Consumer Rights, Confidentiality and HIPAA Privacy Rules

1. Consumer Rights, Confidentiality and HIPAA Privacy Rules Coastal Plains Community Center Training July 2, 2013

2. Consumer Rights • The people we serve at Coastal Plains Community Center have the same rights as all other citizens of the United States of America. • Along with those rights afforded to everyone, they have additional rights, depending on what services they receive.

3. Be treated with respect and dignity Privacy Have personal possessions Freedom of movement Freedom from fear Make choices Free from cruel & unusual punishment Freedom of speech & open communication Freedom of religion Vote Marry and procreate Equal education Equal employment opportunities A safe & humane living environment Basic Rights – People have the right to…

4. Special rights for people served • Right to receive services in the least restrictive environment • Right to participate in individualized services • Right to provide informed consent • Right to confidentiality • The right to be free from abuse and exploitation

5. Special rights of persons with Intellectual and/or Developmental Disability Services (40 TAC, chapter 4, subchapter C) • The right to adequate treatment & habilitative services • The right to promptly receive a determination of Intellectual and/or Developmental Disability (DMR) with diagnostic techniques that are adapted to that individual’s cultural background, language, and ethnic origin • The right to request & promptly receive an administrative hearing to contest the findings of the DMR • The right to an independent DMR, at the individual’s own expense, if they question the validity or results of the DMR • The right to the presumption of competency, due process in guardianship proceedings and fair compensation for labor, regardless of any direct or incidental therapeutic value.

6. Other special rights…All consumers have the right… • To participate in development and review of individualized treatment plan (as applicable) • To choose services (based upon need and availability) • To withdraw consent to treatment, at any time, unless court ordered to treatment • To make a complaint, without fear of retaliation • To be told about their rights in a language and way that they understand • To have access to information in their own record, unless it is determined that it would result in an imminent danger to themselves or others (by clinician) • To Fair Hearing if services are denied, reduced or terminated to a Medicaid recipient.

7. Least restrictive environment • The people we serve have the right to receive services and live in the environment that is most beneficial to them. The more restrictive the environment, the less the person is able to learn, grow and be allowed to be themselves. Our goal is to provide services in the community, not in an institution, hospital, state school, etc…Services should be provided based upon need, not convenience, diagnosis or because there are no other options. Basically, people should receive the services they need in their own community, in their own home, if possible. If not, the services need to be based on need and their choice.

8. Individualized Services • Not everyone with allergies have the same symptoms and need the same treatment. • Not all people with curly hair are fun. • Not all white cats are deaf or blind. The point??? Don’t treat the people we serve the same. Each person is an individual, with unique strengths and needs.

9. Individualized Services, continued Treatment plans should be based on the assessment of the individual • What are the individual’s needs? • What do they want to work on learning? • Do they have supports that can help out? • Are there unique symptoms that need to be addressed? • Does the treatment plan look like and address the same issues as other people with the same diagnosis or are you helping them create a unique treatment plan, based upon their needs?

10. Informed Consent & Presumption of Competency • Just because a person has a diagnosis of a mental illness or intellectual and/or developmental disability, it does not mean that they can’t understand what is going on in their own life and that they can’t make decisions on their own. • The people we serve have the right to make decisions on their own, unless they are minors (under the age of 18) or have legal guardians of person and/or estate. • A legal guardian must be able to produce the paperwork, from the court, proving guardianship and it must be updated on an annual basis.

11. Informed Consent & Presumption of Competency, continued • If a person does not have a legal guardian (or in the case of a minor, legally authorized representative – LAR) then we must presume that they are competent. • With this presumption, staff need to make sure that documentation and other information about services are explained in a manner that the person understands. This may be in the person’s native language, reading it to someone who cannot read or it may be explaining things in lay-terms, instead of using our wonderful technical terms that we like to use. • Also, don’t have a person sign something without making sure that they understand what they are signing. If they don’t understand, then explain it in a different way, so they do understand. This is informed consent.

12. Right to Confidentiality • Community Center’s have always had rules regarding confidentiality. Basically, the big rule is: If the person doesn’t give you written consent to release information about them to someone else, then anything and everything about that person is confidential. Then the Health Insurance Portability and Accountability Act (HIPAA) came along.

13. Confidentiality - HIPAA • HIPAA is a rule enacted to reinforce current privacy rules already in place. It defined, in clear and concise (and quite detailed) ways, what can and cannot be released about a person who receives services. This is not just services from Local Authorities’s, but also doctor’s offices, insurance companies and other healthcare organizations.

14. Confidentiality - HIPAA • The goal of HIPAA was to make sure that each individual’s privacy was protected, to the fullest, both in an office setting, paper records and through electronic records and data (computer systems). • Did HIPAA change confidentiality for Local Authorities? • YES & NO • We still need to make sure that we do not release anything about a person served, without their written consent. • There are some exceptions, with HIPAA, such as we can release some information for treatment, payment-billing, and healthcare operations, without written consent. Confidentiality – HIPAA • We did have to put in more stringent security measures and provide people with the additional information about their rights (e.g. provide them with a notice of privacy practices at admission/upon first receipt of services) • And…consumers have more access to their records than they did before (now we must release their information to them, unless it would result in imminent harm, before we could restrict this right if we thought it would be detrimental to their mental health)

15. HIPAA, continued • One of the big issues regarding the Health Insurance Portability & Accountability Act is forms. There are many forms to be filled out, to ensure confidentiality is protected. • Authorization for Disclosure Form (also called HIPAA Request for Information) • HIPAA Disclosure Non-authorized Form • HIPAA Amendment of Record • HIPAA Acknowledgment of Notice (of Privacy Practices) • Consumer Request for Records

16. HIPAA Forms • All of the previously noted forms need to be completed, prior to releasing information about a consumer (with the exception of the Acknowledgment of Notice form, which is completed when you provide a copy of the Privacy Notice to the consumer or LAR). • The forms should be completed, with all information filled in. There should be no blanks. Blanks in any documentation leave room for alteration and falsification. Please do not leave any blanks on forms, put an N/A or line through.

17. HIPAA forms, continued • Consumer Request for Records form is used when a person would like to see or have a copy of their records. This also applies to parents who wish to have a copy of their child’s records. Though they have a right to the record, they still need to complete this request and it must be approved, by a physician/psychiatrist on staff or the privacy officer (Andrea Tippit). The agency only has 10 days to review the record and request and either approve the request or provide justification of why the request is denied. Get the request to the doctor or privacy officer, ASAP. There are very few reasons to turn a consumer/LAR down, however…there are some such as imminent danger issues and, in the case of children, there may be a divorce, custody or abuse issue. If the doctor denies the request, the Privacy Officer must be notified immediately, as there must be clinical reasons as per HIPAA guidelines.

18. HIPAA forms, continued • Disclosure, non-authorized: This form is to be used when you release information to agencies without a written authorization from the consumer, but are allowed by law. For example: If you are releasing information to the probation/parole office and there is not a written authorization, then you must fill this form out. Same goes for releasing information to the police (if the person is in jail and they need to know the person’s medications and diagnosis), the hospital (the hospital needs meds/diagnosis for treatment purposes) or even adult or children’s protective services.

19. BIG ISSUE regarding CONFIDENTIALITY AND HIPPA WITHOUT A WRITTEN AUTHORIZATION FOR DISCLOSURE, SPECIFYING THAT IT IS OK TO RELEASE INFORMATION ABOUT DRUG/ALCOHOL &/or HIV/AIDS DIAGNOSIS OR TREATMENT INFORMATION, YOU CANNOT RELEASE THIS INFORMATION TO ANYONE!!! EVEN IF IT IS PART OF A RECIPROCOL AGREEMENT OR PART OF THE ‘EXCEPTIONS’ FOR TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS. BOTTOM LINE…YOU CANNOT RELEASE DRUG/ALCOHOL DIAGNOSIS OR TREATMENT INFORMATION TO PROBATION/PAROLE, POLICE, APS, CPS, OR OTHER STATE AGENCIES (WHEN OTHER INFORMATIO IS ALLOWED, UNDER THE RULE, TO BE RELEASED) WITHOUT A WRITTEN AUTHORIZATION SPECIFYING DRUG/ALCOHOL INFORMATION.

20. HIPAA forms, continued • Disclosure forms – Authorization for Disclosures: This is the standard form (there is one in Anasazi and there is a hard copy) for people to sign, to allow our agency to release specific information to specific individuals or agencies. These forms are the most important forms, as you cannot even talk to the person’s spouse, parent (of an adult), brother, sister, etc…without one. • When you first get your case load and at least annually, check to see that you have authorization to talk to family members and specific agencies. Ask the consumer if there is anyone special in their life that we should be able to talk to, especially in an emergency or if the consumer needs help with something related to their care. Help them fill out a form, for each individual or agency, making sure that the form specifies what can and cannot be released. Many people want family members to be able to come in with them to the doctor, to know about their medications or to be able to call in for them, if they need help. They also have primary care physicians or other providers in the community, such as the housing authority or WIC, where they might need assistance in coordinating services.

21. HIPAA forms, continued • Amendment of Record – with HIPAA came a new right. People now have the right to dispute what is in their record and request to have their record amended or appended. Once something is in our records, we will not destroy it, however…if a consumer disagrees with what is in their record, and they make a request for an amendment, then we will consider the amendment. This request must come to the Privacy Officer (Andrea Tippit) immediately. • Upon review of the request and review of the record (to include possible interviews with the consumer and staff who wrote what was documented) a decision will be made on whether to accept the request and amend what was written or deny the amendment and stand by what was documented by the staff. • The request should be placed, in the record, no matter whether the amendment is denied or accepted. The denial or acceptance will also be placed in the consumer’s record.

22. Other HIPAA InformationProtecting Confidentiality • Keep the records in the record room, unless in use. • Sign the record out and sign it back in – you are responsible for the record. Don’t remove documents. • You don’t have the right to read treatment plans or other information about people that aren’t on your caseload or if you are not part of their team. • Keep confidential information off of your desk or turn it over, so people can’t just come into your office and read information about them. • Lock confidential information up • If you really need to discuss a case or just decompress about a case, talk to your boss or a co-worker on the team, don’t go home and talk about the people we serve.

23. Other HIPAA InformationProtecting Confidentiality • Keep your computer screen turned away from other people’s line of site • Don’t talk about people’s in the hallways, in public, at home, etc… • Don’t take work home – that is what the office is for (there have been a lot of state and federal employees who have ‘lost’ disks and pen drives with client identifying information because of carelessness and taking work home) • Change your password on your computer, often (at least every 90 days) and don’t give it out to anyone (or write it down in obvious places) • Call and confirm fax number, before faxing and let the person know a fax is coming in, so it doesn’t sit around accessible to everyone.

24. What could happen if you breach confidentiality? • You could be fined • You could be put in jail • You could be sued • You could be disciplined by CPCC, up to and including termination • CPCC could be fined and management could be jailed • CPCC could lose their ability to provide services to the people who need them

25. Rights Contacts • Coastal Plains Community Center’s Rights and Privacy Officers are: • Andrea Tippit • America Contreras (assistant) • 1-361-777-3991 • 1-888-819-5312 (toll free) • atippit@coastalplainsctr.org or acontreras@coastalplainsctr.org • 200 Marriott Drive, Portland, Texas 78374

26. Other Rights Contacts: • Dept. of Aging & Disability Services (DADS) Consumer Rights (IDD Services) • 1-800-458-9858 • Dept. of State Health Services (DSHS) Consumer Rights (MH Services) • 1-800-252-8154 Disability Rights Texas (this is a group of private attorneys who advocate for people with disabilities, to ensure that their rights are not violated. They choose specific issues that they will address.) 1-800-880-8401

27. Most IMPORTANT Rights Contact? • YOU. You can help people exercise their rights by informing them of their rights. • Give them and read them the rights handbook that is appropriate to their services at admission and annually. • Help a person exercise their rights, by working with them to develop their own treatment plans and make choices in their own lives.

28. What could happen if you violate a consumer’s rights? • We just covered the consequences of breaching confidentiality, but…there are other rights that can be violated and CPCC does not want people to be disrespected in any way. Therefore, you can still be disciplined for violating rights of consumers, up to and including termination. • Ways to prevent violating any rights? Treat everyone with respect, dignity and how you would like to be treated (not necessarily how you are treated or have been treated, but how you would like to be treated).

29. "Build upon strengths, and weaknesses will gradually take care of themselves." ---Joyce C. Lock

30. Coastal Plains CC’s Mission & Values • “Enhancing personal growth in our community through support, guidance, education and advocacy.” • Communication begins with listening and results in mutual understanding • People, given the opportunity, will fully participate in decisions affecting their lives, gain skills and define their own success. • The acquisition of skills and knowledge is a lifelong process. • We find harmony in diversity by appreciating differences (individuality & diversity) • There is power in positive thinking • Effective partnerships begin with trust and honesty • Reduction of needless complication helps people make informed choices. • Happiness comes from having a sense of purpose