, employee review activities, training of students, licensing and conducting or arranging for other business activities. We may share your PHI with third parties known as BAs (see below) that perform various business activities (e.g., billing or transcription services) for Ashley Addiction Treatment, provided we have a written contract with the BA.
- Disclosures to You. We may contact you regarding programs and services offered by Ashley Addiction Treatment, such as alumni events and workshops, or recovery newsletters. We may contact you to request a tax-deductible contribution to support Ashley’s important fundraising activities. (If you do not want to receive fundraising requests, call 1-866-313-6307 ext. 246 or email firstname.lastname@example.org).
Uses and Disclosures That Do Not Require Your Authorization:
- Pursuant to an Agreement with a Business Associate (“BA”). We may enter into a contract with a third-party BA to provide services to Ashley Addiction Treatment. Examples of these services include data processing, bill collecting, dosage preparation, laboratory analysis, or legal, medical, accounting and professional services. The BA may access your PHI but only to fulfill the BA’s function, and may not re-disclose your PHI.
- As Required By Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law, is limited to the relevant requirements of the law, and is permitted under the privacy laws applicable to Ashley Addiction Treatment. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with applicable law if requested.
- For Audits and Investigations. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include public and private agencies and organizations that provide financial assistance to the program (such as third-party payers), regulatory agencies, and organizations performing utilization and quality control. If we disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.
- In Medical Emergencies. We may use or disclose your protected health information in a medical emergency situation to medical personnel only.
- Suspicion of Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect. However, the information we disclose is limited to only that information which is necessary to make the initial mandated report.
- For Deceased Patients. We may disclose PHI regarding deceased patients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death.
- Criminal Activity on Program Premises/Against Program Personnel. We may disclose your PHI to law enforcement officials if you have committed a crime on Ashley’s premises or against program personnel.
- By Court Order. We may disclose your PHI if the court issues an appropriate order and follows required procedures.
- Uses and Disclosures of PHI With your Written Authorization. Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke an authorization at any time, for the exception of your emergency contact.
Your Rights Regarding Your Protected Health Information
Your rights with respect to your protected health information are explained below. Any requests with respect to these rights must be in writing. A brief description of how you may exercise these rights is included.
- You have the right to inspect and copy your Protected Health Information. You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the record. A “designated record set” contains medical and billing records and any other records that the program uses for making decisions about you but does not include psychotherapy notes. Your request must be in writing. We may charge you a reasonable cost-based fee for the copies. We can deny you access to your PHI in certain circumstances. In some of those cases, you will have a right to appeal the denial of access. Please contact our Privacy Officer if you have questions about access to your medical record.
- You may have the right to amend your Protected Health Information. You may request, in writing, that we amend your PHI that has been included in a designated record set. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of it. Please contact Ashley’s Privacy Officer if you have questions about amending your medical record.You have the right to receive an accounting of some types of Protected Health Information disclosures. You may request an accounting of disclosures for a period of up to six years, excluding disclosures made to you, made for treatment purposes or made as a result of your authorization. We may charge you a reasonable fee if you request more than one accounting in any 12-month period. Please contact our Privacy Officer if you have questions about accounting of disclosures.
- You have a right to receive a paper copy of this notice. You have the right to obtain a copy of this notice from us. Any questions should be directed to our Privacy Officer.
- You have the right to request added restrictions on disclosures and uses of your Protected Health Information. You have the right to ask us not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care. Your request for restrictions must be in writing and we are not required to agree to such restrictions. Please contact our Privacy Officer if you would like to request restrictions on the disclosure of your PHI.
- You have a 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. Normally we will communicate with you through the phone numbers, postal address, and/or email addresses you provide. We will accommodate any reasonable request to communicate with you by alternative means or at an alternative location, but we may condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact. We will not ask you why you are making the request. Please contact the Privacy Officer if you would like to make this request.
Discrimination is Against the Law
Ashley, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Ashley, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact the Director of Corporate Compliance, Quality and Risk Management/Civil Rights Coordinator. If you believe that Ashley, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
You can file a grievance in person or by mail, fax, or email.
If you need help filing a grievance, Director of Corporate Compliance, Quality and Risk Management/Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
If you believe we have violated your privacy rights, you may file a complaint in writing to us by notifying our Privacy Officer at:
800 Tydings Lane
Havre de Grace, Maryland 21078,
Telephone (410) 273-6600
We will not retaliate against you for filing a complaint.
You may also file a complaint with the U.S. Secretary of Health and Human Services as follows:
200 Independence Avenue, S.W.
Washington, D.C. 20201
To report a Patient Safety Concern or Event to The Joint Commission:
Submit Online: https://www.jointcommission.org/about/contactus.aspx
By Fax: 630-792-5636
Office of Quality and Patient Safety
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL 60181