Notice of Privacy Practices

This Notice of Privacy Practices describes how the Mental Health Association of Monmouth County may use and disclose your protected health information to carry out treatment, payment, or healthcare operations, and for other purposes permitted or required by law. It details your rights regarding the health information we maintain and provides a brief description of how you may exercise these rights. It also outlines our obligations to protect your health information.

Protected Health Information (PHI) is identifying health information we collect from you or receive from healthcare providers, health plans, employers, or healthcare clearinghouses. This may include information regarding past, present, or future physical and/or mental health conditions, the provision of your healthcare, and payment for your healthcare services.

The Mental Health Association of Monmouth County is required by law to maintain the privacy of your PHI and to inform you of our legal duties and privacy practices. We must comply with the terms of our current Notice of Privacy Practices.

USES AND DISCLOSURES FOR TREATMENT, PATMENT, AND OPERATIONS

Treatment: The Mental Health Association of Monmouth County may use and disclose your PHI without your consent to employees and agents to provide, coordinate, and manage your healthcare and related services. We may disclose your PHI to our clinicians and other staff, including clinicians beyond your primary therapist, who work at the Mental Health Association of Monmouth County. We may also disclose your PHI to another healthcare provider for treatment purposes.

Payment: We may use or disclose your PHI without your consent to bill for the treatment and services you receive and to collect payment from your health plan or other third-party payer. We may also disclose your PHI to health plans to:

Determine eligibility or coverage for health insurance.
Assess whether services are medically necessary.
Review services to ensure they are appropriately authorized or certified in advance of your care.
Conduct utilization reviews to confirm the appropriateness of your care or justify charges for your care.

Health Care Operations: We may use or disclose your PHI without your consent for our health care operations. These uses and disclosures are necessary to run our organization and to ensure our consumers receive quality care. These activities may include quality assessment and improvement, performance and qualification reviews, training, licensing, accrediting, business planning and development, and general administrative activities. We may combine our consumers' PHI to determine what additional services should be offered, what services are unnecessary, and whether certain treatments are effective.

We may also provide your PHI to other health care providers or to your health plan to assist them in performing their health care operations. We only do so if you have or have had a relationship with a provider or health plan. We may also use and disclose your PHI for appointment reminders and to inform you of possible treatment options or alternatives.

Health-related Benefits and Services: We may use and disclose PHI to inform you of health-related benefits or services during your visit to your primary therapist or psychiatrist. If you do not consent to receiving information about health-related benefits or services, please notify the Executive Director in writing at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724.

OTHER USES AND DISCLOSURES

The Mental Health Association of Monmouth County does not maintain a directory at our outpatient facilities. If asked, we will not confirm your status with the exceptions listed below.

Persons Involved in Your Care: The Mental Health Association of Monmouth County may provide your PHI to someone who financially supports your care. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or any other person responsible for your care of your location, general condition, or death. We may also use and disclose your PHI to an entity assisting in disaster relief efforts and to coordinate uses and disclosures for this purpose to family or other individuals involved in your healthcare.

In limited circumstances, we may disclose your PHI to a friend or family member involved in your care. If you are physically present and have the capacity to make healthcare decisions, your PHI may only be disclosed with your consent to persons authorized to be involved in your care. However, we may disclose your PHI during emergency situations if we determine that disclosure is in your best interests and, if so, only to the extent relevant to participation in your care to a family member or friend to assist in your care.

If you are not experiencing an emergency but are unable to make healthcare decisions, we will disclose your PHI to:

A person authorized to participate in your care in accordance with an advanced mental health directive validly executed under state law.

Your guardian or other fiduciary if one has been appointed by a court; or

If applicable, the state agency responsible for consenting to your care.

EXTRAORDINARY CIRCUMSTANCES

Emergencies: The Mental Health Association of Monmouth County may use and disclose your PHI during emergency treatment. If a clinician is required by law to treat you and attempts to obtain your authorization without success, the treating clinician may use or disclose your PHI to treat you

Research: We obtain written authorization prior to disclosing your PHI for research approved by an Institutional Review Board or similar privacy board that has reviewed the research proposal and established protocols to protect the privacy of your PHI. All research projects are subject to an approval process that balances research needs with consumers' privacy.

Required by Law: We disclose your PHI when required by federal, state, or local law.

To Avert a Serious Health or Safety Threat: We may use and disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety, or to the health or safety of the public or another person. Under these circumstances, we disclose PHI to someone able to prevent or lessen the threat.

Organ and Tissue Donation: If you are an organ donor, we may release your PHI to an organ procurement organization or entity that conducts organ, eye, or tissue transplants or serves as an organ donation bank as necessary to facilitate organ, eye, or tissue donations and transplants.

Public Health Activities: We may disclose PHI about you as necessary for public health activities, including, by way of example, disclosures to:

Report to public health authorities to prevent/control disease, injury, or disability.

Report vital events such as birth or death.

Conduct public health surveillance or investigations.

Report child abuse and/or neglect.

Report events to the Food and Drug Administration (FDA) or to a person subject to the FDA's jurisdiction, including information about defective products or problems with medications.

Notify consumers of FDA-initiated product recalls.

Notify a person who may have been exposed to a communicable disease or who is at risk of contracting or spreading a disease or condition.

Notify authorities if we believe you're a victim of abuse, neglect, or domestic violence, only with consent or as required by law.

Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law, including government agencies that oversee the health care system, government benefits programs (e.g., Medicare or Medicaid), other government programs regulating health care and civil rights laws.

Disclosures in Legal Proceedings: We may disclose your PHI to a court or administrative agency when a judge or administrative agency compels us to do so. We will not disclose your PHI in legal proceedings without your consent or without a judge or administrative agency's order. If we are subpoenaed for your PHI, we will not provide this information in response to a subpoena without your written authorization.

Law Enforcement Activities: We may disclose your PHI to a law enforcement official for law enforcement purposes when:

A court order, warrant, summons, or similar process requires us to do so.

The information is needed to identify or locate a suspect, fugitive, material witness, or missing person.

We report a death we believe may be the result of criminal conduct.

We report criminal conduct occurring on the premises of our facility.

We determine the law enforcement purpose is responding to a threat of imminent danger by you against yourself or another person.

The disclosure is otherwise required by law.

We may also disclose PHI about a consumer who is the victim of a crime without a court order or without being required to do so by law. However, we will do so if the disclosure has been required by law enforcement and the victim agrees to the disclosure or, in the case of the victim’s incapacity:

Law enforcement presents: (i) the victim is not the investigation subject, and (ii) immediate disclosure is needed for public safety.

We determine the disclosure is in the victim's best interest.

Medical Examiners or Funeral Directors: We may provide your PHI to a medical examiner appointed by law to assist in identifying deceased persons and determining cause of death, as well as funeral directors as necessary to carry out their duties.

Military and Veterans: If you are a member of the United States Armed Forces, we may disclose your PHI as required by military command authorities. We may also disclose your PHI to determine eligibility for benefits provided by the Department of Veterans Affairs. If you are a member of a foreign military service, we may disclose your PHI to the appropriate foreign military authority.

National Security and Protective Services for the President and Others: We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We may also disclose your PHI to authorized federal officials so they may provide protection to the President of the United States, or other authorized persons or foreign heads of state, or conduct investigations.

Inmates: If you are an inmate or under law enforcement custody, we may disclose your PHI to the correctional institution or law enforcement.

Workers’ Compensation: With your consent, we may disclose your PHI to comply with New Jersey's Workers’ Compensation law.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION WITH YOUR CONSENT

Uses and disclosures not described in the Permitted Uses and Disclosures of this Notice of Privacy Practices will generally be made with your written permission or authorization. You have the right to revoke an authorization at any time. If you revoke your authorization, we will not make any further uses or disclosures of your PHI under that authorization unless we have already acted on the uses or disclosures you previously authorized.

Right to Inspect and Copy: You have the right to request an opportunity to inspect or copy PHI used to make decisions about your health care, including decisions about your treatment or payments. This usually applies to clinical and billing records, not psychotherapy notes. To make this request, submit it in writing to the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724. If you request a copy, we may charge a fee for copying, mailing, and supplies. We may deny your request in certain circumstances (e.g., if the release of information would harm your well-being). You have the right to have the denial reviewed by a licensed healthcare professional not involved in the original decision. We will inform you in writing if your request’s denial may be reviewed. Once the review is completed, we will honor the decision made by the licensed healthcare professional reviewer.

Right to Amend: While we maintain your consumer record, you have the right to request an amendment to any PHI used to make decisions about your care. To request an amendment, submit it in writing to the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724, stating why you believe the information is incorrect or inaccurate. We may deny your request if it is not in writing or lacks sufficient reasoning.

We may also deny the request if the information:

Was not created by us unless the creator is unavailable.

Is not part of the PHI we maintain to make decisions about your care.

Is not part of the information you are permitted to inspect or copy.

Is accurate and complete.

If we deny your amendment request, we will send you a written notice stating the denial's basis and offer you the opportunity to provide a written statement of disagreement. If you choose not to prepare a written statement, you may request that the amendment request and its denial be attached to all future disclosures of the PHI. If you submit a written statement of disagreement, we may prepare a written rebuttal, which will be attached to all future disclosures along with the original request and denial.

Right to an Accounting of Disclosures: You have the right to request an accounting or list of your PHI disclosures, but this list will not include certain disclosures related to treatment, payment, and healthcare operations. To request this accounting, submit your request in writing to the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724. The request must specify the accounting period, which should be no longer than six years from the date of request. The first accounting request within a 12-month period will be free. For additional requests within the same period, we may charge a fee for providing the account. We will notify you of the charges, and you may choose to withdraw or modify your request before any fees are applied.

Right to Request Restrictions: You have the right to request a restriction on the PHI we use or disclose about you for treatment, payment, or healthcare operations. To request a restriction, submit it in writing to the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724. The Executive Director will ask you to sign a request for restriction form, which you must complete and return. We are not required to agree to your request for a restriction. If we do agree, we will honor the request unless the restricted PHI is needed to provide you with emergency treatment.

Right to Request Confidential Communications: You have the right to request that we communicate with you regarding your health care only in a certain method or location. To request confidential communication, submit your request in writing to the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724. We will accommodate all reasonable requests. You do not need to provide a reason for the request, but it must specify how or where you wish to be contacted.

Right to a Paper Copy of the Notice of Privacy Practices: You have the right to obtain a physical copy of this Notice of Privacy Practices, regardless of whether you agree to receive it electronically.

CONFIDENTIALITY OF SUBSTANCE USE DISORDERS

For consumers who have received treatment, diagnosis, or referral for treatment from our drug or alcohol abuse programs, confidentiality is protected by federal law and regulations. Generally, we may not disclose your attendance or identifying information unless:

You authorize the disclosure in writing.

The disclosure is permitted by court order.

The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation purposes.

You threaten to commit a crime at the program or against any individual working for our programs.

A violation of federal law and regulations governing drug or alcohol abuse is a crime. Suspected violations may be reported to the U.S. Attorney in the district where the violation occurred. Federal law and regulations permit us to report suspected child abuse and/or neglect under state law to appropriate authorities. See 42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2 for federal regulations governing the confidentiality of alcohol and drug abuse patient records.

CONSUMER COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Mental Health Association of Monmouth County by contacting the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724. The Executive Director will assist you with your complaint if you request such assistance. We will not retaliate against you for filing a complaint. You may also contact:

US Department of Health and Human Services
Office for Civil Rights
26 Federal Plaza, Suite 3312
New York, NY 10278

CHANGES TO THIS NOTICE OF PRIVACY PRACTICES

We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all present and future PHI collected. We will post a copy of the Notice of Privacy Practices at our main office and in each site where we provide care. You may also obtain a copy of the current Notice of Privacy Practices by calling (732) 542-6422 or accessing our website at www.mentalhealthmonmouth.org.

WHO OBSERVES THIS NOTICE

All Mental Health Association of Monmouth County locations listed below follow this Notice of Privacy Practices:

Mental Health Association of Monmouth County
106 Apple Street, Suite 110
Tinton Falls, NJ 07724

Red Bank Resource Network
103 Drs James Parker Blvd, Suite B/D
Red Bank, NJ 07701

Consumer Rights

Consumers receiving services at the Mental Health Association of Monmouth County have rights and responsibilities. Consumers will be informed of their rights and any rules governing their conduct with respect to the Mental Health Association of Monmouth County within five business days of admission. This information shall be provided in writing and supplemented by an offer to discuss the written description. Explanations shall be in a language the consumer understands. If the consumer cannot read the provisions of the notice, it shall be read to them.

In the case of an adjudicated incompetent consumer, the procedure above shall be followed for the consumer's guardian. Receipts of the written notice shall be documented in the consumer's file. If the consumer or guardian refuses to acknowledge receipt of the notice, the person delivering the notice shall document this in the consumer's file.

Subject to any other provisions of law, no consumer shall be deprived of any civil rights solely by reason of their receiving mental health services. Nor shall such services modify or vary any legal or civil rights of any consumer.

No consumer may be presumed to be incompetent because they have been examined or treated for mental illness, regardless of whether such evaluation or treatment was voluntary or involuntarily received.

PROCEDURE

Staff will explain to consumers their rights and responsibilities as a regular part of the intake and assessment process within five business days of admission.
Program Directors will ensure the Consumers Rights and Responsibilities statement is available to consumers and participants in written form and made available in the consumer’s preferred language.
Staff will ensure they are familiar with the Mental Health Association of Monmouth County's confidentiality policy so they can answer consumers' questions and assist them in exercising their rights regarding their record and in accordance with N.J.A.C. 10:37-4.5.

CONSUMER RIGHTS

Be free from unnecessary or excessive medication (N.J.A.C. 10:37-6.54).
Not be subjected to non-standard treatments, experimental procedures, research, psychosurgery, sterilization, electroconvulsive therapy, or provider demonstration programs without written consent. For adjudicated incompetent consumers, authorization must follow N.J.S.A. 30:4-24.2(d)2.
Receive treatment in the least restrictive setting, free from physical restraints and isolation.
Be free from corporal punishment.
Privacy and dignity.
Conditions necessary to achieve treatment/service goals in the least restrictive manner.
Understand and use these rights. If unclear, the agency must assist, including providing an interpreter or translator.
Receive services without discrimination based on race, color, religion, sex, national origin, disability, sexual orientation, or source of payment.
Know the names, positions, and functions of agency staff involved in their treatment.
Receive complete information about their diagnosis, treatment, and prognosis (if applicable).
Review their clinical record at no cost and obtain a copy upon written request unless deemed clinically harmful by the case manager and supervisor.
Confidentiality of case files, information, and communication as per law. Disclosure requires written consent, a court order, agency staff involved in treatment, or audit teams designated by the NJ Division of Mental Health Services, Division of Licensing, or in case of imminent risk.
Complain without fear of reprisals about care and services received. Speak to an agency representative or contact:

Monmouth County Mental Health Administrator: (732) 431-7200
NJ Division of Mental Health Services: (1-800) 792-8820, (732) 531-9191, after hours (732) 531-9111
Community Health Law Project: (732) 380-1012
Division of Mental Health Advocacy: (609) 826-5090
Division of Child Protection and Permanency Services: (1-877) 652-2873
DCP&P Division Action Line: (1-800) 331-DCPP

14. Participate in discussions about agency policies, procedures, and ethical issues related to their care with agency management.

CONSUMER RESPONSIBILITIES

Provide accurate and complete information regarding current complaints, past illnesses, hospitalizations, medications, and other health-related matters.
Report any unexpected changes in their condition to the responsible staff member(s).
Report whether they understand the contemplated course of action and what is expected of them.
Follow the service plan formulated by the case manager and others involved with their care and with their participation.
Keep scheduled appointments and notify the agency in a timely manner if unavailable for the scheduled appointment.
Assume responsibility for their actions upon refusing service or not following the prescribed service plan.
Be considerate of the rights of other consumers and agency personnel.
Be respectful of the property of other consumers and the agency.
Consent to the release of relevant information to Monmouth County’s Crisis Screening Services: Monmouth Medical Center, CentraState Medical Center, Jersey Shore Medical Center, and Riverview Medical Center in a crisis.
Provide a safe working environment for agency personnel who are providing in-home services and inform staff immediately of anything that may endanger their health and safety.

RESIDENTIAL RIGHTS

Interact with members of any gender.
Wear personal clothes, keep and use personal possessions (e.g., toiletries), and spend personal money.
Access individual storage space for private use.
See visitors each day.
Have reasonable access to and use of a telephone for confidential calls.
Have reasonable access to letter-writing materials (e.g., paper, utensils, stamps) and unopened mail.
Engage in regular physical exercise.
Spend time outdoors at regular and frequent intervals, barring medical considerations.
Practice or abstain from religion. Provisions for worship in inpatient care shall be nondiscriminatory.
Receive prompt and adequate medical treatment for any physical ailment.

Privacy Summary

This Privacy Summary for the Mental Health Association of Monmouth County is not complete without reference to the attached Notice of Privacy Practices. You must receive the Notice of Privacy Practices along with this summary.

The Mental Health Association of Monmouth County understands your protected health information (PHI) is private and confidential. Under HIPAA, we are required to maintain the privacy of any individually identifiable information obtained by you or others relating to your past, present, or future physical or mental health, health care services you received, or payment for your healthcare.

OTHER USES AND DISCLOSURES

Your PHI will be used as needed by the Mental Health Association of Monmouth County for treatment, payment, and routine healthcare operations, including sharing your information from one program in our system to another.

We may use your PHI in other ways, though all such uses and disclosures will be subject to the restrictions of applicable law. For example, we may:

Contact you to provide appointment reminders for treatment.
Disclose information to your authorized family members or friends involved in your care or payment.

Disclose your information to comply with applicable laws.

Other uses and disclosures of PHI not covered by the Notice of Privacy Practices or the laws applicable to the Mental Health Association of Monmouth County will be made only with your written permission.

CONSUMER RIGHTS

Among other things, consumers have the right to:

Request restrictions on the Mental Health Association of Monmouth County’s uses and disclosures of PHI for treatment payments and healthcare operations.
Request an accounting of any disclosures of your PHI that we made over a 12-month period, beginning with disclosures made on April 14, 2003.
Make a reasonable request to receive communications by alternative means or at alternative locations.
Inspect and copy certain PHI contained in your medical and billing records used to make decisions about you.
Request an amendment to your PHI. We may deny your request for amendment in certain circumstances. However, we will notify you in writing as to our reasoning.

LIMITS OF CONFIDENTIALITY

Information discussed in a therapy setting is held in the strictest confidence. No information will be shared without the consumer's written permission except in the following circumstances:

The consumer threatens suicide.

The consumer threatens another individual with physical harm, including assault or murder.

The consumer is a minor under the age of 18 and reports suspected child abuse, including but not limited to abuse of a physical, sexual and/or neglectful nature.

The consumer reports sexual exploitation by a therapist.

The consumer reports elder abuse.

The consumer reports they are abusing animals.

The consumer is legally compelled to share information by a court order.

New Jersey law mandates a mental health professional is required to report these incidents to the appropriate person and/or agencies. Communication between the consumer and clinician will otherwise be deemed confidential as defined under New Jersey law.

CONSUMER COMPLAINTS

If you believe your privacy rights have been violated, you should immediately contact the Executive Director at 106 Apple Street, Suite 110, Tinton Falls, NJ 07724. The Mental Health Association of Monmouth County will not retaliate against you for filing a complaint. Complaints concerning PHI privacy violations may also be filed with the US Department of Health and Human Services, located at 26 Federal Plaza, Suite 3312, New York, NY 10278.

If you have any questions or would like further information not included in this Privacy Summary, please contact the Executive Director at 732-542-6422.

Effective August 1, 2024