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Kyo Autism Therapy, LLC
Effective Date: October 25, 2023
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT A CLIENT MAY BE USED AND DISCLOSED AND HOW CLIENT AND/OR A PARENT/GUARDIAN CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR LEGAL DUTY
Federal and state law requires Kyo Autism Therapy, LLC (“Kyo”, “we” or “us”) to maintain the privacy of client health information. That law also requires us to give our client and/or the client’s parent/guardian (together, “you”) this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices we describe in this notice while it is in effect. This Notice takes effect October 25, 2023 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided applicable law permits such changes. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
You may request a copy of our notice at any time. We will provide you with a copy promptly. For more information about our privacy practices, or for additional copies of this notice, please use the contact information listed at the end of this notice.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We are required by applicable federal and state law to maintain the privacy of your protected health information. “Protected health information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We use and disclose PHI for treatment, payment and health care operations. For example:
Treatment. We may use and disclose your PHI for treatment or disclose it to a physician or other health care provider providing treatment for you so that they can order our services. For example, we may issue a report to your physician so that he or she can order services for you.
Payment. We may use and disclose your PHI for payment activities including submitting claims and invoices, determining eligibility or coverage, reviewing services and responding to audit requests from payers, such as insurers and school districts. In some cases, state law may require us to obtain your consent before we share mental health PHI with health plans or other entities that we may bill. We may disclose your PHI to our technology partners who assist us in managing payments.
Health Care Operations. We may use and disclose your PHI for our health care operations. Health care operations include quality assessment and improvement activities, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. We may disclose your PHI to another health care provider or organization that is subject to federal Privacy rules and that has a relationship with you to support their health care operations. For example, your PHI may be disclosed to our administrative team or our consultants to evaluate the quality of the professionals who have provided you with health care or to our technology partners who assist us in our healthcare operations.
On Your Authorization. You may give us written authorization to use your PHI or disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your PHI for any reason except those described in this notice.
To Your Family and Friends. We may disclose your PHI to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. Before we disclose your PHI to these people, we will provide you with an opportunity to object to our use or disclosure. If you are not present, or in the event of your incapacity or an emergency, we will disclose your PHI based on our professional judgment or whether the disclosure would be in your best interest. We may use our professional judgment and our experience with common practice to make reasonable inferences of your best interest.
Treatment Programming. The Kyo team will communicate with you regarding your treatment schedule, treatment options and treatment results; collectively the “Treatment Programming”. We may use or disclose your PHI to communicate with you regarding your Treatment Programming, via internet webpages, mobile applications (“apps”), emails, phone calls, text messages or voicemail messages. We may transmit information containing PHI to you through a secure, encrypted email system. You may not opt out of the encryption service. We may disclose your PHI to our technology partners who assist us in managing/communicating the Treatment Programming.
Breach Notification. In the case of a breach of unsecured PHI, we will notify you as required by law. If you have provided us with a current email address, we may use email to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate.
Public Benefit. We may use your PHI as authorized by law for the following purposes deemed to be in the public interest:
WHEN WE MAY NOT USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Except as described in this Notice of Privacy Practices, Kyo will, consistent with its legal obligations, not use or disclose PHI which identifies you without your written authorization. If you do authorize this practice to use or disclose your PHI for another purpose, you may revoke your authorization in writing at any time.
In the cases listed below we never share your PHI unless you give us written permission:
Access. You have the right to look at or get copies of your PHI, with limited exceptions. You must make a request in writing to obtain access to your PHI. You may request access by sending us a letter to an address at the end of this notice. There may be a cost-based fee associated with providing copies of the PHI requested, depending on the volume of PHI information.
Disclosure Accounting. You may request a list, or accounting, of certain disclosures of your PHI made by us or our business associates for purposes other than treatment, payment, healthcare operations and certain other activities. The request must be in writing and state a time period, which may not be longer than the prior six years.
Restriction. You have the right to request that we place restrictions on our use or disclosure of your PHI. We are not required to agree to your request, except to the extent that you request us to restrict disclosure to a health plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the health plan or insurer), has paid for the item or service out of pocket in full. If we agree to your request, we will abide by our agreement (except in an emergency). Any agreement we make to a request for additional restrictions must be in writing signed by our Privacy Officer. Your request is not binding unless our agreement is in writing.
Alternative Communication. You have the right to request that we communicate with you about your PHI by a specific way. You must make your request in writing. You must specify in your request the alternative means or locations and provide satisfactory explanation of how you will handle payment under the alternative means or location you request.
Amendment. You have the right to request that we amend your PHI. Your request must be in writing, and it must explain why we should amend the PHI. We may deny your request under certain circumstances, but we will let you know within sixty (60) days whether we have agreed to amend the PHI as you have requested.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Protections will apply to all PHI that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. The most recent version will also always be available on our website at: kyocare.com/privacy-practices/ .
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice or you may contact our Client Services Department at firstname.lastname@example.org, if you believe that:
You may contact us using the information below:
Kyo Autism Therapy, LLC
Attn: Privacy Officer
295 89th Street, Suite 306
Daly City, CA 94015
If you have any complaints or concerns about your insurance, please call the number at the back of your insurance card to understand your insurance’s grievance procedures. We will not retaliate against you for filing a complaint
If you need to contact the BACB to make a complaint about clinical quality, please visit their website at https://www.bacb.com/notice/.
AZ: If you need to contact the Arizona Division of Developmental Disabilities, please visit their website at https://des.az.gov/services/disabilities/developmental-disabilities.
CA: If you need to contact the California Department of Developmental Services, please visit their website at https://www.dds.ca.gov/general/appeals-complaints-comments/consumer-rights-complaint/.
CO: If you need to contact the Colorado Department of Human Services, please visit their website at https://www.colorado.gov/pacific/cdhs/contact-us-5.
FL: If you need to contact the Agency for Persons with Disabilities, please visit their website at https://apd.myflorida.com/contacts/.
GA: If you need to contact the Georgia Department of Behavioral Health and Developmental Disabilities, please visit their website at: https://dbhdd.georgia.gov/how-do-i-contact-constituent-services.
OR: If you need to contact the Oregon Health Licensing Office, please visit their website at: https://www.oregon.gov/oha/PH/HLO/Pages/File-Complaint.aspx.
TX: If you need to contact the Texas Council for Developmental Disabilities, please visit their website at https://tcdd.texas.gov/.
UT: If you need to to contact the Utah Department of Human Services, please visit their website at https://hs.utah.gov/contact.
WA: If you need to contact the Washington State Department of Health, please visit their website at https://www.doh.wa.gov/licensespermitsandcertificates/filecomplaintaboutproviderorfacility.
You may contact us using the information listed above. You may also submit a complaint to the US Department of Health and Human Services by to: Office of Civil Rights, 90 7th Street Suite 4-100, San Francisco, CA 94103; 877-696-6775; http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the US Department of Health and Human Services.