A to Z Behavioral Services

Notice of Privacy Practices:
Health Insurance Portability and Accountability Act (HIPAA)

This notice describes how protected health information about a client may be used and disclosed  and how the client can gain access to this information. Please review it carefully.  

A to Z Behavioral Services, LLC understands we collect private and/or potentially sensitive medical  information about each client and/or the client’s family. We call this information “protected  health information.” This notice explains the client’s privacy rights and addresses how A to Z Behavioral Services, LLC may use and disclose protected health information. A to Z Behavioral Services, LLC  does not use or disclose protected health information unless permitted or  required to do so by law. A to Z Behavioral Services, LLC must adhere to laws aimed at securing  the privacy of the client’s protected health information. These laws are known as the Health  Insurance Portability and Accountability Act (HIPAA) privacy rules. 

When we do use or  disclose protected health information, we will make every reasonable effort to limit its use or the  level of disclosure to the minimum we deem necessary to accomplish the intended purpose.  Please note that the privacy provisions articulated in this notice do not apply to health  information that does not identify the client or anyone else. For more information on A to Z Behavioral Services, LLC privacy practices, or to receive another copy of this notice, please  contact:  

A to Z Behavioral Services, LLC 

732-800-2869

3100 Princeton Pike, Lawrenceville NJ

Protected Health Information 

Protected health information is information about the client relating to a past, present, or future  mental health condition, or treatment or payment for the treatment that can be used to identify  the client. This includes any information, whether oral or recorded in any form, that is created or  received by A to Z Behavioral Services, LLC. This also includes electronic information and  information in any other form or medium that could identify the client. Examples of information  that can identify a client include, but are not limited to the following:  

  • Client’s Name 
  • Telephone Number 
  • Address 
  • DOB 
  • Social Security Number 
  • Service State/End Date 
  • Diagnosis

 

Uses and Disclosures of Health Information for Treatment, Payment, and Health Care Operations 

  1. Treatment, Payment, and Health Care Operations: The following section describes different ways we use and disclose protected health information  for treatment, payment, and health care operations. Not every possible use or disclosure will be  noted, and there may be incidental disclosures that are a byproduct of the listed uses and  disclosures.  
  2. Treatment – We may use a client’s protected health information to provide the client with services,  and may disclose this information to any and all A to Z Behavioral Services, LLC staff  involved with the client’s treatment. Treatment includes (a) activities performed by A to Z Behavioral Services, LLC personnel in the course of providing service to the client or in  coordinating or managing the client’s service with other service providers and (b)  consultations with and between A to Z Behavioral Services, LLC staff and other  professionals involved in the client’s treatment  
  3. Payment – We may use and disclose the client’s protected health information so we may bill and  collect payment from the client, an insurance company, or another party for services  A to Z Behavioral Services, LLC provided to the client. We may also inform the client’s  health plan provider of the treatment we intend to administer to obtain prior approval or to  determine whether the client’s plan will pay for the treatment.  
  4. Health Care Operations – A to Z Behavioral Services, LLC may use and disclose the client’s protected health  information in order to maintain necessary administrative, education, quality assurance,  and business functions. For example, we may use a client’s protected health information  to evaluate the performance of our staff in providing treatment for the client. We may  also use information about clients evaluate what additional services to offer, how we can  improve efficiency, or the effectiveness of certain treatments. Additionally, we may use  protected health information for review, analysis, and other teaching and learning  purposes.  
  1. Special Circumstances: Treatment, payment, and health care operations further include the circumstances listed below.  
  2. Appointment Reminders–We may use and disclose the client’s protected health information to contact the client as  a reminder that he/she may have an appointment for treatment or services. 
  3. Treatment Information–We may use and disclose the client’s protected health information to contact him/her  about treatment information.  
  4. Satisfaction Surveys–We may use and disclose the client’s protected health information to contact him/her  about A to Z Behavioral Services, LLC satisfaction surveys.  
  5. Uses and Disclosures You Can Limit 
  6. A to Z Behavioral Services, LLC Client Directory – Unless the client notifies us that he/she objects, we may include certain information about  him/her in A to Z Behavioral Services, LLC Client Directory in order to respond to inquiries  and disseminate information more efficiently. This directory is accessed by A to Z Behavioral Services, LLC staff who may or may not be involved in the client’s treatment.  
  7. General Notification – Unless the client notifies us that he/she objects, we may provide his/her protected health  information to individuals such as the client’s family members, caregivers, and friends,  who are involved in the client’s treatment or who pay for the client’s treatment. We may do this if the client informs us we have their consent to do so, or if the client knows we  are sharing the client’s protected health information with these individuals and the client expresses no objection or makes no reasonably discernable attempt to prevent us from  doing so. 


There may also be circumstances when we can assume, based on our  professional judgment, the client would not object to disclosure of his/her protected  health information. Also, if the client is not able to approve or object to disclosures, we may make disclosures to a particular individual (such as a client’s family member or  friend) we feel are in the client’s best interests and that relate to that person’s involvement in the client’s care.  


OTHER PERMITTED USES AND DISCLOSURES OF HEALTH CARE  INFORMATION  

We may use or disclose the client’s health information without the client’s permission in the  following circumstances, subject to all applicable legal requirements and limitations: 

  1. Required By Law  – A to Z Behavioral Services, LLC must make any disclosures required by federal, state, or local law.  These may include, but are not limited to, disclosures pertaining to: the reporting of abuse or  neglect; court orders, subpoenas, warrants, or other lawful processes; identification/location of a  suspect, fugitive, witness, missing person, or crime victim; crime on our work premises; or a serious, imminent threat. Employees of A to Z Behavioral Services, LLC are designated as Mandated Reporters.  
  2. Public Health Risks  – We may make disclosures for public health reasons in order to prevent or control disease, injury,  or disability; or to report births, deaths, disease or condition, suspected abuse or neglect, non accidental physical injuries, reactions to medications or problems with products.  
  3. Health Oversight Activities – We may disclose protected health information to agencies authorized to receive reports for health  oversight activities for audits, investigations, inspections, licensing purposes, or as necessary for  certain government agencies to monitor the health care system, government programs, and  compliance with civil rights laws.  
  4. Lawsuits, Disputes, or Other Legal Proceedings – We may make disclosures in response to a subpoena or court or administrative order, if the client  is involved in a lawsuit or dispute, or in response to a court order, subpoena, warrant, summons  or similar process, or if requested to do so by law enforcement.  
  5. Coroners, Medical Examiners, Funeral Directors, and Organ Donation – We may disclose information to a coroner or medical examiner, (as necessary, for example to  identify a deceased person or determine cause of death) or to a funeral director, as necessary to  allow him/her to carry out his/her activities.  
  6. Research – We may use or disclose protected information for research purposes under certain limited  circumstances. Research projects are subject to approval by an institutional review board.  Therefore, we will not use or disclose the client’s protected health information for research  purposes until the particular research project, for which the client’s information may be used or  disclosed, has been approved through the institutional review board.  
  7. Serious Threat to Health or Safety; Disaster Relief – We may disclose information to appropriate individual(s)/organization(s) when necessary (a) to  prevent a serious threat to the client’s health and safety or that of the public or another person, or  (b) to notify the client’s family members or persons responsible for the client in the course of a  disaster relief effort. We will disclose protected health information only to persons we believe to  be able to lessen/prevent the threat and will limit disclosure to that which we deem necessary to  lessen or prevent the threat.  
  8. Military and Veterans – We must make disclosures as required by military command or other government authority for  information about a member of the domestic or foreign armed forces.  
  9. National Security; Intelligence Activities; Protective Services – We may disclose information to federal officials for intelligence, counterintelligence, and other  national security activities authorized by law, including activities related to protection of the  President, other authorized persons or foreign heads of state, or related to the conduct of special  investigations.  
  10. Correctional Facilities – We may make disclosures to a correctional facility (if the client is a ward) or a law enforcement  official (if the client is in that person’s custody) as necessary (a) for the institution to provide the  client with treatment; (b) to protect the client’s or others’ health and safety and the security of the  correctional facility.  


WHEN WRITTEN AUTHORIZATION IS REQUIRED  

Other than for the range of purposes previously identified in this notice, we will not use or  disclose the client’s protected health information for any purpose unless the client provides us  with specific written authorization to do so. If the client grants us authorization, the client can  still withdraw this authorization at any time, though the authorization must be revoked in writing.  In order to withdraw the authorization, the client must deliver, mail or email to:  

AtoZBehavioralServices@gmail.com

If the client revokes the authorization, we will discontinue the use or disclosure of the client’s  protected health information to the extent that we relied on his/her authorization for the  use/disclosure. However, we cannot take back or undo any use/disclosure made under the  client’s grant of authorization prior to our receipt of the client’s written revocation of that  authorization, and we must continue any use/disclosure that is necessary in keeping records of  the client’s treatment.  

THE CLIENT’S RIGHTS REGARDING THE CLIENT’S HEALTH INFORMATION 

The client has certain rights regarding his/her health information, which are listed below. In each  of these cases, if the client wants to exercise his/her rights, the client must do so in writing by  completing a form the client can obtain from A to Z Behavioral Services, LLC . In some cases, we  may charge the client for the costs of providing materials to the client. The client can get  information about how to exercise his/her rights and about any costs that we may charge for  materials by contacting us. 

  1. Right to Inspect and Copy  – With some exceptions, the client has the right to inspect and get a copy of the client’s protected  health information that may be used to make decisions about the client’s care. We may deny the  client’s request to inspect and/or copy information in certain limited circumstances, and, if we do  this, the client may ask that the denial decision be reviewed.  
  2. Right to Amend  – The client has the right to amend his/her health information maintained by ABA Therapy  Solutions, LLC, or used by us to make decisions about the client. We will require that the client  provide a reason for the request, and we may deny the request for an amendment if the request is  not properly submitted, or if it asks us to amend information that (a) we did not create (unless the  source of the information is no longer available to make the amendment), (b) is not part of the  health information we keep, (c) is of a type the client would not be permitted to inspect and copy,  or (d) is already accurate and complete.  
  3. Right to an Accounting of Disclosures – The client has the right to request an accounting of disclosures. An accounting is a list of certain  disclosures we made regarding the client’s protected health information. The list does not include  all disclosures. For example, it does not include disclosure to the client, disclosure for treatment,  payment, and health care operations purposes described above, or disclosure made with the  client’s authorization as described above.  
  4. Right to Request Restrictions – The client has the right to request a restriction or limitation on the health information we use or  disclose about the client (a) for treatment, payment, or health care operations, or (b) to someone  who is involved in the client’s care or the payment for it, such as a family member or friend. We  are not required to agree to the client’s request. Any time A to Z Behavioral Services, LLC agrees  to a restriction, it must be in writing and signed by the Chief Clinical Officer or his designee.  
  5. Right to Request Confidential Communications – The client has the right to request we communicate with the client about health matters in a  certain method or at a certain place. For example, the client can ask that we only contact the  client at home or by mail.  
  6. Right to a Paper Copy of This Notice – The client has the right to a paper copy of this notice, whether or not the client may have  previously agreed to receive that notice electronically.  


Questions and/or Complaints 

If the client has any questions about this notice, he/she should contact:  

A to Z Behavioral Services, LLC 

If the client believes their privacy rights have been violated, the client may file a complaint  with A to Z Behavioral Services, LLC using the contact information provided. To file a complaint with the Secretary of the Department of Health and Human Services, call (877) 696- 6775.  

If the client believes his/her privacy rights have been violated, contact:  

Office of Civil Rights, Medical Privacy Complaint Division 

U.S. Department of Health and Human Services 

200 Independence Avenue, S.W. HHH Building, Room 509H  

Washington, D.C. 20201  

Phone: (866) OCR-PRIV (627-7748) TTY: (886) 788-4989 www.hhs.gov/ocr  

The client will not be penalized for filing a complaint and the client will continue to have the  same access to A to Z Behavioral Services, LLC services.  

Acknowledgement and Receipt 

I acknowledge that I have received a copy of A to Z Behavioral Services, LLC Notice of Privacy  Practices. I further acknowledge that I have reviewed and understand the information presented  in this notice, including the appropriate contact information for the party(ies) I should contact in  the event that I have any further questions, concerns, requests, or complaints regarding any of the  covered subject matter.  

Acknowledgement for A to Z Discharge and Transition Criteria

Reasons for Discharge or Transition
ABA therapy services will be discontinued if one or more of the following criteria are met:

✔ Goal Mastery: The client has achieved treatment goals outlined in the initial and concurrent treatment plan, and further ABA therapy is no longer necessary.

✔ Lack of Progress: Despite treatment modifications, data indicates a lack of meaningful progress over time and at least 2 authorizations.

✔ Transition to Lesser Restrictive Support: The client no longer requires intensive ABA therapy and is transitioning to other services (e.g., school-based supports, social skills groups, etc.).

✔ Lack of Family Participation: The effectiveness of therapy depends on caregiver involvement. At least 2 hours of parent training must be completed per month. If repeated attempts to engage caregivers in parent guidance sessions are unsuccessful, services may be discontinued.

✔ Medical or Psychological Concerns: If medical or psychological factors prevent the client from continuing ABA therapy, discharge may be necessary.

✔ Noncompliance with Policies: Repeated cancellations (see intake form for definitions of excused/unexcused abcenses), failure to follow attendance policies, or non-payment of services may result in discharge.

✔ Parent/Guardian Request: Parents/legal guardians may choose to discontinue services at any time.

✔ Aging Out or Service Limitations: The client has aged out of the program, or insurance limitations prevent further treatment.


Acknowledgment and Agreement
I acknowledge that I have reviewed the discharge criteria and understand the conditions under which services may be terminated or transitioned.

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