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Notice Of Privacy Practices
(Effective April 14, 2003)

This notice describes how your medical information may be used and disclosed and how you can access this information.  Please review it carefully.  If you click on the Table Of Contents below, you will be taken to that part of the document.

If you have any questions about this notice, please contact Tony Reyes, Privacy Officer, at 513-946-8600.

Table Of Contents
     The Board's Pledge Regarding Your Health Information
     Why The Board Collects Personal Health Information
     Personal Information Collected
     How Your Health Information May Be Used And
          Disclosed

     Examples Of How The Board Uses Your Information
     Other Ways The Board May Use Your Health
          Information

     Sharing Your Personal Information
     Other Uses Of Your Information
     Safeguarding Your Health Information
     Individual Client Rights
     Changes To This Notice
     Complaints
     Board Contact Information

The Board's Pledge Regarding Your Health Information
The Hamilton County Mental Health and Recovery Services Board (Board) trustees and staff know that information about you and your health is personal. The Board is committed to protecting health information about you and safeguarding that information against unauthorized use or disclosure. The Board is required by law to: 1) assure health information that identifies you is kept private; 2) give you notice of the Board’s legal duties and privacy practices with respect to health information about you; and, 3) follow the terms of the notice. This notice tells you about the ways in which the Board may use and disclose your health information. The notice also describes your rights and certain obligations the Board has regarding the use and disclosure of your health information. The notice applies to all records related to your services, payments for services, and other information about you that the Board collects.

Why The Board Collects Personal Health Information
The Board collects personal information to:

    bullet Determine eligibility for health care coverage that pays some or all of the cost of services you receive
    bullet Provide benefits and pay claims
    bullet Conduct service evaluation
    bullet Manage Board business
    bullet Provide other information for planning and improving mental health services in the community
    bullet Protect the safety of members

The Board may also be required to collect and keep certain information to meet legal and regulatory requirements. This information is kept after a client’s health care coverage ends.

Personal Information Collected
People seeking benefits are asked to provide certain information when completing a form for enrollment in Board benefit plans. This information may include, for example:

    bullet Name, Address, Phone Number
    bullet Date of Birth
    bullet Marital Status
    bullet Social Security Number
    bullet Family Income

The Board may also receive personal information about you from others, such as:

    bullet Health care providers (doctors, clinics, hospitals)
    bullet Other county behavioral health boards that provide coverage to Board clients
    bullet Business partners (companies with whom the Board has arrangements to assist in providing products and services)
    bullet Other government agencies (courts, child welfare, juvenile justice, law enforcement, etc.)

The information collected from others may include, for example, eligibility, claims and payment information. The Board creates and maintains a record of your enrollment in the Multi-Agency Community Services Information System (MACSIS). MACSIS is the public behavioral health claims processing system of the State of Ohio.

MACSIS also contains records of payment for treatment you receive in the public system. From time to time, the Board also receives information from your treatment provider about your diagnosis, treatment, treatment outcomes, progress in recovery and major, unexpected emergencies or crises you may experience. This information helps the Board plan for and improve the quality of services provided to residents of Hamilton County and ensure the safety of members.

How Your Health Information May Be Used And Disclosed
When you receive services paid for in part or in full by the Board, your personal information may be used for conducting normal Board business known as health care operations. If the services the Board paid for were mental health services, your personal information may also be used for payment and billing.

If you have a guardian or a power of attorney the Board will provide the information to your guardian or attorney in fact.

Examples of how The Board uses your information
Payment for Mental Health Services
– The Board keeps records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment for your services from Medicaid, insurance or other sources. For example, the Board may disclose personal information about the services provided to you to confirm your Medicaid eligibility and to obtain payment from Medicaid.

Health Care Operations – The Board uses information about you to evaluate service outcomes, train staff, manage costs, conduct required business duties and make plans to better serve you and other community residents who need mental health services. The Board exchanges operational information with organizations that provide mental health services to you.

Other Ways the Board May Use Your Health Information
The Board may use your personal information to:

bullet Review and evaluate the quality, effectiveness and efficiency of services you have received
bullet Conduct program and fiscal audits of providers from which you have received services
bullet Investigate major unusual incidents, report these kinds of incidents and take steps to protect your or others’ health and safety
bullet Prepare reports required by the Ohio Department of Mental Health, the Ohio Department of Job and Family Services and the Hamilton County Probate Court
bullet Notify you of issues related to provision of mental health services

Sharing Your Personal Information
There are limited situations when the Board is permitted or required to disclose personal information without your signed authorization. These situations are:

    bullet To protect you or victims of abuse, neglect or domestic violence
    bullet To reduce or prevent a serious threat to public health and safety
    bullet To conduct health oversight activities such as investigations, audits and inspections
    bullet To report to state or federal agencies that oversee or monitor Board operations
    bullet To respond to lawsuits and similar proceedings
    bullet To report for public health purposes dangerous mental conditions, communicable diseases and other diseases and injuries as permitted or required by law
    bullet To report to law enforcement as required by law or court order
    bullet To report to coroners and medical examiners
    bullet To contribute to specialized government functions such as intelligence and national security

Other Uses Of Your Information
Other uses and disclosures of your personal health information not covered by this Notice or the laws that apply to the Board will be made only with your written permission. If you provide permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, the Board will no longer use or disclose your health information for the reasons covered by your written permission. The Board can not take back any disclosures made before you took back your permission.

Safeguarding Your Health Information
In order to protect your health information against unauthorized use or disclosure, the Board maintains a variety of physical, electronic and procedural safeguards that comply with applicable federal and state laws and regulation. Any third party processor or consultant used by the Board has signed an agreement requiring it to maintain the confidentiality of your personal information. The Board also restricts access to your personal information to those employees who need to know the information in order to perform their job duties. The Board maintains policies and procedures that prohibit employees and agents of the Board from improperly using, disclosing, transferring, providing access to or otherwise divulging your health information.

Individual Client Rights
You have the following rights regarding the health information the Board maintains about you:

bullet Right to Request Restrictions. * You have the right to request a restriction or limitation on the health information the Board uses or discloses about you for payment or health care operations. The Board will carefully consider all requests for a restriction but is not required to agree to any requested restrictions.
bullet Right to Limits on Communications. *You also have the right to request a limit on the health information disclosed about you to a family member who is involved in your care if you are receiving mental health services and have previously agreed to limited disclosure to such a family member. The Board will comply with any such restrictions you request regarding disclosure to a family member.
bullet Right to Request Confidential Communications. You have the right to request that the Board communicate with you about health matters in a certain way or at a certain location. For example, you can ask that you are only contacted at work or by mail.
bullet Right to Inspect and Copy.* You have the right to request access to the personal information the Board collects about you. Under certain circumstances, the Board may not share collected information, for example, if the information is the subject of a lawsuit or legal claim, or if release of mental health information may present a danger to you or someone else. Reasonable fees may apply to copied information.
bullet Right to Amend.* You have the right to request corrections or additions to your personal information. You must give the reasons for wanting the change.
bullet Right to an Accounting of Disclosures.*  You have the right to request an accounting of disclosures made of your personal information that were not related to Board business operations or your authorization. Under certain circumstances, the Board may not share collected information, for example, if the information is the subject of a lawsuit or legal claim, or if release of the information may present a danger to you or someone else. Your request must state the period of time desired for the accounting, which can be no longer than the six years prior to your request. The first accounting is free but a fee may apply if more than one request is made in a 12-month period.
bullet Right to a Paper Copy of NoticeYou have the right to a paper copy of this notice at any time and can obtain a copy by contacting the Board office (see the end of this document). This notice is also available on the Board’s web site (www.hccmhb.org).

Requests marked with a star (*) must be made in writing. Contact the Board Client Rights Officer with your request.

To exercise any of your rights described in this paragraph, please contact the Board Client Rights Officer at the address or phone number listed at the end of this document.

Changes To This Notice
The Board reserves the right to change this notice at any time and to make the changed notice effective for health information about you that is already on file as well as any information received in the future. Copies of the current notice are available at the Board Office. The effective date of the notice will always be displayed at the top of the first page. In addition, each time there is a change in the notice, the Board will mail a copy to you at the address shown in the Board’s records.

Complaints
If you have a complaint about the Board’s privacy policies and procedures or you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services.

Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 240
Chicago, Ill. 60601.
Voice Phone (312) 886-2359
FAX (312) 886-1807
TDD (312) 353-5693.

You can also complain to the Board. The Board welcomes the opportunity to hear and respond to your concerns. To file a complaint with the Board, contact the Board Client Rights Officer at the address below. The Board will investigate all complaints promptly and will not retaliate against you in any way for filing a complaint.

Board Contact Information
Hamilton County Community
Mental Health Board
2350 Auburn Avenue
Cincinnati, OH 45219
513-946-8600

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