Community Counseling Associates

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
Community Counseling Assocociates (CCA) has developed this Notice of Privacy Practices (*Notice*) to comply with the Health Insurance Portability and Accountability Act of 1996 (*HIPAA*). HIPAA was enacted by Congress to establish standards for protecting the confidentiality and security of your health information.

Community Counseling Associates (CCA) and its employees follow the privacy practices described in this Notice.  This Notice describes the general ways your protected health information may be used and disclosed in order for CCA to administer your benefits, and to facilitate CCA to administer your benefits, and to facilitate CCA health care operations.  Protected health information, as described by HIPAA, means your personal health information, which is found in your medical and billing records and which relates to your past, present, or future physical or mental health conditions or the provision of payment for services related to payment and health care operations and activities, this may include information created or received by health care providers, benefit plan sponsors, and insurance companies.

Your Health Information Rights
As a member receiving services from CCA, you have the following rights regarding your protected health information. To exercise any of the following rights, regarding your protected health information, you must submit a written request on a form provided by CCA. The form can be obtained by contacting the CCA Privacy Officer at (281) 447-7230.

Right to a copy of this Notice.  You may obtain a paper copy of this notice at any time, even if you have been provided with an electronic copy, by contacting CCA at (281) 447-7230.  You do not have to submit a written request to obtain the Notice.

Notice of Privacy Practices

Right to inspect and copy.  You have the right to inspect and/or receive a copy of your protected health information maintained by CCA.  CCA may charge you a reasonable fee for copying your information.

Right to request amendment.  If you believe your protected health information maintained by CCA is incorrect or incomplete, you may request an amendment to your information.  CCA is not required to agree to your request.

Right to request restriction.  You may request limitations on how CCA uses and/or discloses your protected health information. For example, you may ask CCA to not disclose that you have had a particular procedure. CCA agrees to your request unless the use or disclosure is necessary in order to provide you with emergency treatment or is otherwise required by law.

Right to receive confidential communications.  You may request that communications from CCA regarding your protected health information be provided to you in an alternative way or at an alternative location. If you state that the disclosure of all or part of your protected health information go to an address other than your usual mailing address,
you must specify in writing how or where you wish to be contacted.

Right to accounting of disclosures.  You may request a list of CCA's disclosures of your protected health information that have been made to the persons or entities other than for the purposes of health care treatment, payment or operations, or pursuant to your specific authorization.  This will contain each disclosure CCA has made for the past six (6) years, but not prior to April 14, 2003.  If you make more than one request in a 12-month period, CCA may charge you a reasonable fee.

CCA Responsibilities

CCA is required by law to:
1. Ensure your protected health information, that identifies you, is kept private in accordance with federal and state law: and Provide you with this Notice of CCA*s legal duties and privacy practices with respect to your protected health information; and

2. Follow the terms of this Notice as long as it is in effect.  

Use and Disclosure of Your Protected Health Information
The following is a list of ways CCA may use and disclose your protected health information.  Each bold-faced section provides you with examples of how your information will be used and/or disclosed.  Not every possible use or disclosure is in any given section listed, however, all of the ways CCA is permitted to use and disclose information will fall within one of the bold-faced print sections below.

Treatment.  CCA may disclose your protected health information to doctors, dentists, pharmacies, hospitals and other health care providers who provide medical treatment services to you.  For example, a psychiatrist  may request protected health information from CCA to supplement their own records to ensure they are informed about your medical condition and treatment needs.  

Payment.  CCA may use and disclose your protected health information to help pay for your covered services in a number of ways, including but not limited to: conducting utilization and medical necessity reviews; coordinating care; determining eligibility; determining formulary compliance; collecting premiums; calculating cost-sharing amounts; coordinating of benefits with other insurers; claims adjudication and settling subrogation claims; and responding to complaints, appeals and requests for external review.  For example, CCA may use your protected health information to decide whether a particular treatment is medically necessary and may disclose this information to your provider.

HealthCare Operations.  CCA may use and disclose your protected health information for routine health care operations. Health care operations at CCA include quality improvement, credentialing of providers, outcomes assessment, preventive health, care coordination, administration of reinsurance and stop loss; underwriting and rating; detection and investigation of fraud, and other general administrative activities, including data and information systems management and customer service. For example, CCA may use your protected health information when assessing how a particular treatment affected your particular outcome.  CCA may also disclose your protected health information to your health care providers to assist in their health care operations.

Appointments and Alternatives.   CCA may use and disclose your health care information to contact you to provide appointment reminders or information about our programs and other communications regarding your case management or care coordination.

Business Associates.  CCA may disclose your protected health information to business associates in order to carry out treatment, payment, or health care operations.  For example, CCA may disclose your protected health information to a company who prepares CCA documents for billing or transcription purposes.

Correctional Institutions.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, CCA may disclose your protected health information to the correctional institution to provide you with health care, to protect your health and safety of others, or for the safety and security of the correctional institution.

Health Oversight Activities.  CCA may disclose your protected health information to a health oversight or regulatory agency or entity for activities authorized by law, such as audits, investigations, inspections, and licensure.

Health-Related Benefits and Services.  CCA may disclose your protected health information to a family member, other relative, or close personal friend who is involved in your medical care or in the payment for your medical if the protected health information disclosed is directly relevant to such person*s involvement, unless you tell CCA otherwise.  For example, if a family member or caregiver calls CCA with prior knowledge of a claim.  CCA may confirm whether or not the claim has been received and paid.

Law Enforcement.  CCA may disclose your protected health information for law enforcement purposes, as required by law or in response to a valid subpoena.

Lawsuits and Disputes.  CCA may disclose your protected health information in response to a court or administrative order. In addition, CCA may disclose your protected health information in response to a valid subpoena, discovery request or to obtain an order protecting the information requested, as requested by law.

Medical Examiners.  CCA may disclose protected health information to health examiner in coordination with your physician to identify a deceased person or to determine the cause of death, or as otherwise permitted by law.

Public Health Activities.  As required by law, CCA may disclose your protected health information for public health activities, including, but not limited to, reporting child abuse or neglect; notifying government authorities of suspected abuse, neglect or domestic violence.  

Research.  CCA may disclose your protected health information to researchers when the research has been legally approved and protocols have been established to ensure the privacy of your protected health information.

Serious Threat to Health or Safety.   CCA may use and disclose your protected health information when CCA deems it necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Worker*s Compensation.  CCA may disclose your protected health information to worker*s compensation or similar programs to the extent necessary to comply with laws relating to worker*s compensation or similar programs.

Written Authorization.  Except as described above, CCA will not use or disclose your protected health information unless you authorize such use or disclosure to CCA in writing, on the form provided by CCA.  You may revoke such authorization by providing a completed Revocation of Authorization form to CCA. A written revocation will not apply to any previous use or disclosure of protected health information made in good faith under prior authorization.  CCA has an Authorization Form and a Revocation of Authorization form available for your use and can be obtained by contacting the CCA Privacy Officer at (281) 447-7230.

Changes to this Notice.  CCA reserves the right to change this Notice from time to time.  CCA reserves the right to make the revised Notice effective for protected health information CCA already has about you as well as any information  CCA receives in the future.  The revised Notice will be provided to you in writing within 60 days of the changes. Additionally, a copy of the current Notice will be posted in the CCA office on the effective date of the Notice or summary. In addition, you may request a copy of the current Notice in effect at any time from the CCA privacy officer.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with CCA or with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint to CCA or the United States Department of Health and Human Services.

If you wish to file a complaint with CCA, you may contact the CCA Privacy Officer at (281) 447-7230.

If you wish to file a complaint with the Secretary of the United States Department of Health and Human Services, you may write to:

Region VI
Office of Civil Rights
U.S. Department of Health and Human Services
1302 Young Street
Suite 1169
Dallas, TX 75202


Contact

If you have any questions about this Notice of your privacy rights, or wish to obtain a form to exercise your rights as described above, you may contact the CCA Privacy Officer at (281) 447-7230 or write to:

Community Counseling Associates
ATTN: Privacy Officer
P.O. 691288
Houston, TX 77269-1288