HIPAA Notice of Privacy Practices

Prairie Spring Health LLC is subject to and must comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other laws protecting the confidentiality, privacy, security, and availability of protected health information (“PHI”). This Notice of Privacy Practices describes how Prairie Spring Health LLC and it’s employees and providers (herein referred to as “PSH LLC”) may use and disclose your PHI to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services. This Notice is effective as of the date posted at the top of this Notice.

PSH LLC is dedicated to maintaining the privacy of your PHI. We are required by HIPAA to provide you with this Notice describing our legal duties and privacy practices. The terms of this Notice apply to all records containing your PHI that are created and/or retained by PSH LLC. We reserve the right to revise or amend this Notice at any time. Any revision or amendment of this Notice will be effective for all of your records that PSH LLC has created or maintained in the past and any of your records we may create or maintain in the future. A copy of our current Notice is posted in our reception area and on our webpage. By law, we must follow the terms of the Notice in effect at the time. You may request a copy of our current Notice at any time. Bear in mind that the information we disclose in accordance with this Notice might potentially be subject to redisclosure by the recipient and no longer protected under HIPAA.

1. How PSH LLC May Use and Disclose Your Health Information. PSH LLC may use and disclose your health information for the following purposes without your written authorization:

A. Treatment: We may use and disclose your PHI to provide, coordinate, or manage your care. This includes the use/disclosure of your PHI for treatment purposes by/to healthcare providers within and outside of PSH LLC, such as other mental health providers, physicians, and other personnel involved in your care and treatment. For example, if a clinician were to consult with another licensed health care provider about your condition, PSH LLC would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

B. Payment: We may use and disclose your PHI to bill and obtain payment for services provided. This may include disclosures to you, an insurance company, or another third-party payor. We may also tell your health plan about a treatment you are going to receive in order to obtain prior authorization or to determine whether your plan will cover treatment. We may disclose your PHI to other healthcare providers and health plans for payment activities of those other providers and plans. For example, we may provide your PHI to a provider who is not affiliated with PSH LLC so that the provider may bill you or your insurer for services you received from that provider.

C. Healthcare Operations: We may use and disclose your PHI for administrative, quality improvement, staff training, and other operational purposes in the course of running our business. These uses and disclosures are necessary for our operations and to make sure that all clients receive quality care. We may disclose your PHI to other individuals and organizations, including physicians, hospitals, and/or health plans, to assist with the healthcare operations activities of such individuals and organizations, so long as they have a treatment relationship with you. Student therapists and interns may be assisting with your case under the supervision of a licensed mental health practitioner as part of their professional training program; this is considered a part of our healthcare operations. These are just some of the various uses and disclosures of your PHI that PSH LLC may engage in as part of its routine healthcare operations. 

2. Other Uses and Disclosures Without Your Consent. Subject to certain limitations in the law, PSH LLC can use and disclose your PHI without your written authorization for the following reasons:

A. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

B. For authorized state and federal public health activities, such as to report adverse reactions to medications and/or to notify a person who may have been exposed to, or be at risk for contracting or spreading, a disease or condition. 

C. To report suspected child, elder, or dependent adult abuse, or if we believe that you have been a victim of abuse, neglect, or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable law and with due regard for the safety of the individual.

D. To prevent or reduce a serious threat to anyone’s health or safety. Any such disclosure, however, would only be to someone able to help prevent the threat and/or to identified victims of the threat.

E. To a state or federal agency for health oversight activities, including audits and investigations.

F. For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an Authorization from you before doing so. If you are involved in a lawsuit, PSH LLC may disclose health information in response to a court or administrative order. PSH LLC may also disclose health information about you or your child 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.

G. For law enforcement purposes, including reporting crimes occurring on our premises.

H. To coroners or medical examiners, when such individuals are performing duties authorized by law, or to a funeral director as needed to carry out his/her duties.

I. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

J. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

K. For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, PSH LLC may provide your PHI in order to comply with workers’ compensation laws.

L. Appointment reminders and health related benefits or services. PSH LLC may use and disclose your PHI to contact you to remind you that you have an appointment with PSH LLC. PSH LLC may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that PSH LLC offer.

M. Business Associates. PSH LLC may disclose your PHI to various third-party entities that provide certain services for PSH LLC that involve access to your PHI. We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the privacy and security of your PHI in accordance with HIPAA.

3. Certain uses and disclosures require you to have the opportunity to object. 

A. Disclosures to family, friends, or others: PSH LLC may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

4. Uses and Disclosures Requiring Your Authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke that authorization in writing at any time. 

A. Psychotherapy Notes: PSH LLC providers keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your written authorization unless the use or disclosure is:

1) For PSH LLC use in treating you.

2) For PSH LLC use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

3) For PSH LLC use in defending ourselves in legal proceedings instituted by you.

4) For use by the Secretary of Health and Human Services to investigate PSH LLC compliance with HIPAA.

5) Required by law and the use or disclosure is limited to the requirements of such law.

6) Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

7) Required by a coroner who is performing duties authorized by law.

8) Required to help avert a serious threat to the health and safety of others.

B. Marketing Purposes: PSH LLC will not use or disclose your PHI for marketing purposes.

C. Sale of PHI: PSH LLC will not sell your PHI in the regular course of PSH LLC business.

A valid authorization must contain a description of the PHI to be used, name of person(s) authorized to make the use or disclosure, name of person(s) to whom we may make the requested use or disclosure, description of the purpose of the use or disclosure, expiration date or event, signature, and date. You may revoke an authorization at any time, provided that the revocation is in writing. Your revocation will not be effective for uses and disclosures made in reliance on your prior authorization.

5. Substance Use Disorder Treatment Records. If we receive or maintain any substance use disorder treatment records about you that are protected under 42 C.F.R. Part 2 (“SUD Treatment Records”), we will not disclose such SUD Treatment Records without you written consent. We may use and disclose such SUD Treatment Records as follows:

A. Treatment, Payment and Healthcare Operations: If we receive or maintain your SUD Treatment Records from a substance use disorder treatment program that is covered under 42 C.F.R. Part 2 (a “Part 2 Program”) pursuant to a general written consent that you provide to the Part 2 Program to use and disclose your SUD Treatment Records for purposes of treatment, payment, or healthcare operations, then we may use and disclose your SUD Treatment Records for treatment, payment, and healthcare operations purposes as described in Section 1, above.

B. Specific Authorization: If we receive or maintain your SUD Treatment Records through a specific written authorization that you provide to us or to a third party, then we may use and disclose your SUD Treatment Records only as expressly permitted by you in your specific consent.

In no event will we use or disclose your SUD Treatment Records, or testimony that describes the information contained in your SUD Treatment Records, in any civil, criminal, administrative, or legislative proceeding by any federal, state, or local authority against you, unless authorized by your written consent or the order of a court after you have been provided notice of the court order and an opportunity to be heard.

6. Breaches. In the event your unsecured PHI is accessed, acquired, used or disclosed in a manner not permitted by law and that compromises its security or privacy, we are required by law to notify you within sixty (60) days. We will report any breaches of unsecured PHI in accordance with applicable federal and state law. In certain circumstances, our business associate may provide the notification to you.

7. Your Rights Regarding Your Health Information. You have the right to:

A. Request Limits on Uses and Disclosures of Your PHI. You have the right to ask PSH LLC not to use or disclose certain PHI for treatment, payment, or health care operations purposes. PSH LLC is not required to agree to your request, You must submit your request in writing to our Privacy Officer, and your request must specifically describe in a clear and concise fashion: (i) the PHI you want to limit; (ii) whether you want to limit our use, disclosure, or both; and (iii) to whom you want to the limits to apply. We do not have the authority to bind anyone else to restrictions that you request and that we agree to. We may say “no” if PSH LLC believes it would affect your health care. We are not required to agree to your request unless the restriction involves the disclosure of your PHI to a health plan for purposes of payment or healthcare operations and such PHI pertains solely to a healthcare item or service for which you have paid out-of-pocket in full.

B. Choose How PSH LLC Sends PHI to You. You have the right to ask PSH LLC to contact you in a specific way (for example, home or office phone) or to send mail to a different address. You must submit your request in writing to our Privacy Officer. We will not ask you the reason for your request, and PSH LLC will agree to all reasonable requests. We reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will attempt to notify you per your original request before we attempt to contact you by other means or at a different location.

C. See and Get Copies of Your PHI. Subject to certain grounds for denial, you have the right to inspect and obtain an electronic or paper copy of your medical record and other health information that PSH LLC has about you, not including psychotherapy notes. Any request for access to or copies of your PHI must be submitted in writing to our Privacy Officer. PSH LLC will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and PSH LLC may charge a reasonable, cost based fee for doing so. We may deny your request to inspect and/or receive a copy of your PHI in certain circumstances. For example, we may deny your request if it is determined that providing your PHI could cause harm to you or another person. If your request is denied, you may, in some instances, have the right to have such denial reviewed. We will provide you with a written statement of the reasons for the denial and, if you are allowed to have such denial reviewed, we will provide you with instructions for how to request a reconsideration.

1) Access to Psychotherapy Notes. Psychotherapy notes are the provider’s personal notes taken during a therapeutic session. The information contained in psychotherapy notes is intended only for use by the mental health professional and is not a part of the client’s medical record. Neither the client nor the client’s personal representative (including the parent or legal guardian of a minor client) has the right to access, inspect, or receive a copy of the provider’s psychotherapy notes.

D. Get a List of the Disclosures PSH LLC Has Made. You have the right to request a list of instances in which PSH LLC have disclosed your PHI (if any) during the six (6) years prior to the date of your request, except for disclosures (i) to carry out treatment, payment, or health care operations; (ii) made directly to you; (iii) incident to a use or disclosure otherwise permitted or required by law; (iv) to persons involved in your care or for notification purposes; (v) for national security purposes; (vi) to correctional institutions or law enforcement officials having custody over you; (vii) as part of a limited data set ; or (viii) for which you provided PSH LLC with a written authorization. PSH LLC will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list PSH LLC will give you will include disclosures made in the last six years unless you request a shorter time. PSH LLC will provide the list to you at no charge, but if you make more than one request in the same year, PSH LLC will charge you a reasonable cost based fee for each additional request.

E. Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that PSH LLC correct the existing information or add the missing information. Your request must be submitted in writing to our Privacy Officer. PSH LLC may say “no” to your request, but PSH LLC will tell you why in writing within 60 days of receiving your request.

F. Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. Even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it. You may ask us to give you a copy of this Notice at any time. To obtain a copy, please contact our Privacy Officer or ask for one at your next visit. You are also able to obtain an electronic copy of this Notice on our website.

8. Complaints. If you believe your privacy rights have been violated, you may file a complaint with PSH LLC or with the Secretary of the U.S. Department of Health and Human Services (HHS). Complaints must be submitted in writing. To submit a complaint to PSH LLC, send a letter describing your concerns to our Privacy Officer. HHS provides information on its public website (www.hhs.gov) about how to file a complaint with the Secretary. You will not be penalized for filing a complaint.

9. Contact Information. If you have any questions or wish to file a complaint, please contact: Prairie Spring Health LLC
Attn: Privacy Officer

Email: annmarie@prairiespringhealth.net Phone: 402-256-5867