GENERAL COUNSELING & HIPAA POLICIES

Entering into a therapeutic relationship with a counseling professional requires an establishment of trust.  When you begin therapy, you are committing your time, money and emotional energy and it is important to fully understand what that commitment will entail. Included below is a summary of the policies and processes that guide the work of this counseling practice and your work with your therapist.

1. APPOINTMENTS: You can make an appointment by calling 302-552-3574.  Confidential messages will be returned within 24 hours.  Since clients are seen by appointment only, unless an emergency requires an immediate appointment, this appointment time is reserved only for you.  If it is necessary for you to cancel an appointment, notice of cancellation must be made at least 24 hours prior to your scheduled appointment time or you will be billed for the set appointment fee.  If you are experiencing a mental health emergency, please go directly to your nearest emergency room for assistance, call 911, or call the Crisis Intervention Services at 800-969-4357.

1. FEES AND PAYMENTS FOR COUNSELING SERVICES: Fees for counseling services are set and potentially reduced on a sliding scale fee or waived for a limited number of clients who display financial need, but do not have accepted insurance.  Otherwise all fees are billed through accepted insurance.

1. INSURANCE: Some insurance carriers are accepted at this time, check with your assigned worker or call 302-552-3574 to verify.

1. CONFIDENTIALITY: Delaware State law and ethical requirements of the State Board indicate that what is discussed in private counseling sessions is privileged communication, meaning that clients control the release of this information to a third party.  There are several limits to confidentiality that involve the required release of information in order to keep clients and/or others safe from harm.  These limits include: clear and imminent danger to self or others; suspected child or elder abuse; a direct court order by a judge ordering the release of records or an appearance in court to testify.  If it would benefit clients in counseling progress, clients may be asked to sign a release of information to allow LHC to discuss information with the client’s primary healthcare professional or other key providers (e.g., your child’s school teacher if your child is receiving counseling services with me).

1. HIPAA NOTICE OF PRIVACY PRACTICES: Included with this initial introductory paperwork is a copy of the HIPAA document.  LHC is required by law to provide this to you and to secure your signature.  If you should have any questions about this document, please do not hesitate to ask for clarification.

1. BENEFITS AND RISKS OF COUNSELING: Counseling can be of great benefit to a client who fully commits to being open and honest in the counseling relationship.  It requires the client to come to the table with their own personal goals for counseling.  LHC cannot create change in a client’s life; the clients are the change agents in their own lives.  LHC cannot guarantee a specific outcome from services provided.  Clients are ultimately responsible for their own growth and direction in counseling.  During counseling sessions, LHC along with the client may discuss additional resources or activities that, added to counseling, may help further change and growth in the client.  These may include referrals to a primary care physician for medication evaluation, directions for a specific activity plan of exercise, referrals to a nutritionist, etc.  Wellness comes from whole body health that should include an emphasis on mind, body and spirit.  After we have met to discuss your concerns, we will create a plan that is individualized to your own goals and desires for counseling outcomes.

1. ADOLESCENTS IN CARE: When adolescents participate in therapy, it is important that all custodial parents or guardians are in agreement regarding that participation. By signing below, you acknowledge this and assert that you are the person legally responsible for the adolescent for whom you are seeking services.  You also declare that any other person(s) who are legally responsible for him or her are aware of this adolescent’s participation in therapy and do not object to his/her participation.

When adolescents are involved in therapy, their parents may, in some circumstances, have the legal right to view records kept on their behalf.  However, it is typically in the best interest of the adolescent that these records be kept private.  The success of any therapy is generally dependent on a trusting and confidential relationship between therapist and client.  For this reason, LHC staff will keep all records private and will not disclose the content of therapy sessions to parents except in cases where the adolescent is believed to be in significant danger.  LHC staff will encourage both the adolescent and the parents to participate in family therapy sessions as needed/as appropriate to help facilitate healthy communication about the ongoing issues discussed in therapy, but this has to be at the discretion of the adolescent receiving therapy.  It is critical to progress for your adolescent to feel that he or she can confide in their therapist.  Please feel free to discuss this policy with your therapist at any time.

Please feel free to present any questions regarding any of the policies and processes outlined above.  It is important that you clearly understand your rights and responsibilities when entering into a counseling relationship.

HIPAA NOTICE & PRIVACY POLICY

Preamble:

State law provides extremely strong privileged communication protections for conversations between your therapist and you in the context of your established professional relationship with your therapist.  There is a difference between privileged conversations and documentation in your mental health records.  Records are kept documenting your care as required by law, professional standards, and other review procedures.  HIPAA very clearly defines what kind of information is to be included in your “designated medical record” as well as some material, known as “Psychotherapy Notes” which is not accessible to insurance companies and other third-party reviewers and in some cases, not to the patient himself/herself.

HIPAA provides privacy protections about your personal health information, which is called “protected health information” (further referred to as PHI) which could personally identify you. PHI consists of three components: treatment, payment and health care operations.

TREATMENT refers to activities in which your therapist provides, coordinates or manages your mental health care or other services related to your mental health care.  Examples include a therapy session, talking to a client’s physician about medications or other medical conditions, or talking with your child’s teacher about observable behaviors in the classroom.

PAYMENT refers to the reimbursement received for providing clients with mental health care.  If clients have insurance coverage, filing with the client’s insurance for payment of therapy sessions is an example of this type of sharing of PHI information.

HEALTH CARE OPERATIONS are activities related to the business and quality performance of the associated therapy practice.  Insurance companies can request documentation reviews to assure the work with clients is “medically necessary.”

USE applies only to activities within the service office such as sharing, employing, applying, utilizing, examining and analyzing information that identifies you.

DISCLOSURE applies to activities outside of the service office such as releasing, transferring, or providing access to information about clients to other parties.

1. Uses and Disclosures of Protected Health Information Requiring Authorization

Delaware requires authorization and consent for treatment, payment and healthcare operations.  When beginning therapy with LHC, you will sign this general consent to care and authorization to conduct payment and health care operations, authorizing LHC to provide treatment and to conduct administrative steps associated with your care.  LHC may use or disclose PHI for purposes outside of treatment, payment and health care operations only when you sign an additional authorization for release of information.  An “authorization” is written permission above and beyond the general consent that permits only specific disclosures that clients identify in writing.  LHC will also need to obtain an authorization before releasing your psychotherapy notes.  “Psychotherapy notes” are notes made about conversations during a private, group, joint, or family counseling session, which are kept separate from the rest of your medical record.  These notes are given a greater degree of protection than PHI.

1. Uses and Disclosures with Neither Consent or Authorization

LHC may use or disclose PHI without client consent or authorization in the following circumstances:

• Child Abuse: If we have reasonable cause to believe or suspect abuse of a child or children, we are required by law to report this abuse to authorities.
• Elder or Domestic Abuse: If we have reasonable cause to believe that an older adult is in need of protective services (regarding abuse, neglect, exploitation or abandonment), we must report this to the local protective services agency.
• Health Oversight Activities: If the licensing board of professional counselors in Delaware were to audit activities at LHC, we would be required to release information for quality review purposes.
• Judicial or Administrative Proceedings: If a client is involved in a court proceeding and a request is for LHC to directly appear to report on the therapy we have provided, or the records we maintain documenting these therapy meetings are requested, such information is privileged under state law and we will not release the information without your written consent or a court order. The privilege does not apply when clients are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
• Serious Threat to Health or Safety: There are two types of threats to safety: threats toward you or threats toward others. If you express a serious threat to yourself, or intent to kill or seriously injure an identified person, and LHC determine that you are likely to carry out the threat, we must take reasonable measures to prevent harm. Reasonable measures may include directly advising the potential victim of the threat or intent.
• Worker’s Compensation: If a client files a worker’s compensation claim, LHC will be required to file periodic reports with the client’s employer which shall include, where pertinent, history diagnosis, treatment and prognosis.

III. Clients Rights and Therapist’s Duties

Client’s Rights:

• Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you should provide permission for me to leave a voice message at your home or provide an alternative way to reach you if you are worried about sharing your PHI with those at your home residence. Additionally, if you do not want your bills sent to your home address, you can provide an alternative billing address.
• Right to Inspect and Copy: You have the right to inspect and/or copy your protected health information in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, I will discuss with you the details of the request and the denial process.
• Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request. At your request, I will discuss with you the details of the amendment process.
• Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this notice). At your request, I will discuss with you the details of the accounting process.
• Right to a Paper Copy: You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.
• Right to Revoke Authorization: You have the right to revoke your authorization of protected health information except to the extent that action has already been taken based on that authorization.

Therapist’s Duties:

• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
• If I revise my policies and procedures, I will present you with a revised copy when you present for a session.

1. Questions and Complaints

Forrest Watson III is the appointed “privacy officer” for this practice per HIPAA regulations. If you have any concerns of any sort that my office may have somehow compromised your privacy rights, please do not hesitate to speak with him immediately about this matter. You may reach him by phone at 302-513-9268. You will always find all vested parties at LHC willing to talk with you about preserving the privacy of your protected mental health information. You may also send a written complaint to the Secretary of the U. S. Department of Health and Human Services.

1. Effective Date, Restrictions and Changes to Privacy Policy

This notice will go into effect 7/1/2014.

I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain.  I will provide you with a revised notice when your present at this office.