SOUTHERN ALABAMA REGIONAL COUNCIL ON AGING
AREA AGENCY ON AGING

NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION

Effective Date: November 22, 2004

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices is provided to you as required by Section 164.520 of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation.

Your “protected health information” consists of all individually identifiable information which is created or received by SARCOA and which relates to your physical or mental health condition.

SARCOA reserves the right to change the terms of this Notice at any time. The revised Notice will apply to all protected health information SARCOA received or created in the past as well as all protected health information SARCOA receives or creates in the future. A current copy of the Notice will be posted in each of our offices and over our web site.

If you have any questions or wish to receive additional information about the matters covered by this Notice of Privacy Practices, please contact the Privacy Officer at (800) 239-3507.

This notice describes the practices of the Southern Alabama Regional Council on Aging/Area Agency on Aging (SARCOA) with regard to your protected health information. Service providers of SARCOA may have different privacy practices from those described in this notice. For more information about the privacy practices of service providers, please contact them directly.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR WHICH YOUR CONSENT OR AUTHORIZATION IS NOT REQUIRED

Treatment
SARCOA will use and disclose your protected health information to provide, coordinate or manage your health care and related services by SARCOA and other health care providers, including consulting with other health care providers about your health care or referring you to another health care provider for treatment. For example, SARCOA will disclose your protected health information to a home health agency to ensure that the agency has the necessary information needed to serve you.

Payment
SARCOA will use and disclose your protected health information, as needed, to obtain payment for the health care SARCOA provides to you. When SARCOA performs an assessment of your needs for in-home services such as home health aide service, the assessment process is considered a health care service. SARCOA then bills Medicaid and other funding sources for health care services provided to you. In order to receive payment SARCOA will disclose protected health information.

Health Care Operations
SARCOA may use or disclose your protected health information in order to support the business activities of SARCOA . These activities include, but are not limited to, quality assessment and improvement activities, reviewing the competence or qualification of health care professionals, conducting training programs in which students provide assessment under the supervision of one of SARCOA’s employees, business planning and development and business management and general administrative activities. For example, SARCOA may use Protected Health Information to track trends in clients’ conditions and care. Additionally, SARCOA may use your protected health information to help ensure that all in-home service providers provide the highest quality health care.

Appointment Reminders
SARCOA may use or disclose your protected health information in order to contact you and remind you of a scheduled appointment.

Treatment Alternatives
SARCOA may use or disclose your protected health information to research treatment alternatives.

Health Related Benefits and Services
SARCOA may use and disclose your protected health information to make inquiries about health-related benefits and services that may be of interest to you.

Agency Administrative Activities
SARCOA may use or disclose your protected health information to make information available to you for program advocacy, surveys, fundraising, and providing you with information about senior news and area events. If you do not wish to be contacted for the above purposes, please contact the Privacy Officer at (800)-239-3507.

Others Involved in Your Health Care and Disaster Relief
Unless you object, SARCOA may disclose to a family member, other relative, close personal friend or any other person identified by you, protected health information related to that person’s involvement in your health care or payment related to your health care. SARCOA may also use or disclose to a person responsible for your care your protected health information that relates to your location, general condition or death. If the opportunity for you to agree or object to any such disclosure cannot be provided due to emergency circumstances, SARCOA will make these disclosures if they are in your best interest. Additionally, SARCOA may disclose protected health information relating to your location, general condition or death to any public or private entity authorized to assist in disaster relief efforts.

Required by law
SARCOA staff may use or disclose PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to relevant requirements of the law. Included are disclosures required by the Secretary of the Department of Health and Human Services to investigate or determine SARCOA compliance with HIPAA requirements.

Public Health Authority
We may disclose your protected health information to a public authority that is permitted by law to collect or receive the information. The disclosure may be necessary to do the following:
• Prevent or control disease, injury or disability
• Report births and deaths
• Report child abuse or neglect
• Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
• Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence
All disclosures will be made consistent with the requirements of applicable federal and state laws.

Health Oversight
SARCOA may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Judicial and Administrative Proceedings
SARCOA may, upon certain conditions, disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal, a subpoena, discovery request, or other lawful process.

Law Enforcement Purposes
SARCOA may disclose your protected health information for law enforcement purposes to a law enforcement official in certain circumstances including (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the agency, (6) medical emergency and it is likely that a crime has occurred, and (7) to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Coroners, Medical Examiners, Funeral Directors and Organ Donation
SARCOA may disclose your protected health information to a coroner or medical examiner for the purpose of identifying you, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. SARCOA’s staff may also disclose PHI to a funeral director, as authorized by law, in order to carry out their duties. Such disclosures may be in reasonable anticipation of death. PHI may also be used and disclosed for organ, eye or tissue donation purposes.

Research Purposes
SARCOA staff may disclose PHI to researchers when their research has been approved by the agency after review of the research proposal and established protocols to ensure the privacy of PHI.

Military Activity and National Security
When the appropriate conditions apply, SARCOA staff may use or disclose PHI of individuals who are Armed Forces personnel a) for activities deemed necessary by appropriate military command authorities, b) for the purpose of a determination by the Department of Veterans Affairs of the client’s eligibility for benefits, or c) to foreign military authority if the client is a member of that foreign military service. SARCOA staff may also disclose PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Social Security/Workers’ Compensation
PHI may be disclosed by SARCOA to comply with Social Security dependent or disability benefits, workers’ compensation laws and other similar legally established programs.

Other Uses and Disclosures of Protected Health Information
Any use or disclosure of your protected health information that is not listed above will be made only with your written authorization. You have the right to revoke your authorization at any time, except to the extent that SARCOA has already used or disclosed your protected health information in reliance on the authorization.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Restriction of Use and Disclosure
You have the right to request that SARCOA restrict the protected health information SARCOA uses and discloses in carrying out treatment, payment and health care operations. You also have the right to request a restriction of the protected health information SARCOA discloses to a family member, other relative or any other person identified by you, which is relevant to such person’s involvement in your treatment or payment for your treatment. SARCOA IS NOT OBLIGATED TO AGREE TO ANY RESTRICTION THAT YOU REQUEST. If SARCOA agrees to a restriction, however, SARCOA may only disclose your protected health information in accordance with that restriction, unless the information is needed to provide emergency health care to you.

If you wish to request a restriction on the use and disclosure of your protected health information, please send a written request to the Privacy Officer which specifically sets forth (1) whether you are restricting the use or the disclosure of your protected health information, (2) what protected health information you wish to limit, and (3) to whom you wish the limits to apply. SARCOA will not ask why you are requesting the restriction. The Privacy Officer will review your request and notify you whether or not SARCOA will agree to your requested restriction. SARCOA reserves the right to terminate its agreement to a restriction by notifying you. The restriction will no longer apply to protected health information obtained after the revocation of the restriction.

Access to Protected Health Information
You have the right to inspect and obtain a copy of your protected health information that SARCOA maintains in a designated record set, for so long as that protected health information is maintained in a designated record set. A “designated record set” is a group of records maintained by or for SARCOA which includes medical records, case management records, billing records and records used in whole or in part to make decisions about you. You do not have the right to inspect or copy psychotherapy notes, information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding, or information that SARCOA is otherwise prohibited by law from disclosing.

If you wish to inspect or obtain a copy of your protected health information, please send a written request to the Privacy Officer. If you request a copy of your protected health information, SARCOA may charge a fee for the cost of copying and mailing the information.

SARCOA may, for certain limited reasons, deny your request to inspect or obtain a copy of your protected health information. If SARCOA denies your request, you may be entitled to a review of that denial. If you are entitled to a review and you wish to have SARCOA’s decision reviewed, please contact the Privacy Officer. The Privacy Officer will designate a licensed health care professional to review your request. This reviewing health care professional will not have participated in the original decision to deny your request. SARCOA will comply with the decision of the reviewing health care professional.

Right to Request Amendment
If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.

Right to an Accounting of Disclosures
You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. This right excludes disclosures made to you, an individual designated by you, persons involved in your care, or for notification. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this notice.

To request an accounting of the disclosures of your protected health information made by SARCOA, please send a written request to the Privacy Officer. You will be notified of SARCOA current fees.

Obtaining a Copy of this Notice
You have the right to request and receive a paper copy of this Notice of Privacy Practices from SARCOA at any time.

COMPLAINTS
If you believe that your privacy rights have been violated, you may file a complaint with SARCOA, PO Box 1886, Dothan, AL 36302 or with the Secretary, US Department of Health and Human Services, Washington, DC 20201. All complaints must be submitted in writing. The agency will not retaliate against you for filing a complaint.