NOTICE OF PRIVACY

This notice describes how medical information about you may be used and disclosed and how you can have access to this information.

Please review this notice carefully.

 

If you have any questions about this notice, please contact our administration office at:

Recovery Management Services and Affiliates

5760 Patriot Boulevard

Austintown, OH 44515

(330) 953-0243

 

Your patient record contains personal information about you and your health. The confidentiality of patient records is specifically protected by state and federal laws.  This Notice of Privacy Practices describes how Recovery Management Services and Affiliates (RMS) may use and disclose your protected health information (“PHI”), as well as your rights regarding your PHI. We reserve the right to change the terms of this Notice at any time by posting a copy at our facilities.  You may request a copy of the Notice at any time.

 

How We May Use and Disclose Health Information About You

Listed below are examples of the uses and disclosures that RMS may make of your PHI.  The disclosure may be made verbally, in writing, or electronically, such as by email or text message.

Treatment.  We may use your PHI to provide, coordinate, or manage your care and any related services including sharing information with others outside of RMS that we are consulting with or referring you to for your care, such as a specialist, laboratory, or pharmacy.  In particular, treatment at RMS may include frequent care coordination between affiliates New Day Recovery, On Demand Counseling, On Demand Occupational Medicine, TRK Properties and Valley Recovery Partners.

Payment.  Generally, we will obtain your authorization to use your PHI to obtain payment for your services.  We may use or disclose your PHI for such reasons as determining if you have insurance benefits, and if they will cover your treatment, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.

Healthcare Operations.  We may use or disclose your PHI, as needed, to coordinate our business activities and to share PHI with third parties that provide services to us such as billing or computer services, quality assessment activities, employee review activities, training of students, or other services who have entered into agreements promising to maintain the confidentiality of your PHI.

Contact with our Patients.   We may use or disclose your PHI for patient activities and to contact you.  We may also use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or counselor. We may also call you by name in the waiting room when it is time to be seen.  We may contact you by phone or text to remind you of your appointments.  We may leave voice messages at the telephone number you provide to us.  If you choose to have us contact you by text, texting charges may apply.  If we contact you, you can tell us to contact you in another way or opt out of future contacts.  We may contact you to provide information to you about treatment alternatives or other health-related benefits and services that may be of interest to you.

Required by Law.  We may use or disclose your PHI if it is required by law.  For example, we must make disclosures of your PHI to you upon your request and 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 the Privacy Rule.  We may also disclose your PHI if a court issues a subpoena and appropriate order and follows required procedures.

Health Oversight.  We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, licensure and accreditation inspections.  Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to RMS (such as third party payers) and peer review organizations performing utilization and quality control.

Medical Emergencies.  We may use or disclose your PHI in a medical emergency situation to medical personnel only.

Child Abuse or Neglect.  We may disclose your PHI to a state or local agency as authorized by law to receive reports of child abuse or neglect.  We only disclose necessary information to make the initial mandated report.

Deceased Clients.  We may disclose PHI of deceased clients 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.

Research.  Information that has no identifying information or is part of a limited data set may be used for research purposes without your authorization. PHI may only be disclosed for research purposes after a special approval process or with your authorization.

Court Order.  We may disclose your PHI if the court issues an appropriate order and follows required procedures.

Law Enforcement.  We may disclose your PHI to law enforcement officials if you have committed a crime on program premises or against program personnel.

Public Health.  We may use or disclose your PHI in certain limited circumstances to a public health authority authorized by law to collect or receive such information for purposes of preventing or controlling disease, injury, or disability.

 

Rights Regarding Your PHI

Inspect and Copy Your PHI. You can view and get 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 RMS uses to make decisions about you.  If we maintain a copy of your PHI in an electronic format, then we will provide that PHI to you electronically upon your request.  We may charge you a reasonable cost-based fee for the copies. We can deny you access to your PHI in certain circumstances.

Amend Your PHI.  You may request, in writing, that we amend your PHI in your records. We may deny your request in certain cases.  You have a right to file a statement of disagreement with us.

Accounting of PHI DisclosuresYou may request an accounting of disclosures for certain other disclosures.  We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

Restrictions on Disclosures and Uses of PHI.  You have the right to restrict disclosures of PHI to your health plan where you have paid for the services out of pocket and in full.  As a convenience to our patients, at some locations we offer text message appointment reminders.  There are privacy risks to texting and text messages may be accessed by others.  You may opt out of receiving text messages at any time by notifying Medical Records.

Confidential Communications.  You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  We will accommodate reasonable, written requests. We may also condition this request by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact.

Breach Notification.  If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach.

Complaints. You may file a complaint in writing to us in-person or by mail to the address above.  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 at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling 202-619-0257.   [email protected].

Notice to Substance Abuse Patients.          

The confidentiality of alcohol and drug abuse patient records is protected by federal law 42 USC 290dd-2 and 42 CFR Part 2. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug patient, unless: (1) the patient consents in writing; (2) the disclosure is allowed by a court order; (3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation; (4) the patient commits or threatens to commit a crime either at the program or against any person who works for the program. Violation of federal regulations by a program is a crime. Suspected violations may be reported via phone to the Youngstown U.S. Attorney’s Office (330-746-7974). Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state of local authorities.

 

PATIENT GRIEVANCE

NDR is committed to providing each patient with the best possible care during the patient’s time in treatment.  NDR is also committed to providing that care in an environment and manner, which respects and protects each patient’s personal dignity and rights.  If a patient or a family member / loved one feels the rights of the patient have been violated, or if a patient or a family member / loved one has a complaint or grievance, that individual has the right to initiate a complaint or grievance.  This right shall be free of any interference, coercion, discrimination, or reprisal.

The grievance shall be in writing, on the “Grievance Form”, and shall include, if available, the date, approximate time, and description of the incident and names of individuals involved in the incident or situation being grieved.  The written grievance must be signed by the patient or a family member or loved one who is filing the grievance on behalf of the patient.  The Director, or a staff member designated by the Director, of the site where the patient is receiving treatment shall be available to assist the patient or a family member or loved one in filing a grievance.

Grievance resolution decisions will be made within twenty calendar days post receipt of the grievance.  NDR shall maintain, for 2 years from the date of resolution, the records of written grievances, which include: a copy of the grievance, documentation reflecting the process used and the resolution/remedy of the grievance, if applicable, documentation of extenuating circumstances for extending the time period for resolving the grievance beyond twenty calendar days, and a copy of the letter to the grievant reflecting the resolution.

 

Procedure:

Information regarding this NDR’s grievance procedure may be obtained from any staff person and is posted in a prominent location.

The Client Rights Advocate for this facility is the Program Director and he/she is available to assist you in filing and investigating your grievance. It is the responsibility of the Client Rights Advocate to help ensure respect for the rights of our patients and their family members / loved ones are upheld, and to ensure that quality care is provided with compassion and consideration.

In his/her/their absence, or if he/she/they are the subject of a grievance, this grievance may be filed through the following personnel:

Brandon Miller, Chief Operating Officer       Tess Crofford, Executive Assistant

[email protected]                                  [email protected]

(330) 953-0243 EXT. 1109                            (330) 953-0243 EXT. 1103

The Client Rights Advocate is to explain the grievance procedure including the following:

  • Grievances are required to be in writing
  • Grievances must be signed and dated
  • Grievances must include (to the best of your knowledge) the date, time, description, and/or names of individuals involved in the incident or situation being grieved
  • Notification of name of the staff person to whom to give the grievance
  • Patients have the option at any time to file with an outside organization including the County MHR Board, OhioMHAS, Disability Rights Ohio, and the U.S. Department of HHS, Civil Rights regional office in Chicago.
  • Upon written request, information concerning the patient grievance can be forwarded to any outside the patient identifies.
  • Written acknowledgment of receipt of the grievance will be provided within three (3) working days and includes:
    •       Date grievance received
    •       Summary of grievance
    •       Overview of investigation process
    •       Facility contact person ‘s name, address, and phone number
  • The Client Rights Advocate will attempt to bring about a resolution to the patient complaint and provide written and oral explanation of the resolution within seven (7) working days of initiation of the complaint
  • The patient may appeal to the Chief Executive Officer within five (5) working days of receiving the decision of the Client Rights Advocate.
  • Within five (5) working days of an appeal, the Chief Executive Officer will schedule time to meet with the patient to discuss the complaint
  • Within four (4) working days of meeting with the Chief Executive Officer, the patient will be provided, in writing, the Chief Executive Officer’s determination regarding the complaint
  • A final resolution decision will be made within 21 calendar days of receipt of the complaint.
  • Any extenuating circumstances that necessitate a need for an extension will be given to you in writing.

If the hearing by NDR does not settle the grievance to satisfaction, or a patient does not desire to bring a grievance to this agency, a patient may contact the Trumbull County Mental Health and Recovery Board

The Client Rights Advocate will be available to help a patient prepare and present the grievance if desired.

A patient has the right to initiate a grievance outside of the facility. This could involve the following:

  • Mahoning County Mental Health and Recovery Board 222 West Federal Street Suite 201 Youngstown, OH 44503 330-746-2959
  • Trumbull County Mental Health and Recovery Board 4076 Youngstown Rd. SE Suite 201 Warren, OH 44484 330-675-2765
  • Columbiana County Mental Health and Recovery Board 27 Vista Drive Lisbon, OH 44432 330-424-0195
  • Ohio Department of Mental Health and Addiction Services (OhioMHAS) 30 East Broad Street 8th Floor Columbus, Ohio 43215-3430 1-614-466-2596 * 877-275-6364
  • Attorney General’s Office, Medicaid Intake Officer, 150 E. Gay Street, 17th Floor Columbus, Ohio 43215 (614) 466-6670 * 800-282-0515
  • Disability Rights Ohio 200 Civic Center Drive Suite 300 Columbus, Ohio 43215 * (614) 466-7264
  • Office for Civil Rights Department of Health and Human Services 233 N. Michigan Avenue, Suite 240 Chicago, IL 60601 (800) 368-1019
  • Counselor and Social Worker and Marriage and Family Therapy Board 77 South High Street 24th. Floor Columbus, Ohio 43215 (614) 466-0912
  • CARF International 6951 East Southpoint Road Tuscan, Arizona 85756 (888) 281-6531 www.carf.org
  • Ohio State Medical Board 30 E. Broad Street 3rd. Floor Columbus, Ohio 43215 (614) 466-3934
  • Ohio Board of Nursing 17 South High Street Suite 400 Columbus, Ohio 43215 (614) 466-3947
  • U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 (877) 696-6775
  • Ohio Credentialing Board of Chemical Dependency Professionals Vern Riffe Center 77 South High Street 16th. Floor Columbus, Ohio 43215 (614) 387-1110