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.

This notice describes:

• HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
• YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
• HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
• YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH PRIVACY OFFICER AT (888) 235-4673 AND HIPAA@PARTNERSBHM.ORG IF YOU HAVE ANY QUESTIONS.

Partners Health Management (Partners) is required by law to maintain the privacy of your protected health information and to provide you with this Notice of our legal duties and privacy practices. If you have questions about any part of this Notice or if you want more information about our privacy practices, please contact the Privacy Officer at (888) 235-4673 or at 901 S. New Hope Road, Gastonia, NC 28054.

General Information

Partners must protect and secure health information that we have created or received about your past, present, or future health condition, health care we provide to you, or payment for your health care.  We are only allowed to use and disclose protected health information in the manner described in this Notice. This Notice is posted on our website, and we will provide you with a paper copy upon your request.

We may have access to your personal health information in one or more of the following ways:

• We may be the manager of the mental health, intellectual/developmental disability, traumatic brain injury, substance use disorder (MH/IDD/SUD), physical health and pharmacy services you receive. If so, Partners staff may assess, manage, authorize and/or monitor your care. Staff may also link you with other community resources. Actions may include:
  • Referring you to a provider of your
  • Working with your provider to make sure you receive the care and services you
  • Monitoring the quality of
  • Helping resolve problems with your
• Partners may be the payer of claims for MH/IDD/SUD, TBI, physical health or pharmacy services you

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health Act and the North Carolina General Statute 122C place certain obligations upon us with regard to your protected health information and require that we keep private and confidential any such information that identifies you.  Additionally, if your record contains substance use disorder (SUD) information protected by Part 2, the federal Confidentiality of Substance Use Disorder Patient Records regulations at 42 C.F.R. Part 2 (“Part 2”) place certain additional obligations upon us with regard to your Part 2 record and requires that we keep private and confidential any such SUD information that identifies you.

Under these laws, we may not use or disclose your protected health information or Part 2 Record except as allowed by law. We take this obligation and your privacy seriously. When we need to use or disclose your protected health information or Part 2 Record, we will comply with the terms of this Notice. Anytime we are permitted to or required to share your protected health information or Part 2 Record outside Partners, we only provide the minimum amount necessary to respond to the need or request, unless otherwise permitted or required by law.

How Partners May Use or Disclose Your Health Information

The sections below describe ways that we may use or disclose/share your health information. Not every use or disclosure in a section will be listed but all the ways that we are allowed to use and disclose information will fall under one of the sections.

Partners can only use or disclose substance use disorder records with your written consent or as specifically permitted under federal law. The ways we can share your substance use information are listed in the section, How Partners May Use or Disclose Your Substance Use Disorder Health Information.

Treatment: Partners is not a treatment provider, but may need to disclose your information with professionals to:

• set up an appointment with other providers
• make a referral for an assessment
• coordinate care, treatment and services
• help create a treatment plan
• facilitate emergency treatment services

Payment: We may use or disclose health information about you to determine eligibility for plan benefits, facilitate payment for treatment and services you received from a provider, determine plan responsibility for benefits and to coordinate benefits. Your health information may also be shared with other government programs such as Medicare, NC Medicaid, NC Health Choice, and Prepaid Health Plans to manage your medical necessity of health care services or determine if a treatment is covered under your plan.

Healthcare Operations: We may use and disclose health information about you to carry out necessary managed care/insurance related activities, such as:

• activities related to plan coverage
• conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs
• quality assessment and improvement activities, such as investigating complaints

Required by Law: We may use and disclose your health information as required by law. Some examples include:

• if the law requires the use and disclosure
• to make a report to the Department of Social Services of suspected child abuse or neglect, or suspected abuse or neglect of a disabled adult
• when a member is committed for inpatient treatment

Public Health Activities: Your health information may be reported to a public health authority or other appropriate government authority authorized by law to collect or receive information for purposes such as:

• preventing or controlling disease (communicable disease reporting)
• help with product recalls
• reporting adverse reaction to medications

Health Oversight Activities: We may disclose your health information to health oversight agencies, like the NC Department of Health and Human Services, during audits, investigations, inspections, and other proceedings related to oversight. For example, health information may be reviewed by the Department of Health and Human Services to make sure we are complying with federal privacy law.

Judicial or Administrative Proceedings: We may disclose your health information in response to a court order or administrative order. We may also disclose your information in response to a subpoena, discovery request, or other lawful process, when permitted by law. We may share your information with an attorney who represents Partners, other legal representatives of Partners, or appropriate Partners employees, as necessary for litigation, business operations, or payment for services provided to you by a provider in Partners’ provider network.

Law Enforcement Officials: We may disclose your health information to respond to a serious and imminent threat of harm; for example, to report a threat to commit a violent crime on Partners premises or against Partners personnel or others.

Special Government Functions: We may disclose your health information for special government functions such as military, national security and presidential protective services.

Workers’ Compensation: We may disclose your health information to comply with worker’s compensation laws for workers’ compensation claims.

Research: We may use and disclose your protected health information for limited research purposes when permitted by law. In most circumstances, however, your written authorization will be required to conduct research using your protected health information.

North Carolina Health Information Exchange Authority (NC HIEA): The NC HIEA operates NC HealthConnex, which is an electronic system that allows health care providers to share patient health information. Partners is required by law to send your health information to the NC HIEA. Your information may be seen by your health care providers who use NC HealthConnex. If you do not want NC HealthConnex to share your information with your health care providers, you must opt out by sending a form to the NC HIEA. To learn more and access these forms, go to NCHealthConnex.gov. You may also contact our Privacy Officer at (888) 235-4673. Partners is still required to send the information, even if you opt out, but providers will be blocked from seeing it.

Decedents: We may share your health information with a coroner, medical examiner, or funeral director when an individual dies. We may also share your health information with your estate executor or next of kin.

How Partners May Use or Disclose Your Substance Use Disorder Health Information

We are permitted by law to use and disclose your health information, including our Part 2 Record, without your written or other form of consent in very limited circumstances. Before disclosing your health information under one of these exceptions, Partners will consider the request and make sure that only needed information is disclosed. These exceptions include, but are not limited to the following uses and disclosures:

• to a county Department of Social Services or law enforcement to report abuse, neglect or domestic violence
• to a health care provider that is providing emergency medical treatment
• to respond to a court order
• for research, audit, and program evaluation
• internal communications
• to law enforcement if we learn that you might commit a crime against a Partners employee or on Partners property
• to public health authorities (Information that identifies you, will be removed, if it is being shared for public health reasons)
• to qualified service organization agencies, when appropriate

In all other situations, Partners is required to get your written consent before your substance use disorder information can be disclosed. These situations include, but are not limited to:

• Treatment: to make a referral for diagnosis, to help create a treatment plan, or to coordinate care, treatment and services.
• Payment: for the treatment and services you receive from health care providers and to manage your benefits
• Healthcare Operations: such as population-based activities for improving health care or for disclosure made to fraud and abuse detection programs

You may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes. When you consent to uses and disclosures for all future treatment and payment purposes and to run our business, we may share your information with other substance use disorder treatment programs, doctors’ offices, providers and health care businesses for those activities. If the person who receives it is subject to HIPAA, then they are allowed to use and share your information again without your consent for the purposes that HIPAA allows.

Partners will not use or share your substance use disorder treatment information or provide testimony about that information in any civil, administrative, criminal, or legislative proceedings against you without your written consent or a court order that complies with federal confidentiality regulations (42 CFR Part 2). Any court order authorizing the use or disclosure of your Part 2 information must meet federal requirements, including providing you with notice and an opportunity to be heard. Additionally, a court order authorizing use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before the information is used or disclosed.

Other types of uses and disclosures of your SUD information that require your consent include sharing with probation and parole officers, family members, for disability determination, and with a county Department of Social Services.

North Carolina Treatment Outcomes and Program Performance System (NC-TOPPS)

NC-TOPPS is a web-based program that gathers outcome and performance data on behalf of individuals who use mental health and substance use treatment services in North Carolina’s public system. The NC-TOPPS system provides reliable information that is used to measure the impact of treatment and to improve service and manage quality throughout the service system. NC-TOPPS assessments fall under that audit and evaluation exception of federal confidentiality regulations (42 CFR Part 2 and 45 CFR Parts 160 and 164). Your identifying information collected via these assessments may be disclosed without your consent to the North Carolina Division of Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS) and to authorized contractors. DMH/DD/SUS or its authorized contractors may redisclose any member identifying information only to the chosen provider facility and to the members assigned LME/MCO for which this information has been sent.

When Partners May Not Use or Disclose Your Protected Health Information

Before Partners can use or disclose any information about your health in a manner not described above, in this Notice, we must first obtain your written consent allowing us to make the disclosure. Any such written authorization may be revoked by you in writing, except to the extent of use or disclosure has already been made.

• Your written consent is needed for most psychotherapy notes and substance use disorder (SUD) counseling notes. An authorization for disclosure of SUD counseling notes or psychotherapy notes may not and will not be combined with any other authorization.
• We may contact you for appointment reminders, to give you information about treatment choices, or to give you information about health-related benefits and services.
• We will not sell your information.
• Federal laws do not allow us to use or share genetic information to make decisions about your eligibility for enrollment as a member or approval of benefits and services. However, genetic information can be used or disclosed to decide if a benefit and service you request is medically appropriate for you.
• Your written consent is needed for most uses and disclosures of SUD information (except as listed above).

Your Rights Regarding Your Health Information

Right to Request Restrictions: You have the right to request restrictions be placed on certain uses and disclosures of your protected health information, including substance use information. Although we will carefully consider all requests for additional restrictions on how we will use or disclose your protected health information, we are not required to grant your request unless your request relates solely to disclosure of your protected health information to a health plan or other payor for the sole purpose of payment or health care operations for a health care item or service that you or your representative have paid us for in full and out-of-pocket. Requests for restrictions must be in writing and sent to the Privacy Officer at the address listed below.

Right to Request Confidential Communications: You have the right to make a reasonable written request to receive your protected health information by alternative and reasonable means of communication or at alternative reasonable locations. You must send your request in writing to the Privacy Officer at the address listed below. Such requests are honored if they are reasonable.

Right to Inspect and Copy: You have the right to inspect and request copies of your protected health information, that we maintain, be sent to you in electronic or paper format. You must submit your request in writing to the Privacy Officer at the address listed below. In limited circumstances, access may be denied if a licensed health care professional determines that access is reasonably likely to endanger the life or physical safety of you or another individual. If access is denied, you may request that the decision be reviewed. We may charge you a reasonable fee for paper copies of your protected health information or the amount of our reasonable labor costs for a copy of your protected health information in an electronic format.

Right to Request Amendment: You may request, in writing, that we amend, or change, your protected health information that we maintain by contacting the Privacy Officer at the address listed below. We will comply with your request unless:

• We believe the information is accurate and complete;
• We maintain the information you have asked us to change but we did not create or author it, for example, your medical records from a provider were brought to us and incorporated into your medical records with our information;
• The information is not part of the designated record set or otherwise unavailable for inspection.

Right to Accounting of Disclosures: You may request an accounting of certain disclosures we have made of your protected health information within the period of six (6) years from the date of your request for the accounting. Partners is not required to provide an accounting for disclosures made for purposes of treatment, payment, healthcare operations, or made to you. For SUD records, you may request an accounting of disclosures for treatment, payment and healthcare operation which we made through an electronic medical record for a period of three (3) years from the date of your request. At this time, Partners does not share member information through an electronic medical record. All accounting of disclosure requests must be made in writing to the Privacy Officer at the address listed below. The first accounting you request within a period of twelve (12) months will be free of charge. You may be charged for additional accountings.

Right to a Copy of this Notice: You have a right to request a copy of this Notice electronically or on paper. To request a copy, you may contact the Privacy Officer in writing at the address below, online at https://www.partnersbhm.org or call (888) 235-4673.

Right to Be Notified of a Breach: You have the right to be notified if we (or a Business Associate of Partners) discover a breach of your unsecured protected health information and inform you of what steps you may need to take to protect yourself.

Changes to the Terms of this Notice

We are required to follow the terms of this notice that are currently in effect. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on our website or by calling (888) 235-4673 to request an electronic or paper copy.

Complaints/Additional Information

You may file a complaint with Partners if you feel your HIPAA privacy rights have been violated. You may do so using any of the options below:

• Online, please visit https://www.partnersbhm.org/feedback/
• Email, Grievances@partnersbhm.org
• By phone, please call our Alert Line at 1-866-806-8777
• Mail your written complaint to (please include your full name, address, and phone number) Partners Health Management, Attn: Privacy Officer, 901 S. New Hope Road, Gastonia, NC 28054

You may also file a complaint with the Secretary Department of Health and Human Services at https://www.hhs.gov/civil-rights/filing-a-complaint/index.html or call 800-368-1019.

Partners will not retaliate against you or treat you any differently for filing a complaint.