Notice of Privacy Practices

Statement of Privacy Practices

ASI is required to provide you with a copy of this Notice and document your receipt. Please sign and return the Acknowledgement of Receipt of Notice after receiving and reading this Notice.

ASI is dedicated to protect the privacy rights of our participants and the confidential information entrusted to us. The commitment of each ASI employee to ensure that your health information is never compromised is a principal concept of our practice. We may, from time to time, amend our privacy policies and practices, but will always inform you of any changes that might affect your rights.

Protecting your Personal Healthcare Information

ASI use and disclose the information we collect from you only as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and the State of Indiana. This includes issues relating to your treatment, payment, and our operations. Your personal health information will never otherwise be given to anyone, even family members, without your written consent. You, of course, may give written authorization for us to disclose your information to anyone you choose, for any purpose.

ASI’s offices and electronic systems are secure from unauthorized access and our employees are trained to make certain that the confidentiality of your records is always protected. Our privacy policy and practices apply to all former, current, and future participants, so you can be confident that your protected health information will never be improperly disclosed or released.

Collecting Personal Health Information

We will only request personal information needed to provide our standard of quality services, implement payment activities, conduct normal operations, and comply with the law. This may include your name, address, telephone number, socials security number, employment data, medical history, health records, etc. While most of the information will be collected from you, we may obtain information from third parties if deemed necessary. Regardless of the source, your personal health information will always be protected to the full extent of the law.

Disclosure of your Protected Health Information

As stated above, we may disclose information as required by law. We are obligated to provide information to law enforcement and governmental officials under certain circumstances. We will not use your information for marketing purposes without your written consent. We may use and/or disclose your health information to communicate reminders about appointments, including voicemail messages, answering machine messages, and letters or postcards. Participant Rights You have the right to request copies of your healthcare information, to request copies in a variety of formats, and to request a list of instances in which we, or our business associates have disclosed your protected information for uses other than stated above. All such requests must be in writing. We may charge you for copies in an amount allowed by law. If you believe your rights have been violated, we urge you to notify us immediately. You can also notify the U.S. Department of Health and Human Services.

NOTICE OF PRIVACY PRACTICES AND POLICIES (effective 1/1/2015)

AS REQUIRED BY FEDERAL LEGISLATION, THIS NOTICE DESCRIBES HOW HEALTHCARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice applies to all paper and electronic records of your care maintained by ASI, whether created by ASI, ASI staff, or records acquired from outside resources. You are encouraged to keep a copy of this notice for your records and reference.

Ways ASI May Use and Disclose Your Information

The following categories describe ways that ASI uses and shares your confidential information. Confidential information includes Protected Health Information (PHI), information that could be used to identify you. Not every use or disclosure in a category is listed. However, all of the ways ASI is permitted to use and disclose information will fall into one of the following categories.

Disclosures Which Require Authorization

Confidential information may be released for payment and healthcare operations only to health insurance plans and their agents, as well as business associates of ASI. The definition of a health insurance plan does not include life insurance, automobile insurance, or worker’s compensation carriers. These are NOT covered under HIPAA. If you would like information submitted to one of these companies, an authorization will be required, unless it is already mandated by state or federal law.

Routine Situations

1. For service provision. ASI may use information about you in order to provide appropriate services.

2. For payment. ASI may use and disclose information about you so that services may be billed and payment can be collected from State funding, insurance, or other sources.

3. For Healthcare Operations. Members of the ASI staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all of the patients we serve. We may also use and disclose information to remind you that you have an appointment, assess your satisfaction with our services, to tell you about benefits or services. When disclosing information, primarily reminders and billing efforts, we may leave messages for you on your answering machine / voicemail.

4. Communications. ASI may communicate with you via newsletters, mailings, or other means regarding intervention options, health related information, health programs, research projects, or other community based initiatives or activities we may be participating in. In certain circumstances, ASI may share information about you with an individual involved in your care or payment for your care unless you have requested that such disclosures not occur and ASI has agreed. Whenever possible, this individual will be a parent or guardian, or someone specifically designated by you. Shared information will be directly relevant to the services ASI is providing. In the case of an emergency, we may need to share information about you with other individuals, organizations, or other entities to coordinate your care and /or notify your family.

Special Situations

Law Enforcement – ASI may disclose health information to a law enforcement official for purposes such as providing limited information to locate a missing person or to report a crime.

For Judicial or Administrative Proceedings – ASI may disclose protected health information as permitted by law in connection with judicial or administrative proceedings, such as in response to a court order, search warrant, or subpoena.

State Specific Requirements – Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may apply additional legal requirements. If the state laws are more stringent than federal privacy laws, the state law preempts the federal law.

Your information may be disclosed to a health oversight agency for activities authorized by law. These may include: audits, investigations, inspections, and compliance.

Health and Safety

Your information may be disclosed to law enforcement officials to respond to a violent crime or to protect the target of a violent crime. Your information may be disclosed, without authorization, if there is any indication of imminent danger to your health and safety or that of another individual.

Public Health Risks

Your information may be disclosed for public health activities which may include:

• To prevent or control disease, injury, or disability

• To report child abuse or neglect

• To report adult and domestic abuse

• To report reactions to medications or problems with products

• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

• To notify the appropriate government authority if we believe a participant has been the victim of abuse, neglect, or domestic violence.

ASI’s PRACTICE DUTIES

In addition to your rights as a participant, we have duties to protect your confidential information and inform you of changes to protection measures. ASI is required by law to maintain the privacy of confidential information and to provide you with notice of our legal duties and privacy practices with respect to such information. ASI is required to abide by the terms of this Notice currently in effect.

ASI Reserves the right to revise or change provisions in this Notice. Participants will be notified of any new Notice provisions via the email address on file or the physical mailing address on file. Participants who are not actively being served by ASI may receive the updated provisions at the time of their next scheduled visit or interaction.

The most current version of policies, provisions, requirements, and other documents can be found on the ASI website (www.inautism.org), or by calling 800-609-8449 x77.

Dana Renay, Chief Executive Ally is the Compliance officer for the Autism Society of Indiana. She may be reached by phone at 800-609-8449 x11 or via email at dana@inautism.org

Download Notice of Privacy Practices