Privacy Policy

Effective Date of This Notice: April 14, 2003

This notice describes how health information about you may be used or disclosed and how you can get access to your health information. Please review this information carefully. 

ACHIEVE is required, by HIPAA (Health Insurance Portability and Accountability Act) law, to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at ACHIEVE please contact: ACHIEVE at 607.723.8361 and ask for the Privacy Officer.

I. Use or Disclosure of Your Health Information

ACHIEVE collects health information from you, your family, your physician or other service providers and stores the information in a record or on a computer. This is your medical record. The medical record is the property of ACHIEVE, but the information in the medical record belongs to you. ACHIEVE protects the privacy of your health information. The law permits ACHIEVE to use or disclose your health information for the following purposes:

1. Treatment- ACHIEVE provides treatment services to include Medicaid Service Coordination, Residential Services, Residential Habilitation, Day Habilitation, Article 16 Clinic, Day Treatment Services, Supported Employment, Prevocational Services, Day Training, Sheltered Employment, Family Support Services, and Summer Program. In order to provide these services, ACHIEVE must use and disclose health information to individuals such as consultants, business associates, direct care staff and other individuals involved in your care.

2. Payment-ACHIEVE participates in the activities of obtaining reimbursement for services, coverage determinations, billing, claims processing and utilization review.

3. Regular Health Care Operations- ACHIEVE is required to conduct quality assurance and quality improvement activities, evaluation of health care provider performance, investigation of incidents or complaints, auditing, business planning, and general management which may result in disclosure of protected health information.

4. Information Provided to You -You or your personal representative (unless otherwise restricted) may obtain information, when requested in writing, in accordance with the policy and procedure of protected health information. Obtain further information on access to your records by requesting the form Request for Access to Health Information.

5. Directories- ACHIEVE may list your name, your general medical condition and where you are located in our facilities in a directory list. This list is needed internally to provide a safe environment and the provision of treatment. This information may be provided to other people who ask for you by name. If you wish to restrict the information provided to others outside ACHIEVE, please do so in writing. Request the form: Request for Special Privacy Protections

6. Notification and Communication with Family-ACHIEVE may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of injury or death. If you are able and available to agree or object to this notification, ACHIEVE will give you the opportunity to agree or object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

7. Required by Law-As required by law, ACHIEVE may use and disclose your health information.

8. Public Health- ACHIEVE may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure, as required by law.

9. Health Oversight Activities- ACHIEVE may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings. (These may include but not limited to Broome DDSO, OMRDD, Medicaid, Medicare, Department of Social Security, etc.).

10. Judicial and Administrative Proceedings.- ACHIEVE may disclose your health information in the course of any administrative or judicial proceeding.

11. Law Enforcement-ACHIEVE may disclose your health information to a law enforcement officer for purposes of identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes. This disclosure will not supersede ACHIEVE policies.

12. Deceased Person Information- Should you become deceased, ACHIEVE may disclose your health information to coroners, medical examiners and funeral directors.

13. Organ Donation -ACHIEVE may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.

14. Research.- ACHIEVE consumers will not participate in research. ACHIEVE will abide by OMRDD regulation 633.13.

15. Public Safety- ACHIEVE may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

16. Specialized Government Functions- ACHIEVE may disclose your health information for military, national security, or prisoner purposes.

17. Worker's Compensation- ACHIEVE may disclose your health information as necessary to comply with worker's compensation laws.

18. Marketing- ACHIEVE may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you. For any other marketing activities, ACHIEVE will contact you for your authorization.

19. Fund-raising- As an enrollee of ACHIEVE, the agency may contact you regarding fund-raising activities. You may choose whether you wish to participate.

20. Change of Ownership-In the event that ACHIEVE merges with another organization, your health information/record will become the property of the new entity.

II. ACHIEVE Will Not Use or Disclose Your Health Information

Except as described above in this Notice of Privacy Practices, ACHIEVE will not use or disclose your health information without your written authorization. If you do authorize ACHIEVE to use or disclose your health information for another purpose, you may revoke your authorization at any time. Revocation of the authorization must be in writing. ACHIEVE will maintain an accounting of the disclosures

III. Your Health Information Rights

1. You have a right to a paper copy of this Notice of Privacy Practices.

2. You have the right to request restrictions on certain uses and disclosures of your health information. However, please be advised that ACHIEVE is not required to agree to the restriction that you requested.

3. You have the right to inspect your health information. You have the right to receive your health information through a reasonable alternative means or at a reasonable alternative location. You must complete your request in writing; ask for the Confidential Channel of Communication form.

4. You may also obtain copies of your health information. However, ACHIEVE is not required to provide information beyond the previous six years (Beginning April 15, 2003 forward). There will be no charge for coping up to 12 months of health information within a twenty-four month period. For more than twelve months of copied information in a twenty-four month period, there will be a standard charge.