THIS NOTICE DESCRIBES HOW HEALTH INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
Our Commitment to Your Privacy:
We at the Arc, Fayette know and understand how important it is to you and your family to keep your personal health information secure and private.We have been committed and will remain committed to the premise of confidentiality. This notice tells you of your rights about the privacy of your personal health information and how the Arc, Fayette may use and share this information.If you are the parent of an Early Intervention child, FERPA requires that you annually receive this notice. A complete list of Early Intervention children is maintained by the State of Pennsylvania. This list is used to link Early Intervention children to needed services. If you are a parent or a consumer of an individual enrolled in any other of our programs, you will only receive updates
If you have any questions about this notice, please contact Brenda Fike, Privacy Officer at brenda.fike@verizon.net or Nancy Davis, Assistant Executive Director at nancy.davis12@verizon.net or at(724) 438-8416. Ms. Fike and Ms. Davis can come to your home if you do not understand this notice.
Information that relates to your son/daughter's health and/or treatment and that identifies your son/daughter is protected under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This notice can be viewed online at any time at: www.arcfayette.org
You have the right to give informed consent before providers can use or share your son/daughter's health care information, even for routine purposes such as treatment or payment. If you do not give consent, you have the right to restrict information if it is to be used for non-routine purposes, such and marketing and fund-raising. You may request that information not be sent to a specific person or agency. This request must be submitted in writing to Arc, Fayette.
We collect and share information from many sources. Keeping your confidentiality is one of our primary jobs. We make sure that only people who need to use your information can get it. We may use and share your information for:
Under HIPAA, Arc, Fayette is a health care provider. Please know that nothing at our agency regarding your information is changing; only better safeguards are being implemented.
OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We keep a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
HOW WE MAY USE AND SHARE HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose health information.
For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment. Information obtained by a program specialist, special instructor, therapist, or any other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you.Examples of this may include:
We may use health information about you to provide you with health care treatment or services.We may disclose health information about you to our Medical Coordinator, billing clerk, program specialist, caseworkers, health students, or other personnel who are involved in taking care of you. For example, SSI may request information regarding your son or daughter in reference to eligibility for disability payments. We will send that information with your written consent.Team members may discuss the goals of your son or daughter to provide better services without specific written consent.
For Payment: A bill may be sent to you or another public source of health coverage that you have identified. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used. Information that may accompany the bill may include:
For Health Care Operations:Member of a quality assurance team may use information in your health record to assess the care and outcomes in your case and others like it.This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide. To best service our individuals and families, we need information about you.This may include:
We also receive information from other public agencies, such as Fayette County MH/MR Program Office, The Office of Vocational Rehabilitation (O.V.R.), The Office of Medical Assistance, etc.This information may be in the form of a written intake, referral or billing inquiry.We may receive information in writing, a telephone call, or electronically. We may use and disclose health information about you for operations of our agency. These uses and disclosures are necessary to run our agency and make sure that all of our individuals receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many individuals to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who our specific individuals are.
Fundraising Activities: We may use pictures and/or names of individuals to promote public awareness; this may include newspaper articles and/or pictures or brochures.We will always get consent from the parent/guardian before this is done.
As Required By Law.We will disclose health information about you when required to do so by federal, state, or local law e.g., our Business Associates.An Example of this may be when an Auditor comes in to compare an individual's file in regards to billing.
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Coroners, Health Examiners and Funeral Directors. We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records. This does not include psychotherapy notes. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to Brenda Fike, Privacy Officer. If you request a copy of the
information, we may charge a fee for the costs of copying, mailing or other supplies and
services associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by our practice will review your request and the denial.
The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to an Accounting of Disclosures. You have the right to request a list accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described.
To request this list of disclosures, you must submit your request in writing to Brenda Fike, Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date will not exceed a total of 60 days from the date you made the request.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we restrict a specified therapist or another agency from use of your information.
We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request in writing to Brenda Fike, Privacy Officer. In your request, you must tell us what information you want to limit and to whom you want the limits to apply; for example, use of any information by a specified therapist, or disclosure of a diagnosis to your family.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box.
To request confidential communications, you must make your request in writing to Brenda Fike, Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice at any time. To obtain a copy, please request it from Brenda Fike, Privacy Officer.
You may also obtain a copy of this notice by requesting a copy be sent through electronic mail to brenda.fike@verizon.net. If we know that the electronic message has failed to be delivered, a paper copy of the notice will be provided. Even if you have received a notice electronically, you still retain the right to receive a paper copy upon request.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register for treatment or health care services, we will offer you a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact Brenda Fike, Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION.
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Acknowledgement of Receipt of this Notice We will request that you sign a separate form or notice acknowledging you have received a copy of this notice. If you choose, or are not able to sign, a staff member will sign their name, date. This acknowledgement will be filed with your records.
The Arc, Fayette County
INCIDENT MANAGEMENT AND ABUSE POLICY
It is the policy of the Arc, Fayette to establish procedures for the prevention and management of incidents in accordance with MR Bulletin 6000-04-01. Incident management is the:
Use of incident data to protect those we serve from harm. These procedures outline agency responsibilities that promote the health, the safety, the rights and the dignity of individuals receiving services, by providing quality services in a caring and hospitable environment. This process assures that the Arc, Fayette will develop and implement practices for:
Reportable incidents include, but are not limited to the following list. Employees should refer to MR Bulletin 6000-04-01 for the definition of each reportable incident. Reportable incidents must be reported within 24 hours and include:
Incidents to be reported within 72 hours
Medication error includes:
Restraints any type of restraint that restricts movement or function That are approved as part of an ISP or those that are used on an emergency basis.
Abbreviated incident reports are to be used.
Those categories requiring reporting within 72 hours must have a 30 day analysis completed and maintained by ARC.
Incidents Requiring Investigation
An investigation is the systematic collection of information to describe and explain an event or series of events. According to MR Bulletin 6000-04-01, the following are reportable incidents that require investigation. In addition, The Arc, Fayette reserves the right to investigate any incident of its choice.
Refer to Page 15 of New Bulletin #6000-04-01.
Any reportable incident, in which the CEO or Board of Directors of an organization is the target of the investigation, requires outside investigation by the County or OMR.
When an incident occurs on a weekend or holiday,the point person is required to initiate the web-based initial notification to OMR within twenty-four (24) hours of the incident occurring or of the time the supervisor becomes aware of the incident.
A:Ascertain and secure the safety of the individual(s)involved in the incident.
B:Assure notification requirements of the Older Adult Protective Services Act and Child Protective Services Law are met as applicable.
C:Point person will follow ARC policy and report all incidents,
and will follow MR Bulletin 6000-04-01
D:Determine if an incident should be a site report or multiple individual reports.
E:Assign an investigator promptly
F:Notify appropriate personnel within twenty-four (24) hours of the incident.
G:Initiate web-based initial notification within twenty-four (24) hours.MR Bulletin 6000-04-01.
H:Notify family within twenty-four (24) hours unless otherwise indicated by the individual.
I:Identification of all persons to whom initial notification has been or will be submitted, the date, time and method by which notification has been made, and the person who has/will notify the necessary parties.
The final section is to be submitted through HCSIS within 30 days of the incident being recognized or discovered.
Reporting discussion of any incident will not be done in any shared and/or public office. Only the Point Person, Administrator or assistant CEO will assign certified investigators.
Suspected Abuse and Neglect
Where applicable, the point person or their designee is responsible for ensuring oral notification to the Area Agency on Aging (AAA) immediately; written notification within forty-eight (48) hours of making the oral report on forms prescribed by Pennsylvania Department of Aging (PDA.)If the incident involves sexual assault,serious physical or bodily injury, or suspicious death, in addition to contacting AAA, the point person shall immediately make an oral report. In addition, any notification requirements of the Child Protective Services Law must be made, if applicable. Law enforcement agencies shall also be notified.
The Arc, Fayette is a facility covered under the Older Adults Protective Services Act (OAPSA), Chapter 7 (often referred to as Act 13).In order to comply with the requirements detailed in the Act,all employees of the Arc, Fayette, who have reasonable cause to suspect that an individual receiving services is a victim of abuse or neglect as defined in MR Bulletin 6000-04-01, are mandated to immediately make a report in accordance with the steps outlined in the Reporting Procedure.If the person receiving services is a child under 18, Child Line will also be notified.
In addition, the Arc, Fayette will take the following action to protect the health, safety and rights of those we serve:
The investigation record includes the incident report, evidence, witness statements, and the certified investigator's report. The investigation record is to be secured and separate from the individual's record. Individuals and families (unless otherwise indicated by the individual) shall be notified of the outcome of all investigations.A summary of the investigator's report shall be entered into standardized web-based incident report.The final report will be completed by the provider within thirty (30) days from the date of the incident or of the date the provider learns of the incident.
The Arc, Fayette has employees who are Certified Investigators through the Office of Mental Retardation.Only those certified employees will be assigned to investigate incidents.The Point Person, or, if necessary, the Executive Director/Assistant Executive Director will assign the certified investigator.Whenever possible, the Certified Investigator's immediate supervisor should make every attempt to relieve the investigator of his or her regular responsibilities for the duration of the investigation.
In order to minimize possible conflicts of interest, whenever possible, every attempt will be made to ensure that Certified Investigators will not be assigned to a program area they work in.The investigator should immediately notify the Executive Director or their designee, of any conflicts of interest that may exist that would prohibit them from performing a thorough and objective investigation.Should any conflicts of interest exist, an alternative Certified Investigator will be assigned to the case.
Employee Access to HCSIS
As outlined in MR Bulletin 6000-04-01, all incident reports will be filed on OMR's web-based Home and Community Services Information System (HCSIS).Employees will be granted access to the system based upon their job requirements.Employees requesting access will need to submit the (see attached) to the HCSIS Administrator.Once access has been granted by the HCSIS Administrator or Incident Management Representative, the HCSIS Administrator will assign a password to the employee.Access will be revoked immediately upon termination of employment for whatever reason, or at any time at the discretion of management personnel of the Arc,Fayette.
The Arc, Fayette is committed to protecting the health; safety and rights of those we serve by providing quality services in a caring and hospitable environment.The following proactive measures are taken to reduce the probability of incidents occurring.
All staff shall receive training in the prevention, management and reporting of incidents prior to working with persons who receive services and annually thereafter. Upon orientation, and prior to working with individuals receiving services, staff shall receive a copy of the agency's policy on Incident Management and Abuse and will review this policy with staff.Training is presented by certified investigators and the curriculum includes:
After the initial training, all staff shall be required to receive this
training on an annual basis.
As part of an overall risk management and quality improvement process, an Incident Review Committee will meet no less than quarterly to conduct trend analysis of all documented incidents.Incident reports are to be reviewed individually to determine if agency action has been appropriate and sufficient.They are also to be reviewed in aggregate to determine if trends may be developing that may warrant further intervention.The Incident Review Committee will assess the effectiveness of the incident management process and may recommend further administrative action.Administrative responses may include, but not be limited to referral to the Health Care Quality Unit, revision of an individual plan of support, or any other action necessary to promote the health, safety and rights of individuals served.At a minimum, the Incident Review Committee will consist of the following:
Using system generated data, the Arc, Fayette will complete and file quarterly reports with the county within thirty days of the end of the calendar quarter. The report will include:
A Peer Review Committee will meet to review the quality of investigations no less than quarterly. The Peer Review Checklist #1 Review of Incident Investigations and Checklist #2 Completeness of Witness Statements will be used in obtaining objective information about the quality of the investigation process.The committee will consist of at least three members; this committee should have training in conducting investigations. If there were more than five investigations in the quarter 20% random sample will be used; if less than five, all investigations will be reviewed. An investigator will not review any cases he/she investigated. Copies of the completed checklists will be provided to investigators whose investigations have been reviewed for feed back purposes.
For in-depth explanations refer to:
Mental Retardation Bulletin
(Commonwealth of Pennsylvania)
Department of Public Welfare
Date of Issue:February 18, 2004,
Effective February 28, 2004- #6000-04-01
IM Representative Nancy Davis
Administrator & Data Entry Brenda Fike Kim Kopec
Point Person Geri Kacmar-Martin
Certified Investigator Neil Dinan, Kim Ross Nancy Pohaski, Patti Jo Crawford, Michael Dinan
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