CONFIDENTIALITY At the end of this training, you will have a post-test to complete. GOOD LUCK!

PURPOSE To promote an understanding of the rules and regulations regarding confidentiality of protected health information of individuals served. To become familiar with what information is considered confidential and how to handle situations involving collecting and sharing of protected health information.

Important Reasons for Confidentiality To protect the personal rights of the individuals served. To prevent disclosure of the individual's contact with Pineland MHDDAD Services To ensure proper use of confidential information

What is confidential information? Any information that might be potentially damaging or sensitive and is clearly intended for only restricted and controlled disclosure to those outside the provider system is considered confidential information.

For confidentiality purposes, who is considered an “individual served”? Any person who consults with or is interviewed, examined, or treated by a provider. The words “individuals served” not only includes a person formally enrolled in a treatment program, but also any person making inquiries about or expressing an interest in receiving clinical services.

WHO IS A SERVICE PROVIDER A service provider is any person who provides examination, care, custody, treatment, or support or who hears, sees, reads or writes confidential information. ******YOU ARE A SERVICE PROVIDER!******

WHY GATHER INFORMATION? To identify a person’s problems or needs. To structure a treatment program. To determine an individual’s success with treatment.

All information and records are confidential All information and records are confidential. Persons served are protected by HIPAA (the Health Insurance Portability and Accountability Act) and all relevant chapters of the code of federal regulations and the official code of GA.

Thee (3) categories of confidential information The individual record Informal information Privileged communication

Five Areas of Potentially Damaging Information (Whether written, computerized, or verbal) The fact that a person is or has been served by the agency. Information given by the individual in the course of treatment, diagnosis, or other services. Information regarding an individual given by members of family or other persons. Any diagnosis, opinions, summaries, or instructions issued by providers concerning the individual. Any other personal data, which if released, could be detrimental to the best interests of the individual

WHAT DO WE TELL THE INDIVIDUAL ABOUT INFORMATION SHE/HE TELLS US? THAT THE INFORMATION WILL BE SHARED WITH THOSE SERVICE PROVIDERS WHO ARE INVOLVED IN HER/HIS TREATMENT. THAT THE INFORMATION WILL BE RECORDED THAT PINELAND MHDDAD HAS A CONFIDENTIALITY POLICY TO PROTEXT HER/HIS RIGHTS.

Notice of Privacy Practices A notice that provides a clear explanation of Pineland’s privacy practices and the privacy rights of individuals regarding their personal health information. This notice is given to all individuals seeking or receiving services.

Privacy Officer Pineland MHDDAD has a Privacy Officer who is responsible for receiving complaints and for providing privacy practice information. This person can provide information regarding the complaint process for any individual who suspects, or has reason to believe, that a violation of confidentiality has occurred. Pineland will not take any form of retaliatory action against any individual for filing a complaint relating to privacy rights or privacy policies and practices of the agency.

INQUIRIES ABOUT INDIVIDUALS SERVED SHALL*** PROTECT THE INDIVIDUAL’S CONTROL OVER PROTECTED INFORMATION NOT VIOLATE CONFIDENTIALITY BUT PROVIDE A COMPREHENSIVE EXPLANATION WHEN INQUIRIES OF FRIENDS, RELATIVES, ETC. CANNOT BE SATISFIED. Example: “the information you are requesting is confidential and I am unable to assist you” BE REFERRED TO THE SUPERVISOR, SITE MANAGER OR COORDINATOR AS APPROPRIATE.

DOES AN INDIVIDUAL HAVE TO GIVE WRITTEN AUTHORIZATION FOR RELEASE OF RECORDS? Except for certain situations, a provider cannot release an individual’s records unless the individual has provided a valid written, signed, specific, and time-limited authorization. Specific authorizations must be given for psychotherapy notes and for documents with HIV-related information.

WHO CONTROLS ACCESS TO AN INDIVIDUAL’S MENTAL HEALTH RECORDS? Individuals age 18 or older control the release of their records unless the court has assigned legal guardianship. Persons under 18: Generally, the parent controls the release of records. Persons Adjudicated Incapacitated: Generally, the guardian controls the release of records. Deceased Persons: The individual’s chosen executor or administrator of the estate controls the releases of records. If there is no chosen person, the court must appoint such a person.

INFORMED CONSENT Informed consent is a written statement signed by the person served which gives permission for certain information to be released. Specific consent must be given by the individual for the disclosure of information concerning testing for HIV and/or treatment for HIV or AIDS, and any related information.

WHEN CAN A PROVIDER DISCLOSE PROTECTED HEALTH INFORMATION WITHOUT THE INDIVIDUAL’S CONSENT? Disclosure without individual consent is permitted for: Emergency treatment of the individual; Payment (such as to insurance companies); Certain health care operations (such as disclosure to agencies charged with evaluating the provider). Information is disclosed to an employee or staff member of the facility providing services. An involuntary person is transferred to another facility.

WHEN CAN A PROVIDER DISCLOSE PROTECTED HEALTH INFORMATION WITHOUT THE INDIVIDUAL’S CONSENT CONTINUED… Disclosure without consent is also authorized in limited circumstances relating to the “public interest,” including: When required by law (such as a statute or court-ordered warrants) When appropriate to notify authorities about victims of abuse, neglect, or domestic violence; For certain law enforcement purposes (such as to identify or locate a suspect or missing person) When necessary to prevent or lessen serious and imminent threat to a person or the public. In those situations above when disclosure can be made without individual consent, the provider must limit the information disclosed to the minimum necessary to accomplish the intended purpose of the disclosure.

RELEASE OF SUBSTANCE ABUSE OR HIV INFORMATION Specific authorization or a court order is required for release of substance abuse and HIV information. Individual confidentiality is governed by many detailed laws and regulations. These include: HIPAA (regulations at 45 CFR Parts 160 and 164), the federal law related to privacy of health information; Federal substance abuse law (regulations at 42 CFR Part 2); State mental health confidentiality law (34-BM.M.R.S.A 3608) Federal protection and advocacy agency regulations (42 CFR Part 51); and State mental health confidentiality regulations (Rights of Recipients of Mental Health Services, Part A (IX) and Rules Governing the Disclosure of Information Pertaining to Mentally Disabled Individuals).

Substance Abuse Individuals A court order is required before a law enforcement officer may be informed whether this person is or has been served by the agency. A show of cause hearing may be held to determine if information will be released. Substance abuse individuals are protected by much stricter federal regulations. All communication concerning individuals receiving substance abuse services is considered a privileged communication. Records pertaining to alcohol abuse or drug abuse shall not be produced in response to a subpoena alone Records which are produced must bear notice to the recipient concerning restrictions on further use or disclosure by the recipient.

Tarasoft Decision 1974 Incident 1976 Decision reversed Now if victim identified… Warn the victim Notify Police Take whatever steps necessary to protect the victim

Privileged Communication Gives the individual the legal right to keep certain persons from testifying in court about her/his treatment Privileged communication exists between the individuals served and her/his psychiatrist, or a licensed applied psychologist, licensed clinical social worker, clinical nurse specialist, licensed professional counselor or licensed marriage and family therapist during psychotherapy. This information can be required to be disclosed only under certain circumstances All communication concerning individuals receiving substance abuse services in considered privileged communication.

Mandatory Reporting Providers subject to mandatory reporting related to suspected abuse, neglect, or exploitation, or to suspected misconduct of certain professional licensees may release the information required by the reporting statutes, but may not disclose any others confidential information beyond the minimum required by the reporting statutes.

Release to Disability Rights Center Advocates Providers can release records to advocates of individuals with developmental disabilities if the individual or guardian gives permission.

Confidentiality Post-Test Why is confidentiality important? What is confidential information? Define “individual served” Define “provider” Are you a provider? What Federal Law protects health information? What is the name of the form given to individuals served to explain privacy practices and their rights regarding protected health information? What is the role of the Agency’s Privacy Officer?

Is informed consent necessary when: The individual served requests information from her/his own records to be released to any person or facility she/he designates. In the course of a criminal investigation, a law enforcement officer may be informed whether a person currently or has received substance abuse services. Information is shared between Pineland Programs. An involuntary individual needs to be referred for further treatment at an inpatient psychiatric hospital. The record is to be released to the individual’s attorney. In the course of a criminal investigation, a law enforcement officer may be informed whether a person is or has been served by Pineland’s MH or DD program. A medical emergency exists, determined by a physician, and medical information is required for immediate diagnosis and treatment. An attorney for a person served needs to interview staff in order to advise and represent the individual served. The record of a voluntary individual is to be released or transferred to another treatment facility. Authorized evaluators, researchers, or other persons conducting research after signing a confidentiality agreement with the agency. You become aware or have reason to believe an individual may be a victim of abuse.  A financial clerk bills for payment, such as billing an insurance company.

You receive a call from the emergency room of the local hospital regarding Mrs. Brown, an individual living in your group home who is home on a trial visit. The caller tells you that Mrs. Brown is unconscious and they need to know if she is diabetic and what medication she is on. What should you do? a. take the caller’s name/number and contact the attending physician b. give the information the caller requested c. refuse to give the information and hang up You have had a really bad day at work, several people were late, others had crises, etc. After work you run into a friend at the grocery store and complain to them about your horrible day, you give a brief outline of the day’s events, mentioning no names, but including some other details, Was confidentiality breached? A co-worker has a talent for making the entire office laugh by telling stories of different individuals and their behaviors, although the co-worker does mention names, they are careful to do so only when no non-staff members are around. Was confidentiality breached? As a former co-worker who now works at DFACS is telling you about a DFACS client, you realize that the person currently receives services at Pineland. You know some additional information that your former co-worker obviously does not know. Can you tell them? The father of a 12-year-old calls you for some information about his child. In the child’s chart you see a note that the parents divorced and the mother has custody. What information can you give the father?