HIPAA Notice of Privacy Practices

 

Bright Connections Behavioral 

601 N. Superior Ave., Tomah, WI 54660

Phone: (608) 205-8860 | Fax: (608) 506-1114

 

Effective Date: May 1, 2024

Reviewed Date: June 20, 2025

 

OUR COMMITMENT TO YOUR PRIVACY

 

At Bright Connections Behavioral, we are committed to protecting your Protected Health Information (PHI). This Notice describes how we may use and disclose your PHI to provide ABA services, obtain payment, and carry out operations related to your care. It also explains your rights under the Health Insurance Portability and Accountability Act (HIPAA).

 

PHI includes information that may identify you or your child and that relates to your past, present, or future physical or mental health or condition and related healthcare services.

 

USES AND DISCLOSURES OF PHI

 

We may use and disclose your PHI without your written authorization for the following purposes:

 

1. Treatment

 

We may use and share your PHI to provide, coordinate, or manage your care. This includes communication among behavior analysts, registered behavior technicians (RBTs), supervising clinicians, and other professionals involved in your child’s ABA services. For example:

• We may share data with your child’s pediatrician, speech therapist, or occupational therapist to ensure continuity of care.

• We may communicate with caregivers and authorized individuals involved in your child’s treatment for collaboration and training purposes.

 

2. Payment

 

We may use and disclose your PHI to bill and receive payment from health plans or other payers. For example:

• We may need to provide documentation of medical necessity to your insurance company to obtain prior authorization for ABA therapy.

• We may share information about session attendance, service dates, and treatment plans with billing services or payers.

3. Healthcare Operations

We may use and disclose PHI for our business operations and quality improvement activities. 

 

Examples include:

 

·       Reviewing clinical practices and treatment outcomes to improve services.

• Providing supervision and training for future Board Certified Behavior Analysts (BCBAs) or Registered Behavior Technicians (RBTs), under appropriate confidentiality safeguards.

• Conducting internal audits, quality assurance, and administrative tasks.

 

We may also:

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• Use your contact information to remind you of upcoming appointments.

• Contact you to provide information about treatment alternatives or other services that may benefit you or your child.

 

OTHER USES AND DISCLOSURES PERMITTED WITHOUT AUTHORIZATION

 

We may also use or disclose your PHI in the following situations as permitted or required by law:

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• Public health activities (e.g., reporting communicable diseases)

• Health oversight agencies (e.g., audits or inspections)

• Legal proceedings or in response to court orders or subpoenas

• Law enforcement purposes

• Abuse or neglect reporting

• Workers’ compensation claims

• National security and military activities

• Compliance with the Secretary of Health and Human Services

• To avert a serious threat to health or safety

 

YOUR RIGHTS

 

You have the following rights regarding your PHI:

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• Right to Access: You have the right to request to inspect or receive a copy of your PHI.

• Right to Amend: If you believe the information we have is incorrect, you have the right to request an amendment.

• Right to an Accounting of Disclosures: You have the right to request a list of disclosures we’ve made, excluding those for treatment, payment, and operations.

• Right to Request Restrictions: You have the right to ask us to limit the use or disclosure of your PHI.

• Right to receive notice of a breach: You have the right to be notified if your unsecured PHI has been breached.

• Right to Confidential Communications: You have the right to request we contact you in a certain way or at a certain location.

• Right to a Paper Copy: You have the right to request a paper copy of this Notice at any time, even if you have received it electronically.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. Any changes will apply to PHI we already have, as well as any new information. The revised Notice will be posted in our office and on our website. You may request a copy at any time.

QUESTIONS OR COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. Filing a complaint will not result in retaliation.

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Contact Information:

Catey Rice

Bright Connections Behavioral

601 N. Superior Ave., Suite 2, Tomah, Wisconsin 54660

Phone: 608-205-8860

Email: catey@brightconnectionsbehavioral.com

 

Bright Connections Behavioral is required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to PHI. Bright Connections Behavioral is required to abide by theterms of the notice currently in effect. If you have any questions about this form, please ask to speak with our HIPAACompliance Officer (listed above) in person or by phone.