THIS NOTICE DESCRIBES HOW INFORMATION ABOUT A GWArc CONSUMER MAY BE USED AND SHARED AND HOW ACCESS TO PROTECTED INFORMATION IS GIVEN. PLEASE REVIEW IT CAREFULLY.
Effective Date: April 14, 2003

I. What this Is

This Notice describes the privacy practices of GWArc, Inc. as required by HIPAA, the Health Insurance Portability and Accountability Act of 1996. The effective date for compliance with HIPAA is April 14, 2003

II. Our Privacy Obligations

Privacy is very important to us. GWArc feels responsible for treating consumers with respect and upholding their rights. GWArc has taken many steps to make sure that any information that GWArc has about a consumer is shared only with people who have a need to know. Massachusetts Laws and Regulations and GWArc Policies have required maintaining consumer records in a confidential way for many years. The new HIPAA law requires that GWArc provide you as a consumer or consumer's guardian/ family member with this Notice Of Privacy regarding GWArc's legal duties and privacy practices concerning consumer records and other information. When GWArc uses or gives out information about a consumer to someone other than his or her direct GWArc program staff, GWArc has made a disclosure of Protected Health Information or PHI. GWArc is required to abide by the terms of this Notice or a new privacy notice if GWArc make changes.

III. Uses and Sharing of Information about a GWArc Consumer

When an individual is referred and accepted into GWArc services, GWArc establishes a consumer record that contains information about that person. ISP's, Emergency Fact Sheets, attendance sheets, production sheets and incident reports are some of the types of information that GWArc keeps in the Agency. Participants in the Day Education programs also have a Medical Record.

A. There are generally 3 ways that GWArc uses PHI. These are:

1. Services/Treatment

GWArc of Waltham MA
Some staff train consumers using specialized materials and equipment, or they may dispense medication and monitor side effects.
       
GWArc of Waltham MA
Speech/Communication, Occupational, Physical, Behavioral and Music Therapists consulting with staff review PHI to develop and provide therapeutic activities such as programs of exercise, skills training in food preparation or plants and crafts, individualized communication books/devices and special relaxation or sensory opportunities.
       
GWArc of Waltham MA
Transporters, relief staff, recreation staff and volunteers use only the necessary PSI to assist or act in an emergency.

2. Payment

GWArc uses limited PHI to obtain payment for services that GWArc provides for example, to identify claims for payment from Mass Health, DMR, City of Waltham, MCB, or other Federal, state or local funding sources which pay the cost of some or all services, provided by GWArc.

3. Program Operations

GWArc may use PHI for operations including internal administration, planning and various activities that improve the quality and cost effectiveness of the service that GWArc delivers.

GWArc of Waltham MA
A Case Record Review is done by someone other than the assigned case manager to make sure the right papers are included and that they are in the correct order for each consumer.
       
GWArc of Waltham MA
The GWArc Human Rights Committee reviews incident reports, complaints/investigations and Behavior Plans with minimal identifying information (except to Professional members).
       
GWArc of Waltham MA
The Board of Directors reviews summary reports on program operations such as consumer activities, outcome achievements and Satisfaction Surveys.

B. Disclosure to Relatives, Close Friends and Other Caregivers.

1. GWArc may share PHI with a guardian, family member, staff at the residence, other caregivers who are involved with a consumer and to the DMR Service Coordinator (or other case manager) responsible for oversight of a consumer's services.

2. In an emergency circumstance, GWArc may decide that a disclosure of PHI is necessary and in the consumer's best interest. GWArc will disclose only information that is directly relevant to treatment or payment for treatment.

3. GWArc may in a rare circumstance disclose PHI in order to notify or to assist persons who are helping a consumer such as location, general condition or death.

C. Public Health Activities. GWArc may disclose PHI:

1. To report health information to public health authorities when it is required.

2. To report suspected or observed abuse, or rape or sexual assault to the Disabled Person's Protection Commission (DPPC) and/or DMR.

3. To report information on faulty products and services to the U.S. D.A.

4. To report information to your insurer and/or the Massachusetts Industrial Accident Board as required under laws addressing work-related illnesses, exposure, injuries or workplace medical monitoring;

D. Health Oversight Activities.

GWArc may disclose PHI to Mass Health, Division of Medical Assistance (DMA), Executive Office of Health and Human Services (EOHHS) or a governmental agency that oversees the services.

E. Court, Law Enforcement Officials, Government Agencies & Health/Safety.
Greater Waltham Arc

GWArc may disclose PHI to the police, law enforcement officials as required or permitted by law or in compliance with a court order, a grand jury or for an administrative subpoena.
       
Greater Waltham Arc
GWArc may inform PHI to the police or others to assist if a consumer is missing or lost.

IV. Disclosures Requiring Written Consent

A. Disclosures For Treatment, Payment and Operations.
With written consent (Forms 8/9 107 and 112 in the GWArc Policy Manual), which will be requested annually, GWArc may only disclose necessary PHI so another provider can treat, obtain payment for services provided, and conduct their operations such as:

1. Treatment

Greater Waltham Arc
GWArc may disclose PHI to obtain first aid, treatment by a doctor or hospital emergency room with transportation by our staff or ambulance.
       
Greater Waltham Arc
GWArc may contact a residence or family member to let them know that a consumer is sick, injured or seems to be having difficulty and to discuss this person's symptoms and what GWArc should do to assist.

2. Payment

GWArc will disclose only general, summary descriptive information about consumers served by GWArc to seek funds for services that GWArc provides through general fundraising, proposals, tours and/or grant writing.

3. GWArc Operations GWARC will disclose only the minimal necessary PHI for our operations:
Greater Waltham Arc

GWArc internal and external Quality Review, Accreditation (CARF), Licensing (DMR), Human Rights, Complaint and Auditing activities may involve program observation and reviews of records and services. These reviewers evaluate the quality and competence of our programs, staff and planning.
       
Greater Waltham Arc
GWArc provides Incident Reports and certain Behavior Plans to a DMR Peer Review Committee to meet Human Rights Requirements.
       
Greater Waltham Arc

If a complaint is initiated, GWArc shares PHI with the involved investigators consistent with Human Rights Training. This may involve the release of Highly Confidential Information to a sanctioned Professional.

V. Uses and Disclosures Requiring Written Authorization

A. Uses or Disclosure with Authorization.

GWArc will not disclose PHI except as agreed to upon enrollment (see section III GWArc Policy Manual) or consented to (see section IV GWArc Policy Manual) unless a consumer or their guardian gives specific written authorization on a GWArc authorization form. (Form 8/9-119 GWArc Policy Manual)

1. GWArc will obtain a specific authorization before sending PHI to any agency other than the one currently serving you.

2. GWArc will not send confidential information from a consumer record to a doctor or a mental health clinician without specific authorization.

B. Marketing.

1. GWArc will obtain specific written authorization prior to using identifying PHI on any GWArc brochures, publicity or newspaper articles consistent with the GWArc policy on Release of Information. (Form 8/9-118 GWArc Policy Manual).

2. Without a Marketing Authorization, however, GWArc will mail and distribute general GWArc marketing materials; give consumers, guardians or family members gifts of nominal value; and send consumers and guardians/families newsletters and information on multiple topics related to the organization including Annual Reports, Fundraising appeals, and Recreation/Family Support Program Brochures.

VI. Individual Rights

A. Further Information & Complaints.

GWArc distributes information about privacy, rights and complaints as part of Human Rights Policy. (Section 10 GWArc Policy Manual) If anyone is concerned that GWArc has violated privacy rights or disagrees with a decision that GWArc has made about access to PHI, please contact the Director of Programs who is our HIPAA Office Manager. A written complaint may be filed with the Office for Civil Rights of the U.S. Department of Health and Human Services. If unsatisfied with the Director of Program's response, a complainant will be referred to the Executive Director. GWArc will not retaliate against any person for filing a complaint.

B. Right to Request Additional Restrictions.

A consumer or guardian may request restrictions on GWArc's uses and disclosures of PHI: (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, relative, close friend or any other person identified by you) who are involved with your services or with payment related to your services, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. All requests for such restrictions must be made in writing. While GWArc will consider all requests for additional restrictions carefully, GWArc is not required to agree to a requested restriction. If you wish to request additional restrictions, please obtain a request form from our Office Manager and submit the completed form to the Office Manager. GWArc will assist you with the written request for restriction if you ask. GWArc will send you a written response.

C. Right to Receive Confidential Communications.

Any consumer or his/her guardian may request to receive PHI by alternative means of communication or at alternative locations. For example: you may prefer to be called or mailed copies of information at an alternative phone number or address during certain times. GWArc will consider all requests.

D. Right to Inspect and Copy Health Information.

A consumer/ guardian may request access to a record file and billing records in order to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, GWArc may deny you access to your records. If requesting access to records, please obtain a record request form from the Office Manager and submit the completed form to the Office Manager. GWArc may charge you $0.05. (five cents) for photocopying each page.

E. Right to Revoke Authorization.

A consumer or his/her guardian may revoke any written authorization by delivering a written revocation statement to the Office Manager identified below.

F. Right to Amend Records.

A consumer or his/her guardian has the right to request that GWArc amend PHI maintained in a consumer file or billing records. Please obtain an amendment request form from the Office Manager and submit the completed form to the Office Manager. All requests for amendments must be in writing. GWArc will amend PHI unless GWArc believes that the information that would be amended is accurate and complete or other special circumstances apply.

G. Right to Receive An Accounting of Disclosures.

Upon written request, a consumer, guardian/family member may obtain an accounting of certain disclosures of PHI made by us during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, GWArc will charge you $.05 per page for the accounting statement.

VII. Effective Date and Duration of This Notice

A. Effective Date.

This Notice is effective on April 14, 2003.

B. Right to Change Terms of this Notice.

GWArc may change the terms of this Notice at any time. If GWArc changes this Notice, GWArc may make the new notice terms effective for all PHI that GWArc maintains, including any information created or received prior to issuing the new notice. If GWArc changes this Notice, GWArc will post the revised notice in waiting areas of GWArc, Inc. and on the Internet site at www.gwarc.org. A revised notice may be obtained by contacting the Executive Director.

VIII. Designated Office Manager

The GWArc Director of Programs is the HIPAA designated Office Manager and can be contacted at: Director of Programs

GWArc, Inc.
56 Chestnut St.
Waltham, MA 02453
781 899-1344 x 4121
FAX: 781-899-2197
TTY: 781-899-8555
Email Address: gwarc@gwarc.org