As required by the HealthInsurance Portability and Accountability Act (HIPAA) of 1996, this notice describes how health information may be used and disclosed and how one can get access to this information. Please review it carefully.
WHO WILL FOLLOW THIS NOTICE
The Center for Emotional Health of Greater Philadelphia (hereafter referred to as CEH) may only use your health information for treatment and healthcare operations as described in notice. All of the employees/staff, including: psychologists, social worker(s),
post-doctoral fellows, psychology extern(s)and other personnel of CEH follow these privacy practices.
ABOUT THIS NOTICE
This notice will tell about the ways we may disclose health information about and will also describe your rights and certain obligations that we have regarding the use and disclosure of your health information.We are required by law to: make sure that health information that identifies you is kept private; give you this notice of our legal duties and
privacy practices with respect to your health information; and follow the terms of the notice that are currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
CEH may use or disclose your protected health information(PHI), for treatment and healthcare operations purposes with your consent.To help clarify these terms, here are some definitions:”PHI” refers to information in your health record that could identify
you.”Treatment, Payment and HealthCare Operations” refers to the following:
Treatment is provision,coordination,or management of your healthcare and other services related to your healthcare. An Example of treatment would be a consultation with another healthcare provider, such as your family physician or another psychologist.
HealthCare Operations are activities that relate to performance and operations of the CEH. Examples of healthcare operations are quality assessment improvement activities, business related matters such as administrative services, case management
and care coordination.
“Use”applies only to activities within CEH such as sharing, employing, applying, utilizing, examining,and analyzing information that identifies you.
“Disclosure”applies to activities outside of CEH such as releasing, transferring, or providing access to information about other parties.
USES AND DISCLOSURES REQUIRES AUTHORIZATION
CEH may use or disclose PHI for purposes outside of treatment and healthcare operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when CEH is asked for information for purposes outside of treatment and healthcare operations, an authorization will be obtained from you before releasing this information. Authorization will also be obtained before releasing psychotherapy notes. “Psychotherapy Notes”are notes about conversations with your clinician during private, group, joint, or family therapy sessions, which are separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that CEH has relied on that authorization.
USES AND DISCLOSURES WITH NEITHER CONSENT NOR AUTHORIZATION
CEH may use or disclose PHI without your consent or authorization in the following circumstances:
Child Abuse: If there is reasonable cause to believe that a child has been subject to abuse, CEH must report this immediately to the New Jersey Division Child Protection and Permanency.
Adult Domestic Abuse: If there is reasonable cause to believe that a vulnerable adult is the subject of abuse, neglect, or exploitation, CEH must report the information to the county adult protective services provider.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and requests are made for information about the professional services that CEH has provided to you and/or the records thereof, such information is privileged under state law, and CEH must not release this information without written authorization from you or your legally appointed representative, or a court order. This privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. CEH must inform you in advance if this is the case. If the New Jersey Board of Psychological Examiners issues a subpoena, CEH may be compelled to testify before the Board and produce your relevant records and papers.
Serious Threat to Health or Safety: If you communicate to CEH a threat of imminent serious physical violence against a readily identifiable victim or yourself and CEH believes you intend to carry out that threat, CEH must take steps to warn and protect. CEH must also take such steps if there is a belief that intend to carry out such violence, even if you have not made a specific verbal threat.The steps CEH will take to warn and protect may include arranging for you to be evaluated for admission to a psychiatric unit of a hospital or other healthcare facility, advising the police of your threat and the identity of the intended victim, warning the intended victim or his or her parents if the intended victim is under18, and warning your parents if you are under18.
PATIENT’S RIGHTS
Right To Request Restrictions -You have the right to request restrictions on certain uses and disclosures of your PHI. However, CEH is not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations -You have the right to request and receive confidential communications of PHI by alternative means and alternative locations.(For example, you may not want a family member to know that you are seeing a clinician at CEH. Upon your request, correspondence will be sent to another address.)
Right to Inspect and Copy-You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in your mental healtrecord used to make decisions about you for as long as the PHI is maintained in record.You raccess to PHI maybe denied under certain circumstances, but insome cases, you may have the decision reviewed. On your request, CEH will discuss with you the details of the request denial process.
Right To Amend–You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your request may be denied. On your request, CEH will discuss with you the details of the amendment process.
Right to an Accounting-You generally have the right to receive an accounting of disclosures of PHI for which have neither provided consent or authorization (as described in section III of this Notice). On your request,CEH will discuss with you the
details of the accounting process.
Right to a Paper Copy-You have the right to obtain a paper copy of the notice upon request, even if you have agreed to receive the notice electronically.
SALE OF YOUR HEALTH INFORMATION
The sale of your health information without authorization is prohibited. Under Federal law,certain uses and disclosures are not considered a sale of your information, including, but not limited to,disclosures for treatment, payment,for public health purposes, for the sale of part or all of the entity, to any Business Associate for services rendered on our behalf, and as otherwise permitted or required by law. In addition,the disclosure of your health information for research purposes or for any other disclosure permitted by law will not be considered a prohibited disclosure if the only reimbursement received is a”reasonable, cost-based fee”to cover the cost to prepare and transmit your health information and as may otherwise be permitted under Federal and State law. If an authorization is obtained from you to disclose your health information in connection with a sale of your health information, the authorization must state that the disclosure will result in remuneration (meaning that the entity will receive payment for disclosure of your health information and other requirements of law).
MARKETING
We will,in accordance to Federal law,obtain your written authorization to use or disclose your health information for marketing purposes including all treatment and healthcare operations communications where we receive financial remuneration (meaning that the entity receives director in direct payment from a third party whoseproduct or service is being marketed) unless such marketing is: (i)face to face marketing communications; (ii)promotional gifts of nominal value regardless of whether they are
subsidized; (iii)“refill reminders”,so as long as the remuneration for making such communications are “reasonably related to our costs” for making such communications; and (iii)any other activity that does not require an authorization under Federal and State
law.
PSYCHOTHERAPY NOTES
We will,in accordance to Federal law, obtain your written authorization to release your psychotherapy notes ,if any ,that are contained in your health records.However, the entity may use or disclose your psychotherapy notes for the following: (i) to carry out the following treatment, payment,or healthcare operations: (A)use by the originator of the psychotherapy notes for treatment; (B)use or disclosure by the entity for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family,or individual counseling; or use or disclosure by the entity to defend itself in a legal action or other proceeding brought by you; and (ii) a use or disclosure that is required by or permitted by Federal law.
OUT-OF-POCKET PAYMENTS
If you paid out-of-pocket (or in other words, youhave requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your health information with respect to that item or service not be disclosed to your health plan for purposes of payment or healthcare operations, and we will honor that request.
RIGHT TO RECEIVE NOTIFICATION OF A BREACH
We are required to notify you following discovery of a breach of your unsecured health information.
CLINICIANS’ DUTIES
CEH is required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. CEH reserves the right to change the privacy practices described this Notice. Unless you are notified of such change, however,CEHis required to abide by the terms currently in effect. All current clients will be notified if the current policies are revised.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer of CEH or with the Secretary of the US Department of Healthand HumanServices. For questions or to file a complaint with CEH, call or write to the PrivacyOfficer at the address. You will not be penalized for filing a complaint. The Center for Emotional Health Privacy Officer, 1910Route 70E, Suites 7& 5, Cherry Hill, NJ 08003-2123, (856)220-9672.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE
MEDICAL BILLS
(OMB Control Number: 0938-1401)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and
might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
The Out-of-network Consumer Protection, Transparency, Cost Containment, and Accountability Act, (P.L.2018, c.32), (“Act”), was signed into law on June 1, 2018, and became effective on August 30, 2018. This Act provides enhanced protections for consumers who receive health care services from out-of-network providers under the circumstances
described below. These enhancements include:
· transparency and various disclosure requirements by providers and carriers;
· the creation of an arbitration system for out-of-network payment disputes; and
· protections for consumers for certain out-of-network bills.
The Department of Banking and Insurance issued Bulletin No. 18-14 on November 20, 2018 to provide guidance to carriers, health care providers, and other interested parties to help those entities meet their obligations under the Act, pending the adoption of rules.
Out-of-network Balance Billing Protection: Health care providers are prohibited from balance billing a covered person for inadvertent out-of-network services and/or out-of-network services provided on an emergency or urgent basis above the amount of the covered person’s liability for in-network cost-sharing (i.e. the covered person’s
network level deductible, copayments, or coinsurance).
“Inadvertent out-of-network services,” means health care services that are: covered under a health benefits plan that provides a network; and are provided by an out-of-network health care provider in an in-network health care facility when in-network health care services are unavailable in that facility or are not made available to the covered person. “Inadvertent out-of-network services” also includes laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical
laboratory; and
“Emergency or Urgent basis” means all emergency and urgent care services.
Any attempts by the out-of-network health care provider to bill the covered person for these types of services above the covered person’s in-network cost-sharing liability should be reported to the covered person’s carrier, and a complaint may be filed with the appropriate provider’s licensing board or other regulatory body, as appropriate. A complaint may also be filed with the Department. The Department will investigate the complaint and when appropriate, refer the matter to the appropriate licensing agency or regulatory body for review.
Out-of-network arbitration: The Act creates an arbitration process to resolve out-of-network billing disputes for inadvertent and/or emergency/urgent out-of-network services. More information about arbitration, and the process for initiating the arbitration process, can be found at the Department’s arbitration vendor’s website:
https://njpicpa.maximus.com/njportal/
Arbitrations can be between:
Carriers and providers – Where carriers and out-of-network health care providers cannot agree upon reimbursement for such services, an arbitrator will choose between the parties’ final offers as provided herein.
Self-funded plans that opt in and providers – A self-funded plan may opt to be subject to the claims processing and arbitration provisions, as provided herein, and be subject to the same arbitration process as carriers in the insured markets. To find out if a plan is self-funded, look at the ID card. A self-funded plan that has opted in to arbitration will state “NJ arbitration – YES” on the ID card.
Members of self-funded plans that do not opt in and providers – In the case of a self-funded plan, which does not elect to be subject to the claims processing and arbitration provisions of the Act, a covered person under that plan or an out-of-network health care provider may initiate arbitration, wherein the arbitrator will choose a final amount that the arbitrator determines is reasonable, which is binding on the covered person and the out-of-network health care provider, but not on the self-funded health benefits plan that did not opt-in to arbitration. The process to initiate arbitration by members of self-funded plans that do not elect to the subject to this law (or “opt-in” to the law) is described here:
https://njpicpa.maximus.com/njportal/public/c32QA.xhtml#Q19
Carrier Transparency Requirements: The transparency provisions of the Act apply to all carriers operating in New Jersey with regards to health benefits plans that are issued in New Jersey. Carriers are required to:
maintain up-to-date website postings of network providers;
provide clear and detailed information regarding how voluntary out-of-network services are covered for plans that feature out-of-network coverage;
provide examples of out-of-network costs;
provide treatment specific information as to estimated costs when requested by a covered person; and
maintain a telephone hotline to address questions.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
· You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
· Your health plan generally must:
o Cover emergency services without requiring you to get approval for services in advance (prior authorization).
o Cover emergency services by out-of-network providers.
o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact: NJ Department of Banking and Insurance and Real Estate Commission (https://www.state.nj.us/dobi/consumer.htm)
Visit
https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
Visit [https://www.state.nj.us/dobi/division_consumers/insurance/outofnetwork.html] for more information about your rights under NJ state laws.
Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges”
Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 856-220-9672.