Privacy Practices
Your Rights
Fees
Notice of Privacy Practices

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. If you have any questions about this notice, please contact our Privacy Officer at (802) 334-6744.

WHO WILL FOLLOW THIS NOTICE:
This notice describes the practices of Northeast Kingdom Human Service (NKHS) and that of:

  • Any health care professional authorized to enter information into your health record.
  • All divisions and programs of NKHS.
  • Any volunteer we allow to help you while you are receiving services from NKHS.
  • All employees, staff and other personnel.
  • All NKHS entities, sites and locations follow the terms of this notice. Staff members at these entities, sites and locations may share health information with each other for treatment, payment or operations purposes as described in this notice.

OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that health information about you and your health is personal. We are committed to protecting your privacy and health information about you. We create a record of the care and services you receive at NKHS. 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 generated by NKHS, whether made by NKHS personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your health information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose health information about you.
We also describe your rights and certain obligations we have regarding the use and disclosure of health
information.

We are required by law to:
• Make sure that health information that identifies you is kept private;
• Give you this notice of our legal duties and privacy practices with respect to health information
about you;
• Follow the terms of the notice that is currently in effect;
• Notify you following a breach of your protected health information; and Effective date: 9/23/13
• Comply with any State law that is more stringent or provides you greater rights than this notice.

HOW WE MAY USE AND DISCLOSE 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.

For Treatment: We may use or disclose health information about you to provide you with treatment or services. his includes the potential sharing of information about you to doctors, nurses, clinicians, case managers, interns or other NKHS personnel, or to people outside of NKHS who are involved in your care. For example, a clinician might be treating you for a mental health problem and need to talk with one of our psychiatrists or another clinician who has specialized training in a particular area of care. We may also disclose information about you to people outside NKHS who are involved in your health care. Electronic Exchange of Your Health Information: In some instances, we may transfer health information about you electronically to other health care providers who are providing you treatment or to the insurance plan providing payment for your treatment. Your health information may also be made available through the Vermont Health Information Exchange (VHIE). The VHIE is a health information network operated by Vermont Information Technology Leaders (VITL), Inc. and your treating health care providers may only access your health information through the VHIE if you have provided specific written consent for their access, unless you are in need of emergency treatment. For information about the VHIE, see www.vitl.net.

For Payment: We may use and disclose health information about you so that the treatment and services you receive at NKHS may be approved by, billed to, and payment collected from a third party such as an insurance company. For example, we may need to give your health plan information about counseling you received at NKHS so your health plan will pay us or reimburse you for a counseling session. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the service / treatment.

For Health Care Operations: We may use and disclose health information about you for NKHS operations. These uses and disclosures are necessary to run NKHS and make sure that all individuals receiving services from us 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 serving you. We may also combine health information about many consumers to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, clinicians, case managers, interns and other NKHS personnel for review and learning purposes.
We may also combine the health information we have with health information from other mental health
agencies to compare how we are doing and see where we can make improvements in the services we
offer. We will remove information that identifies you from this set of health information so others may
use it to study health care and health care delivery without learning who the specific consumers are.
NKHS is a Vermont designated Community Mental Health Agency and is obligated under our contracts
with various departments within the Vermont Agency of Human Services to provide certain services. As
a result, these Departments may access health information related to these contracted services for the
purpose of obtaining treatment for clients or making payment or for its health care operations.

Appointment Reminders: We may use and disclose information to contact you as a reminder that you
have an appointment.

Alternative Treatment and Benefits and Services: We may use and disclose information about you in
order to obtain and recommend to you other treatment options and available services as well as other
health-related benefits or services.

Fundraising Activities: Should the need arise where information about you or where your participation is desired for NKHS’ fundraising activities, NKHS would obtain your authorization. No information would be released for this purpose without your authorization

Research: Under extremely limited circumstances, we may use and disclose health information for research purposes. For example, a research project may involve comparing the health and recovery of all consumers who received one medication to those who received another, for the same condition. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with consumer’s need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. We may, however, disclose health information about you to people preparing to conduct a research project; for example, to help them look for consumers with specific health needs, so long as the health information they review does not leave NKHS. We will always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at NKHS.

As Required by Law: We will disclose medical information about you when required to do so by
federal, state or local law. In Vermont, this would include: victims of child abuse; the abuse, neglect or
exploitation of vulnerable adults; or where a child under the age of sixteen is a victim of a crime; and
firearm-related injuries. Under certain circumstances, the Departments within the Vermont Agency of
Human Services who we contract with are mandated to access health information in order to carry out
their responsibilities.

To Avert a Serious and Imminent Threat to Health or Safety: We may use and disclose health
information about you when necessary to prevent a serious and imminent 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.

SPECIAL SITUATIONS
Military and Veterans: If you are a member of the armed forces, we may release health information
about you as required by military command authorities.
Workers’ Compensation: We may release health information about you as authorized for workers’
compensation or similar programs as authorized by Vermont law. These programs provide benefits for
work-related injuries or illnesses.
Public Health Risks: We may disclose health information about you for public health activities. These
activities generally include the following:

  • To prevent or control disease, injury or disability;
  • To report deaths;
  • To report child abuse or neglect;
  • To report abuse, neglect or exploitation of vulnerable adults; any suspicion of abuse, neglect, or exploitation of the elderly (age 60 or older), or a disabled adult with a diagnosed physical or mental impairment, must be reported;
  • To report reactions to medications or problems with products;
  • To notify individuals of recalls of products they may be using;
  • To notify an individual who may have been exposed to a disease or may be at risk for contracting or spreading a communicable disease or condition

Health Oversight Activities: We may disclose health information to a health oversight agency, such as
the Vermont Agency of Human Services Departments who we contract with, for activities authorized by
law. These oversight activities include, but are not limited to, 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.
Legal Proceedings and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health
information about you in response to a court order.
Public Health Officials and Funeral Home Directors: We may release information to a coroner or
medical examiner. This may be necessary, for example, to identify a deceased person or determine the
cause of death. We may also release health information to funeral directors thereby permitting them to
carry out their duties.

Individuals in Custody: If you are an inmate of a correctional institution or under the custody of a law
enforcement official, we may release health information about you to the correctional institution or law
enforcement official pertaining to care provided while you are in custody. This release would be
necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or
the health and safety of others; or (3) for the safety and security of the correctional institution.

USES OF HEALTH INFORMATION REQUIRING WRITTEN AUTHORIZATION
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 authorization. Examples of this may include disclosures to lawyers,
employers, the Vermont Office of Disability Determination Services or others who you know, but who
are not involved in your care. Additionally, uses and disclosures of protected health information for our
fundraising activities, marketing purposes, and disclosures that constitute a sale of protected health
information require authorization. Also, psychotherapy notes maintained by your treating provider can
only be disclosed with your written authorization. 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 services that we
provided to you.

YOUR RIGHTS REGARDING INFORMATION ABOUT YOU
Any assistance (physical, communicative, etc.) you need to exercise your rights will be provided to you by
NKHS.

You have the following rights regarding information we maintain about you:
Right to Review and Copy: You have the right to review and copy health information that may be used
to make decisions about your care. This may include both health and billing records.

To review and copy health information that may be used to make decisions about you, you must submit
your request in writing to our Records Department. If you request a copy of the information, we may
charge a fee for the costs of copying, mailing, or other supplies associated with your request. If you seek
an electronic copy in a specific form or format of any portion of your electronic health record, and NKHS
is unable to readily produce the copy in that form or format, we will work with you to provide an
alternative form or format for the electronic copy.

We may deny or limit access to your request to inspect and copy in certain very limited circumstances. If
you are denied or limited access to health information, you may request that the decision be reviewed.
Another health care professional chosen by NKHS 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 Amend: If you feel that health information we have about you is incorrect or incomplete, you
may ask us to amend the information. You have the right to request an amendment for as long as the
information is kept by or for NKHS.
To request an amendment, your request must be made in writing and submitted to our Records
Department. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support
that request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer
    available to make the amendment;
  • Is not part of the designated record set kept by or for NKHS;
  • Is not part of the information which you would be permitted to inspect and copy; or,
  • Was determined accurate or complete by NKHS.

Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.”
This is a list of the disclosures we made of health information about you which were required by law
and/or were not authorized by you.

To request this list or accounting of disclosures, you must submit your request in writing to our Records
Department. Your request must state a time period, which may not be longer than six years. Your request
should indicate in what form you want the list (for example, on paper, electronically). 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.

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. We are not
required to agree to your request unless your request is to limit disclosures to a health plan for the purpose
of carrying out payment or health care operations that are not otherwise required by law and you or
someone on your behalf other than your health plan has paid for those services in full at the time the
health services are provided. However, if we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment. 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, like a family member. For example, you could ask that we not use or disclose information about a counseling session you received.

To request restrictions, you must make your request in writing to our Records Department. In your
request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use,
disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
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 request confidential communications, you must make your
request in writing to our Records Department. 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 a paper copy of this notice. You may ask
us to give you a copy of the current notice at any time. To obtain a paper copy of this notice, contact
NKHS Privacy Officer at (802) 334-6744.

Security of Health Information: We have in place appropriate safeguards to protect and secure the
confidentiality of your health information. Due to the nature of community based human service
practices, NKHS representatives may possess your health information outside of NKHS. In these cases,
NKHS representatives will ensure the security and confidentiality of the information in a manner that
meets NKHS policy, State and Federal Law.
Specific requirements for electronic notice: A covered entity that maintains a web site which provides
information about the covered entity’s customer services or benefits must prominently post its notice on
the web site and make the notice available electronically through the web site.

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 all NKHS facilities. The notice will contain an effective date. Should we make a material change to this notice, we will, prior to the change taking effect, publish an announcement of the change at every NKHS facility.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with NKHS or with the Secretary of the Department of Health and Human Services. To file a complaint with NKHS, call (802) 334-6744 and ask to speak with our Privacy Officer. All complaints must be submitted in writing. Complaint forms are available at each location including the reception area at NKHS’ main offices. You will not be penalized for filing a complaint.
The Secretary of the Department of Health and Human Services can be contacted through their regional office at Office of Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building – Room 1875, Boston, Massachusetts 02203, voice phone (800) 368 1019, fax (617) 565-3809, TDD (800) 537 7697.

Rights
  1. You have the right to be treated with courtesy, respect and dignity.
  2. You have the right to privacy. We hold all your personal information confidential within the Agency. To view a copy of NKHS’ Notice of Privacy Practices click here.
    See exceptions to these rights below*
  3. You have the right to review your own clinical record in the presence of one of our mental health professionals. You also have the right to make photocopies of your record for a minimal copying fee.
  4. You have the right to refuse unwanted treatment including medication except when ordered by a court or in an immediate emergency.
  5. You have the right to request a change in your counselor or service provider.
  6. You have the right to be involved in all decisions affecting you including your treatment plan and the termination of your treatment.
  7. You have the right to treatment in the least restrictive appropriate setting.
  8. You have the right to request a review of your treatment by a group of mental health professionals other than your own counselor.
  9. You have the right to know the counselor's credentials and treatment approach.
  10. You have the right to know about possible side effects of any medication and/or treatment offered to you.

We encourage consumers to know their rights, to ask questions and make suggestions about their treatment or their family member's treatment. In the event you are not satisfied with your treatment or the services you are receiving, we urge you, your family, or an advocate of your choice to contact us.

We have instituted a grievance procedure in the event you are dissatisfied. The procedure will be given to you during registration. It is also available at each of our reception desks.

* There are several exceptions to the privacy rule as required by Vermont law:

  • If you threaten to do bodily harm or destroy property, we are required to notify the potential victim and/or law enforcement officers.
  • If we suspect child abuse, sexual abuse, or elder abuse, we are required to notify the proper authorities. We will notify you of our intention to report our suspicions. We view various forms of abuse as symptomatic of serious problems that require treatment and counseling.
  • We will disclose confidential information that we have in our written records if it is court ordered for a legal proceeding.
  • Your insurance carrier reserves the right to review your records to determine the need and appropriateness of treatment. Please check with your insurance company if you have questions.
  • The Department of Developmental and Mental Health Services and the Vermont Office of Drug and Alcohol Abuse Prevention are required to review records to determine compliance with fiscal and regulatory requirements.
  • If it becomes necessary, in our opinion, to protect an individual's safety by legal involuntary procedures for hospitalization, we are obligated to discuss relevant information with the court and/or the admitting hospital
Fees

Outpatient and crisis services are provided on a fee-for-service basis and payment is expected at the time of service. However, we accept payment from Medicaid, Medicare and private insurance. Some insurance plans, including some Medicaid plans, are run by managed care companies. Consequently, benefit packages may vary and not all essential services will be covered. You will be billed for services your insurance company does not provide as a benefit. Individuals with no insurance will be charged our standard fees. Adjustments will be made in accordance with an individual's ability to pay. NKHS staff will fully explain billable services at your first appointment.

Service Eligibility: Some agency services have eligibility criteria and can serve only those individuals who meet the criteria.