Health Insurance Portability & Accountability Act

HIPAA REQUIREMENTS
WILR PROTECTED HEALTH INFORMATION PRIVACY POLICY

CONFIDENTIALITY

WILR maintains confidentiality in accordance with 34 CFR part 367.31 and 45 CFR parts 160 and 164 (Privacy Rule/HIPAA) requiring that all protected health information and all personal information about individuals served, including lists of names, addresses, photos and records of evaluation, will be held confidential. The use of the information and records concerning individuals will be limited only to purposes directly connected with the project, including project evaluation activities. This information will not be disclosed, directly or indirectly, other than in the administration of the project unless the consent of the agency providing the information and the individual to who the information applies, or his/her representative, has been obtained in writing. The final product of the project will not reveal any personal identifying information without written consent of the individual or his/her representative.

All applicant/consumer information acquired as a part of the independent living process shall remain the property of Wyoming Independent Living Rehabilitation, Inc. and is strictly confidential. All applicants, consumers and/or consumer representatives shall be informed about the need to collect personal and protected health information and provided notice of privacy practices concerning the policies of the use of such information.

Staff shall explain to each applicant/consumer whether the provision of personal information is mandatory or voluntary and the effects of denying requested information. Staff shall request only that information absolutely necessary to make a determination of eligibility or for the provision of a service. Case closure will result, if needed information is denied. Such information shall only be used for purposes directly related to the administration of independent living services. Use and release of consumer information shall conform with all applicable federal and state laws and regulations.

Individuals who are unable to communicate in English or who rely upon special modes of communication shall be accorded the same right to confidentiality through alternative means of communication. They shall be informed of this availability upon application.

The following procedures shall be completed by WILR Specialists:

1. WILR will provide the Notice of Privacy Practices for Protected Health Information to the individual consumer no later than the date of first service delivery and make a good faith effort to obtain the individual’s written acknowledgment of receipt of the notice. A copy of the signed notice shall be maintained in the Case Service Record (CSR). If an acknowledgment cannot be obtained, WILR Specialists must document his/her efforts to obtain the acknowledgment and the reason why it was not obtained.

2. WILR Specialists shall utilize only the consumer’s first name, last name initial, and Case Service Record (CSR) number when discussing a consumers CSR via the telephone, fax, and/or email.

3. WILR Specialists must utilize a FAX transmission cover sheet which includes the following notice:

“The documents accompanying this transmission contain confidential health information that is legally privileged. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information to any other party unless required to do so by law or regulation and is required to destroy the information after its stated need has been fulfilled.

If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited.

If you have received this information in error, please notify the sender immediately and arrange for the return or destruction of these documents.”

It is recommended that you contact by telephone the individual you are FAXING information to prior to sending the FAX to ensure that individual will be receiving the FAX.

4. All WILR offices shall minimize access to CSR’s by isolating and/or locking file cabinets or office/record rooms, and by providing additional security by maintaining passwords on computers maintaining personal information.

DISCLOSURE OF CONSUMER DATA

Consumer information cannot be disclosed to anyone without the informed written consent of the consumer and/or the consumer’s representative. This does not apply to staff employed by WILR or to other agencies with whom WILR has executed a written, cooperative agreement.

Exceptions to this include:

• 1) The information is required by federal or state laws.

• 2) The information is in response to investigations in connection with law enforcement, fraud, or abuse, except where expressly prohibited by federal and state laws or regulations.

• 3) It is in response to a judicial order.

• 4) It is in order to protect the individual or others, when the individual poses a threat to his/her safety or the safety of others.

A WILR employee shall not testify in court or in a Fair Hearing nor release records for testimony without the written, informed consent or authorization of the individual with a disability, their parent or guardian as applicable, unless served with an appropriate subpoena and/or ordered to do so by a judge or hearing officer.

Informed written consent means that the consumer and/or consumer representative has signed and dated a release of information form which:

• designates the agency or person authorized to release the information;

• specifically designates the parties to whom the information maybe released;

• specifies the purpose for which the requested information may be used;

• designates the specific information to be released; and,

• identifies the expiration date of the informed consent, not to exceed 12 months in duration.

Release of copies of third party records is strictly prohibited. Specifically, Social Security Administration records, Veteran’s Administration records and information obtained from any mental health agency shall not be released, even upon receipt of a duly executed release of information statement by the consumer or his/her representative.

CLIENT ACCESS TO INFORMATION

Applicants, consumers, or, as appropriate their representatives, have the right to see and obtain copies of any information maintained in the CSR except:

• medical or psychological information ascertained by the professional provider to be potentially harmful to the individual may not be released directly to the individual. It must be provided through the individual’s representative, or a licensed physician or a licensed and/or certified psychologist; or,

• information obtained from another organization, agency or provider may be be released only under the conditions established by the other organization, agency or provider.

COURT ORDERS, WARRANTS AND SUBPOENAS

The Executive Director or designee must be notified before a WILR employee takes any action in response to a court order, warrant, subpoena or a request to appear and testify in court or at a Fair Hearing that pertains to a WILR issue.

Employees shall not testify in court or at a Fair Hearing, nor release consumer records, or other WILR specific information, without the consent of the individual with a disability, unless served with an appropriate subpoena and ordered to do so by a judge or hearing officer.

The Executive Director or designee shall obtain advice regarding legal procedures from a licensed attorney.

The Executive Director or designee, in compliance with judicial orders or a lawfully issued subpoena, will decide whether legal counsel is necessary and will make a timely response to the employee who is required to respond to said subpoena or judicial order. All subsequent or ensuing questions necessitating consultation with legal counsel will be referred to the Executive Director or his/her designee.

CONSUMER APPEAL PROCEDURES

All applicants and consumers shall be informed of the procedures for formal, as well as informal, resolution of disagreements. All applicants and consumers shall be provided information about the Wyoming Long Term Care Ombudsman Program and the Client Assistance Program (CAP), what their services consist of and how to access these programs. Wyoming Long Term Care Ombudsman Program and CAP information shall be provided upon application, development of an Independent Living Plan and at closure.

Any applicant or consumer who is dissatisfied with a determination made by an employee of WILR concerning the furnishing or denial of services, may request a timely review of that determination.

The following process will be followed under a time frame of forty-five (45) days from receipt of the initial letter of complaint to the scheduled Fair Hearing.

• 1. An applicant or consumer must send a letter requesting an appeal of a WILR employee’s decision to the Executive Director of WILR within 20 days of the contested decision.

• 2. An Administrative Review is conducted by the WILR Executive Director.

• 3. Fair Hearing.

• 4. Fair Hearing Officer renders a decision.

• 5. The Chairman of the WILR Board of Directors makes a determination of the Fair Hearing Officer’s decision.

• 6. Appeal to District Court.

Date Published: 04-07-03