Jennifer McComas, LCSW, LLC

4869 Chambliss Ave

Knoxville TN 37919

865-224-3822

jennifer@jennifermccomaslcsw.com

PATIENT NOTIFICATION OF PRIVACY RIGHTS

THIS NOTICE DESCRIBES HOW YOUR MENTAL HEALTH RECORDS MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

I. Preamble

The Psychology, Social Work, and Professional Counseling Licensing Laws provide extremely strong privileged communication protections for conversations between your therapist and you in the context of your established professional relationship with your mental health provider. There is a difference between privileged conversations and documentation in your mental health records. Records are kept documenting your care as required by law, professional standards, and other review procedures. HIPAA very clearly defines what kind of information is to be included in your "designated medical record" as well as some material, known as "Psychotherapy Notes" which is not accessible to insurance companies and other third-party reviewers and in some cases, not to the patient himself/herself.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that requires the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. HIPAA provides privacy protections about your personal health information, which is called "protected health information" which could personally identify you. PHI consists of three (3) components: treatment, payment, and health care operations.

Treatment refers to activities in which your therapist provides, coordinates or manages your mental health care or other services related to your mental health care. Examples include a psychotherapy session, psychological testing, or talking to your primary care physician about your medication or overall medical condition.

Payment is when your provider obtains reimbursement for your mental health care. The clearest example of this parameter is filing insurance on your behalf to help pay for some of the costs of the mental health services provided to you.

Health care operations are activities related to the performance of our practice such as quality assurance. In mental health care, the best example of health care operations is when utilization review occurs, a process in which your insurance company reviews our work together to see if your care is “really medically necessary.”

The use of your protected health information refers to activities this office conducts for filing your claims, scheduling appointments, keeping records and other tasks within the office related to your care. Disclosures refers to activities you authorize which occur outside the office such as the sending of your protected health information to other parties (i.e., your primary care physician, your psychiatric provider).

II. Uses and Disclosures of Protected Health Information Requiring Authorization

Tennessee requires authorization and consent for treatment, payment and healthcare operations. HIPAA does nothing to change this requirement by law in Tennessee. Your therapist may disclose PHI for the purposes of treatment, payment and healthcare operations with your consent. You have signed this general consent to care and authorization to conduct payment and health care operations, authorizing us to provide treatment and to conduct administrative steps associated with your care (i.e., file insurance for you). I will never release any information of any sort for marketing purposes.

Additionally, if you ever want me to send any of your protected health information of any sort to anyone outside our office, you will always first sign a specific authorization to release information to this outside party. A copy of that authorization form is available upon request. The requirement of your signing an additional authorization form is an added protection to help insure your protected health information is kept strictly confidential. An example of this type of release of information might be your request that your provider talk to your psychiatrist about your diagnosis or medications. Before I talk to your doctor, you will have first signed the proper authorization for me to do so.

There is a third, special authorization provision potentially relevant to the privacy of your records: my psychotherapy notes. In recognition of the importance of the confidentiality of conversations between psychologist/therapist-patient in treatment settings, HIPAA permits but does not require keeping "psychotherapy notes" separate from the overall "designated medical record". "Psychotherapy notes" cannot be secured by insurance companies nor can they insist upon their release for payment of services. "Psychotherapy notes" are our notes "recorded in any medium by a mental health provider documenting and analyzing the contents of a conversation during a private, group or joint family counseling session and that are separated from the rest of the individual's medical record." "Psychotherapy notes "are necessarily more private and may contain more personal information about you, hence, the need for increased security of the notes. "Psychotherapy notes" are not the same as your "progress notes" which provide basic information about your care each time you have an appointment. Progress notes include, but are not limited to, assessment/treatment start and stop times, the modalities of care, frequency of treatment furnished, results of clinical tests, and any summary of your diagnosis, functional status, treatment plan, symptoms, prognosis and progress to date. Your therapist is not required, but is permitted, to make separate “psychotherapy notes,” but is required to keep progress notes.

Certain payors of care, such as Medicare and Workers Compensation, require the release of both your progress notes and your psychotherapy notes in order to pay for your care. If I am forced to submit your psychotherapy notes in addition to your progress notes for reimbursement for services rendered, I will ask you to sign an additional authorization directing us to release our psychotherapy notes. Most of the time, I will be able to limit reviews of your protected health information to only your "designated record set" which includes the following: all identifying paperwork you completed when you first started your care here, all billing information, a summary of our first appointment, your mental status, any individualized, comprehensive treatment plan, any discharge summary, progress notes, reviews of your care by managed care companies, results of psychological testing, and any authorization letters or summarizes of care you have authorized us to release on your behalf. Please note that the actual test questions or raw data of psychological tests, which are protected by copyright laws and the need to protect patients from unintended, potentially harmful use, are not part of your "designated mental health record." 

You may, in writing, revoke all authorizations to disclose protected health information at any time. You cannot revoke an authorization for an activity already done that you instructed us to do or if the authorization was obtained as a condition for obtaining insurance and Tennessee law provides the insurer the right to contest the claim under the policy.

III. Business Associates Disclosures

HIPAA requires that I train and monitor the conduct of those performing ancillary administrative services for our practice and refers to these people as "Business Associates." Examples of "business associates" related to our office are the collection agency, my accountant and biller. In compliance with HIPAA, I have signed a formal contract with these and other business associates emphasizing the importance of them protecting your protected health information as an absolute condition for association with us.

IV. Uses and Disclosures Not Requiring Consent nor Authorization

By law, protected health information may be released without your consent or authorization for the following reasons:

Child abuse

Suspected sexual abuse of a child

Adult and domestic abuse

Suspicion of Terrorist Activities (Patriot Act)

Health oversight activities (i.e., Tennessee licensing boards)

Judicial or administrative proceedings (i.e., court order)

Serious threat to health or safety of yourself or other

Workers Compensation claims (if you seek to have your care reimbursed under Workers Compensation, all of your care is automatically subject to review by your employer and/or insurer(s))

V. Patient's Rights and Our Duties

You have a right to the following:

The right to request restrictions on certain uses and disclosures of your protected health information which we may or may not agree to, but if we do, such restrictions shall apply unless our agreement is changed in writing;

The right to receive confidential communications by alternative means and at alternative locations. For example, you may not want your bills sent to your home address so I will send them to another location of your choosing;

The right to inspect and receive a copy of your protected health information in our designated mental health record set and any billing records for as long as protected health information is maintained in the record;

The right to amend material in your protected health information, although I may deny an improper request and/or respond to any amendment(s) you make to your record of care.

The right to an accounting of non-authorized disclosures of your protected health information;

The right to a paper copy of notices/information from us, even if you have previously requested electronic transmission of notices/information; and

The right to revoke your authorization of your protected health information except to the extent that action has already been taken.

For more information on how to exercise each of these aforementioned rights, please do not hesitate to ask for further assistance on these matters. I am required by law to maintain the privacy of your protected health information and to provide you with a notice of your Privacy Rights and our duties regarding your PHI. I reserve the right to change our privacy policies and practices as needed with these current designated practices being applicable unless you receive a revision of our policies when you come for your future appointment(s). My duty as your therapist on these matters include maintaining the privacy of your protected health information, to provide you this notice of your rights and our privacy practices with respect to your PHI, and to abide by the terms of this notice unless it is changed and you are so notified. 

VI. Complaints

If you have any concern of any sort that this office may have somehow compromised your privacy rights, please do not hesitate to speak to your therapist immediately about this matter. You will always find me willing to talk to you about preserving the privacy of your protected mental health information. You may also send a written complaint to the U.S. Department of Health and Human Services, Office for Civil Rights, 61 Forsyth Street, SW, Suite 16T70, Atlanta, GA 30303-8909. You may also obtain information for filing a complaint at the DHHS website,www.hhs.gov.

VII. This notice originally went into effect and remains so unless new notice provisions for protected health information are enacted.