Notice of Privacy Practices for Protected Health Information
45 CFR 164.520
Background

The HIPAA Privacy Rule gives individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns, and to prompt them to have discussions with their health plans and health care providers and exercise their rights.

How the Rule Works

General Rule. The Privacy Rule provides that an individual has a right to adequate notice of how a covered entity may use and disclose protected health information about the individual, as well as his or her rights and the covered entity’s obligations with respect to that information. Most covered entities must develop and provide individuals with this notice of their privacy practices. The Privacy Rule does not require the following covered entities to develop a notice:

Health care clearinghouses, if the only protected health information they create or receive is as a business associate of another covered entity. See 45 CFR 164.500(b)(1).
A correctional institution that is a covered entity (e.g., that has a covered health care provider component).
A group health plan that provides benefits only through one or more contracts of insurance with health insurance issuers or HMOs, and that does not create or receive protected health information other than summary health information or enrollment or disenrollment information. See 45 CFR 164.520(a).
Content of the Notice. Covered entities are required to provide a notice in plain language that describes:

How the covered entity may use and disclose protected health information about an individual.
The individual’s rights with respect to the information and how the individual may exercise these rights, including how the individual may complain to the covered entity.
The covered entity’s legal duties with respect to the information, including a statement that the covered entity is required by law to maintain the privacy of protected health information.
Whom individuals can contact for further information about the covered entity’s privacy policies.
The notice must include an effective date. See 45 CFR 164.520(b) for the specific requirements for developing the content of the notice. A covered entity is required to promptly revise and distribute its notice whenever it makes material changes to any of its privacy practices. See 45 CFR 164.520(b)(3), 164.520(c)(1)(i)(C) for health plans, and 164.520(c)(2)(iv) for covered health care providers with direct treatment relationships with individuals.

Providing the Notice.

A covered entity must make its notice available to any person who asks for it.
A covered entity must prominently post and make available its notice on any web site it maintains that provides information about its customer services or benefits.
Health Plans must also:
Provide the notice to individuals then covered by the plan no later than April 14, 2003 (April 14, 2004, for small health plans) and to new enrollees at the time of enrollment.
Provide a revised notice to individuals then covered by the plan within 60 days of a material revision.
Notify individuals then covered by the plan of the availability of and how to obtain the notice at least once every three years.
Covered Direct Treatment Providers must also:
Provide the notice to the individual no later than the date of first service delivery (after the April 14, 2003 compliance date of the Privacy Rule) and, except in an emergency treatment situation, make a good faith effort to obtain the individual’s written acknowledgment of receipt of the notice. If an acknowledgment cannot be obtained, the provider must document his or her efforts to obtain the acknowledgment and the reason why it was not obtained.
When first service delivery to an individual is provided over the Internet, through e-mail, or otherwise electronically, the provider must send an electronic notice automatically and contemporaneously in response to the individual’s first request for service. The provider must make a good faith effort to obtain a return receipt or other transmission from the individual in response to receiving the notice.
In an emergency treatment situation, provide the notice as soon as it is reasonably practicable to do so after the emergency situation has ended. In these situations, providers are not required to make a good faith effort to obtain a written acknowledgment from individuals.
Make the latest notice (i.e., the one that reflects any changes in privacy policies) available at the provider’s office or facility for individuals to request to take with them, and post it in a clear and prominent location at the facility.
A covered entity may e-mail the notice to an individual if the individual agrees to receive an electronic notice. See 45 CFR 164.520(c) for the specific requirements for providing the notice.
Organizational Options.

Any covered entity, including a hybrid entity or an affiliated covered entity, may choose to develop more than one notice, such as when an entity performs different types of covered functions (i.e., the functions that make it a health plan, a health care provider, or a health care clearinghouse) and there are variations in its privacy practices among these covered functions. Covered entities are encouraged to provide individuals with the most specific notice possible.
Covered entities that participate in an organized health care arrangement may choose to produce a single, joint notice if certain requirements are met. For example, the joint notice must describe the covered entities and the service delivery sites to which it applies. If any one of the participating covered entities provides the joint notice to an individual, the notice distribution requirement with respect to that individual is met for all of the covered entities. See 45 CFR 164.520(d).
Please review the Frequently Asked Questions about the Privacy Rule.


OCR HIPAA Privacy
December 3, 2002 Revised April 3, 2003

Emergency
Procedures:

Policy: C.A.T.S. will make every effort to provide a safe environment for both the clients and the staff. In order to have a safe environment the clients and the staff must follow the following procedure in the event of an emergency.

Procedure: 1) In the event of a FIRE the clients will exit the building immediately using the front door; the staff will make sure all clients have exited the building, then they will exit also using the front door.
Once all the clients and staff have exited the building, a staff member will call 911 and report the fire. The program director will also be notified.

2) In the event of a MEDICAL emergency, the counselor shall perform emergency first-aid and shall call 911 for emergency services if they are required and will notify the program director.
A: Injury- the counselor will have the injured person moved to the office, if possible without causing further injury, for first -aid treatment. If the person is unable to be moved, the counselor will have all other persons in the room moved to the waiting area.
B: Illness- the counselor will have the ill person move to the waiting area and make arrangements for the person to return to his/her place of residence.
C: Seizure/fainting- the counselor will request all persons in the room to move to the waiting area until such time the person experiencing the fainting or seizure can move to the office; with the person’s permission, the counselor will contact the family or guardian.

Please note: If you elect to enroll in telehealth for your sessions there will be a one-time technology fee of $25.00 

TELEHEALTH & TELEMEDICINE CONSENT FORM 

DEFINITION OF SERVICES:  I hereby consent to engage in telehealth/telemedicine with Certified Addiction Treatment for Substances (C.A.T.S. LLC)   Telehealth/telemedicine is a form of behavioral health and psychiatric service provided via internet technology, which can include consultation, treatment, transfer of medical data, emails, telephone conversations and/or education using interactive audio, video, or data communications. I understand that telehealth/telemedicine involves the communication of my medical/mental health information, both orally and/or visually. Telehealth/telemedicine has the same purpose or intention as psychotherapy and psychiatric treatment sessions that are conducted in person. However, due to the nature of the technology used, I understand that teletherapy may be experienced somewhat differently than face-to-face treatment sessions. I understand that I have the following rights with respect to telehealth/telemedicine: 

CLIENTS RIGHTS, RISKS, AND RESPONSIBILITIES:  

I, the client, have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment. - The laws that protect the confidentiality of my medical information also apply to telehealth/telemedicine. As such, I understand that the information disclosed by me during the course of my therapy or consultation is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality, which is described in the general Consent Form I received at the start of my treatment with C.A.T.S. LLC. - I understand that there are risks and consequences of participating in telehealth/telemedicine, including, but not limited to, the possibility, despite best efforts to ensure high encryption and security technology on the part of my provider, that: the transmission of my information could be disrupted or distorted by technical failures; the transmission of my information could be interrupted by unauthorized persons; and/or the electronic storage of my behavioral health/ medical information could be accessed by unauthorized persons. - There is a risk that services could be disrupted or distorted by unforeseen technical problems. - In addition, I understand that telehealth/telemedicine-based services and care may not be as complete as face-to-face services. I also understand that if my provider believes I would be better served by another form of therapeutic services (e.g. face-to-face services) I will be asked to attend sessions at the agency. - I understand that I may benefit from telehealth/telemedicine, but that results cannot be guaranteed or assured. I understand that there are potential risks and benefits associated with any form of psychotherapy and that despite my efforts and the efforts of my provider, my condition may not improve, and in some cases may even get worse. - If I am experiencing a crisis, I can contact the Colorado Crisis Services at 1(844) 493-8255 (text "Talk" to 38255). In an emergency situation, I understand that I can call 911 or proceed to the nearest hospital emergency room for help. If I am having suicidal thoughts or making plans to harm myself, I can call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255) for free 24-hour hotline support. - I understand that there is a risk of being overheard by anyone near me if I am not in a private room while participating in Telehealth/telemedicine. I am responsible for providing the necessary computer, tablet, or phone and internet access for my telehealth/telemedicine sessions, and for arranging a location with privacy that is free from distractions or intrusions for my session. It is the responsibility of the treatment provider to do the same on their end. - I understand that dissemination of any personally identifiable images or information from the telehealth/telemedicine interaction to researchers or other entities shall not occur without my written consent. - This will be reviewed bi-annually. 

I HAVE READ, UNDERSTAND AND AGREE TO THE INFORMATION PROVIDED ABOVE REGARDING TELEHEALTH/TELEMEDICINE SERVICES AT C.A.T.S. LLC.

Please be advised there will be no cell phones in any group or session. If you are awaiting a call for an emergency, please advise staff prior to your session.  Due to privacy practices no phone is to be in the group rooms or out in any area of the office.  If you chose to use your phone during your break it must be used in the hallway or outside. As of April 9, 2018, a receptacle will be provided for you to leave your phone if you cannot leave it at home or in your car.

Possession of a cell phone in the group room will be a breach of privacy and you will be asked to leave. A private session will be scheduled to discuss re-admittance to your class. Your signature will denote your understanding of CATS cell phone policy. 

Drugs and drug paraphernalia are not allowed on this property or in this office.  Any indication that you have any drugs, to include alcohol and marijuana, in your possession while at CATS will result in immediate dismissal from our program as well as a report to your probation officer. If you have any schedule I drug in your possession the police will be notified. Schedule II through IV must have a valid prescription and be in the original container with all pertinent information.  Some of you have a medical marijuana card. If this is the case, you must provide a copy of your card and sign an agreement regarding use and class.  Possession of this card does not preclude you from dismissal if you bring marijuana products or paraphernalia into this office. 

This is also your reminder that if you are under the influence of alcohol you will be asked to do a BA. If it is positive you will need to have someone come and pick you up and a report will be made to pretrial or probation. If you are believed to be under the influence of drugs you will need to call for a ride to pick you up and testing will be scheduled with your probation officer, pretrial or through us at intervention. You will not be discharged, but further treatment will be discussed.

I understand, that I have access to my service plan and all signed forms through my patient portal at all times

C.A.T.S. LLC

GRIEVANCE PROCEDURE

Any patient of C.A.T.S. LLC may file a grievance if he/she has a concern regarding any issue involving care or any associated services provided by or through AGENCY.  Any grievance regarding any concern of a patient will immediately be referred to the Program Administrator for resolution.  The Program Administrator receives grievances through the following means:

Direct written communication

Direct verbal communication

The Program Administrator is Andrea Hahn.  The Program Administrator may be contacted by writing at:

Ahahn@catsllc.biz

Or phoning at

C.A.T.S LLC: 970-351-0248

Written and verbal grievances can be initiated by the client, guardian, or any other service provider involved in the patient's care.

Unless grievances require immediate resolution, they will be discussed at the monthly Staffing.  At the staffing, the action for resolution will be determined and the Program Administrator will communicate the result back to the client no later than two days after the monthly staffing meeting.

If the situation requires immediate attention. the Project Administrator will obtain the necessary information from the client and counselor to gain better insight into the situation at hand.  In urgent situations which need resolution immediately, the Project Administrator will communicate with the patient within two days of the complaint.

Should the client not be satisfied with the resolution of the grievance, he or she may contact the Behavioral Health Administration.

You may seek a second opinion from another counselor or may terminate therapy at any time.  The practice of certified alcohol and drug abuse counselors is regulated by the Colorado Behavioral Health Administration

If you have a complaint or grievance with any clinician you may contact:

C.A.T.S.. LLC                    Behavioral Health Administration                  DORA

Program Director                   3824 W Princeton Circle             1560 Broadway-Suite 1350

2619 West 11th St. Rd. Ste. 17       Denver, CO 80236                         Denver, CO 80236  

Greeley, CO 80634                             303-866-7400                                303-894-7800       

   970-351-0248     

My signature below indicates I have read and recieved a copy of the grievance procedure above.