Effective April 14, 2003

This notice describes how personal information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Privacy Promise
S.A.W., Inc. (SAW) in cooperation with the Cuyahoga County Board of Mental Retardation & Developmental Disabilities (CCBMR/DD) understands that your personal information needs to be kept private. Protecting your personal information is important. We follow strict federal and state laws that require us to keep your personal information confidential.

How We Use Your Personal Information
When you are employed by SAW and receive services from the CCBMR/DD, we may use your personal information for such activities as providing you with employment and billing for services.

If you have chosen a personal representative and have agreed to let your personal representative obtain your personal information, we will provide the information to your personal representative. If you have a guardian, we will provide the information to your guardian.

Examples of how we use your information include:

Employment – We keep records of your employment and any services related to it. For example, your service and support administrator keeps notes on all contacts made in coordinating and arranging for services. If you see a nurse working for the CCBMR/DD, the nurse will keep records of any care you receive. CCBMR/DD staff may share your personal information with SAW while helping to develop your service plan.

If SAW staff want to share your personal information with anyone who is not employed by the CCBMR/DD, you must give your written permission first.

Some personal records, including confidential communications with a mental health professional and substance abuse records, may have additional restrictions for use and disclosure under state and federal law. We will rely upon the CCBMR/DD to work with you regarding those kinds of requests.

Payment – We keep records that include payment information and documentation related to rehabilitation technology and assistive technology services provided to you. Your information may be used to assist in providing you services or to answer questions of the Social Security Administration, Department of Labor or to obtain payment for your services from Medicaid, insurance or other sources.

For example, we may disclose personal information about the services provided to you to confirm your eligibility for Medicaid and to obtain payment from Medicaid. Or we may provide information to the Social Security Administration (SSA) for you to qualify for government benefits offered by the SSA. The CCBMR/DD may use your personal information to determine the amount and type of Medicaid services you need and send this information to the proper state department.

Health Care Operations – SAW is not a provider of health care operations. SAW relies upon CCBMR/DD to work with you and may use your personal information to improve the quality of care, train staff, manage costs, conduct required business duties and make plans to better serve you and other individuals enrolled in the CCBMR/DD.

Other Services We Provide
CCBMR/DD may also use your personal information to:

• Determine whether you are eligible for CCBMR/DD services;



• Recommend service alternatives and other possible benefits to you;



• Tell you about other service providers who may be able to help you;



• Remind you of an appointment, unless you tell the CCBMR/DD staff that you do not wish to be reminded;



• Allow the CCBMR/DD to review direct service contracts;



• Allow local, state and federal agencies to monitor your services;



• Investigate incidents affecting health and safety, to report these kinds of incidents and to take steps to protect your health and safety;



• Allow the CCBMR/DD to prepare reports required by the Ohio Department of Mental Retardation and Developmental Disabilities and the Ohio Department of Job and Family Services;
  
• Contact you for assistance in passing levies, unless you notify the CCBMR/DD that you do not wish to be contacted for these purposes;

• Visit the CCBMR/DD website at www.ccbmrdd.org.



• Contact the CCBMR/DD at the phone number and address on the final page of this notice.

Sharing Your Personal Information
There are limited situations when SAW and CCBMR/DD are permitted or required to disclose personal information without your signed authorization. These situations are:

• To protect victims of abuse, neglect, or domestic violence;
  
• To reduce or prevent a serious threat to public health and safety;
  
• For health oversight activities such as investigations, audits and inspections;
  
• For lawsuits and similar proceedings;
  
• For public health purposes, such as reporting communicable diseases, work-related illnesses or other diseases and injuries, as permitted by law; reporting births and deaths and reporting reactions to drugs and problems with medical devices;
  
• When required by law;
  
• When requested by law enforcement, as required by law or court order;
  
• To coroners, medical examiners and funeral directors;
  
• For organ and tissue donation;
  
• For workers’ compensation or other similar programs, if you are injured at work and are covered by workers’ compensation or other similar programs;
  
• For specialized government functions, such as intelligence and national security.
  
• For verification of employment related to your receipt of benefits from the Social Security Administration.
  All other uses and disclosures not described in this notice require your signed authorization. You may revoke your authorization at any time with a written statement.

Our Privacy Responsibilities
SAW and CCBMR/DD is required by law to:

• Maintain the privacy of your personal information;
  
• Provide this notice that describes the ways we may use and share
  
• Follow the terms of the notice currently in effect.

We reserve the right to make changes to this notice at any time and make the new privacy practices effective for all information we maintain.

Current notices will be posted in the CCBMR/DD facilities and on our website, www.ccbmrdd.org.

You may also request a copy of any notice from the CCBMR/DD Privacy Office or SAW.

Your Individual Rights
You have the right to:

• Request restrictions on how we use and share your personal information. We will consider all requests for restrictions carefully but are not required to agree to any restriction.*
  
• Request that we use a specific telephone number or address to communicate with you.
  
• Inspect and copy your personal information, including service, medical and billing records. Fees may apply.*
  
• Request corrections or additions to your personal information. You must give the reasons for wanting the change.*
  
• Request an accounting of certain disclosures of your personal information made by us. Your request must state the period of time desired for the accounting, which must be within the six years prior to your request. The first accounting is free, but a fee will apply if more than one request is made in a 12-month period.*
  
• Request a paper copy of this notice even if you agree to receive it electronically.

*Requests marked with a star (*) must be made in writing. Contact the CCBMR/DD Privacy Office for the appropriate form for your request.

Our Organization
This notice describes the privacy practices of S.A.W., Inc. and the Cuyahoga County Board of Mental Retardation & Developmental Disabilities. This notice also describes the privacy practices of individuals or entities which have signed a contract with the SAW and the CCBMR/DD, which are acting as business associates and which have promised to follow the same rules of confidentiality.

The CCBMR/DD includes:

All services and supports provided by CCBMR/DD as well as the CCB-MR/DD employees and volunteers.

If you want to know about the privacy practices of service providers who are not engaged in a business contract with SAW and who are not business associates of CCBMR/DD, you should contact them directly.

Contact Us
If you would like further information about your privacy rights, are concerned that your privacy rights have been violated or disagree with a decision that we made about access to your personal information:

Contact the CCBMR/DD
Privacy Officer
1275 Lakeside Ave. East
Cleveland, Ohio 44114

or e-mail Privacy Officer@ccbmrdd.org.

We will investigate all complaints and will not retaliate against you for filing a complaint.

You also may file a written complaint with either

• The Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue SW, Washington, D.C. 20201 or call 1-877-696-6775 or
  
• The Office for Civil Rights, U.S. Department of Health and Human Services at 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C., 20201 or call OCR’s hotline – voice at 1-800-368-1019, or e-mail at ocrmail@hhs.gov.