Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. YOU MAY HAVE ADDITIONAL RIGHTS UNDER STATE AND LOCAL LAW. PLEASE SEEK LEGAL COUNSEL FROM AN ATTORNEY LICENSED IN YOUR STATE IF YOU HAVE QUESTIONS REGARDING YOUR RIGHTS TO HEALTH CARE INFORMATION.

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (hereafter, “HIPAA”), you have certain rights regarding the use and disclosure of your protected health information (hereafter, “PHI”). Records relating to substance use disorder (SUD) treatment may also be protected by the federal confidentiality law at 42 U.S.C. § 290dd-2 and its implementing regulations at 42 CFR Part 2 (“Part 2”), as described in Section VII below.

I. OUR PLEDGE REGARDING HEALTH INFORMATION

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We have/will create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by Hope Matters Institute (“HMI”). This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:

• Make sure that PHI that identifies you is kept private.
• Give you this notice of our legal duties and privacy practices with respect to health information.
• Notify you promptly, as required by law, if a breach occurs that may have compromised the privacy or security of your unsecured PHI (or your Part 2 records).
• Follow the terms of the notice that are currently in effect.
• We can change the terms of this Notice, and such changes will apply to all the information we have about you. The new Notice will be posted on HMI’s website and available upon request.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationships with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your PHI for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, to assist the clinician in diagnosis and treatment of your health condition. We may also use your PHI for operational purposes, including sending you appointment reminders, billing invoices and other relevant documentation.

Disclosures for treatment purposes are not limited to the minimum necessary standard, because therapists and other health care providers need access to the full record and/or full and complete information to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about you or your minor child(ren) in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Additional protections apply to SUD records as described in Section VII.

III. TEXT MESSAGE (SMS) COMMUNICATIONS AND MOBILE INFORMATION

With your consent, HMI may communicate with you by SMS text message for customer-care purposes, such as appointment reminders and confirmations, scheduling, billing notifications, intake and care coordination follow-ups, and two-way conversational messages related to your services. Messages are sent from HMI’s business number, (833) 225-HOPE (833-225-4673), or another HMI-registered number.

Consent and opt-in. You opt in to receive text messages by providing your mobile number and agreeing to receive texts on our intake or registration forms, on our website forms, verbally, or by texting us first. Consent to receive text messages is not a condition of receiving treatment or any other service from HMI, and you may choose other contact methods at any time.

Opt-out and help. You can opt out at any time by replying STOP to any message from us. After you reply STOP, we will send one final message confirming your opt-out and will send no further texts unless you re-subscribe (for example, by replying START). Opting out of texts will not affect your ability to receive treatment or non-SMS communications from HMI. Reply HELP for assistance, or contact us at (833) 225-4673 or intake@myhopematters.com. Message frequency may vary. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages.

Emergencies. HMI does not monitor text messages in real time and cannot respond to emergencies via SMS. If you are experiencing a mental health emergency, call or text 988 (Suicide & Crisis Lifeline) or dial 911.

Mobile information privacy. No mobile phone numbers or SMS consent information will be shared with, or sold to, third parties or affiliates for marketing or promotional purposes. Text messaging originator opt-in data and consent will not be shared with any third parties. We share mobile information only with service providers acting on our behalf under written agreements (for example, our telephone and text-messaging service provider) as necessary to deliver messages to you, or as otherwise required by law.

Security of text messages. Standard SMS text messages are not encrypted. We keep the content of text messages to the minimum necessary (for example, appointment dates and times, or a link to a secure portal) and avoid including sensitive clinical details. By opting in, you acknowledge that limited PHI (such as your name, appointment time, or the fact that you are an HMI client) may be included in text messages, and you consent to receiving that information by text. If you prefer not to receive PHI by text, you may request an alternative communication method as described in Section VIII, and we will accommodate all reasonable requests.

Our full SMS Terms & Conditions and this privacy notice are available on our website.

IV. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

1. Psychotherapy Notes. We keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
   • For our use in treating you.
   • For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
   • For our use in defending ourselves in legal proceedings instituted by you.
   • For use by the Secretary of the Department of Health and Human Services (HHS) to investigate our compliance with HIPAA.
   • Required by law and the use or disclosure is limited to the requirements of such law.
   • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
   • Required by a coroner who is performing duties authorized by law.
   • Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. We will not use or disclose your PHI for marketing purposes without your prior written consent. For example, if we request a review from you and plan to share the review publicly online or elsewhere to advertise our services or practice, we will provide you with a release form and HIPAA authorization should the situation arise. The HIPAA authorization is required in the instance that your review contains PHI (i.e., your name, the date of the service you received, the kind of treatment you are seeking or other personal health details). Because you may not realize which information you provide is considered “PHI,” we will send you a blanket HIPAA authorization and request your signature regardless of the content of your review. Once you complete the HIPAA authorization, we will have the legal right to use your review for advertising and marketing purposes, even if it contains PHI. You may withdraw this consent at any time by submitting a written request to us via the email address on file or via certified mail to our address. Once we have received your written withdrawal of consent, we will remove your review from the HMI website and from any other places where it may be posted. There cannot be a realistic guarantee that independent third parties/actors have not copied or reposted review(s) from the HMI website or from other web/social media locations. HMI cannot effectively control independent parties outside of HMI. This is a risk that we want you to be aware of, should you give us permission to post your review.
3. Sale of PHI. HMI will never sell your PHI.

V. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION

Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons. We must meet certain legal conditions before we can share your information for these purposes:

1. Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with HMI, including by phone, mail, email, or text message consistent with Section III and your stated preferences. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that are offered.
2. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
3. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
4. For health oversight activities, including audits and investigations.
5. For judicial and administrative proceedings, including responding to lawful court or administrative order(s) or subpoena(s), although our preference is to obtain an Authorization from you before doing so if we are allowed by the court or administrative official in jurisdiction.
6. For law enforcement purposes, including reporting crimes occurring that involve HMI.
7. To coroners or medical examiners, when such individuals are performing duties authorized by law.
8. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition within HMI.
9. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or helping to ensure the safety of those working within or housed in correctional or similar institutions.
10. For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI to comply with workers’ compensation laws.
11. For organ and tissue donation requests.
12. To business associates. We may share PHI with contractors who perform services on our behalf (such as our electronic health record vendor, telephone and text-messaging vendor, billing vendor, and IT providers), subject to a written Business Associate Agreement requiring them to safeguard your information.

VI. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

Disclosures to family, friends, or others: You have the right and choice to tell us that we may provide your PHI to a family member, friend, or other person whom you indicate is involved in your care or the payment for your health care, or to share your information in a disaster relief situation. The opportunity to consent may be obtained retroactively in emergency situations to mitigate a serious and immediate threat to health or safety or if you are or appear unconscious.

VII. SUBSTANCE USE DISORDER (SUD) TREATMENT RECORDS — 42 CFR PART 2

Records that identify you as receiving substance use disorder (SUD) diagnosis, treatment, or referral for treatment from HMI’s SUD program are protected by 42 CFR Part 2 in addition to HIPAA. With respect to those records:

1. We generally may not use or disclose your SUD treatment records without your written consent. A single written consent may authorize all future uses and disclosures for treatment, payment, and health care operations until you revoke it in writing.
2. Your SUD records, and testimony relaying the information in them, may not be used or disclosed against you in civil, criminal, administrative, or legislative proceedings unless you consent in writing or a court issues a specific order under 42 CFR Part 2.
3. We may not disclose your SUD records to law enforcement without your written consent or a court order meeting Part 2 requirements.
4. If we disclose your SUD records with your consent for treatment, payment, or health care operations, the recipient may redisclose them as permitted by HIPAA, except in proceedings against you as described above.
5. You have the right to an accounting of certain disclosures of your SUD records made with your consent in the prior three years, and to request restrictions on disclosures otherwise permitted.
6. We are required to notify you of breaches of your unsecured Part 2 records, and you will not be retaliated against for filing a complaint. Violations of Part 2 may be reported to the Secretary of HHS.

VIII. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on the disclosure of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone, email, or text message) or to send mail to a different address, and we will agree to all reasonable requests. You may opt out of text messaging at any time by replying STOP or by contacting us.
4. The Right to See and Get Copies of Your PHI. Other than in limited circumstances, you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or if you agree, a summary of it, within 30 days of receiving your written request or what is applicable by law. We may charge a cost-based fee for processing.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, and other disclosures (such as any you ask us to make). Ask us how to do this. We will respond to your request for an accounting of disclosures within 60 days of receiving your request or as required by law. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a cost-based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request or as required by law.
7. The Right to Be Notified of a Breach. You have the right to be notified if a breach occurs that may have compromised the privacy or security of your unsecured PHI or Part 2 records.
8. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it.
9. The Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can make choices about your health information.
10. The Right to Revoke an Authorization. You may revoke a HIPAA authorization or a Part 2 written consent at any time by notifying us in writing, except to the extent we have already acted in reliance on it.
11. The Right to Opt Out of Communications and Fundraising from our Organization. This includes the right to opt out of text messages at any time by replying STOP.
12. The Right to File a Complaint. You can file a complaint if you feel we have violated your rights by contacting us using the information in this Notice, by calling us at (833) 225-4673, or emailing us at intake@myhopematters.com, or by filing a complaint with the HHS Office for Civil Rights located at 200 Independence Avenue, S.W., Washington D.C. 20201, calling HHS at (877) 696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints. Complaints regarding SUD records may also be filed with the Secretary of HHS. We will not retaliate against you for filing a complaint.

IX. ADDITIONAL CALIFORNIA PRIVACY RIGHTS

As a California resident, you may have additional rights under the California Confidentiality of Medical Information Act (CMIA) and, to the extent applicable and not preempted, the California Consumer Privacy Act (CCPA, as amended by the CPRA). Medical information governed by HIPAA and the CMIA is generally exempt from CCPA requirements. To ask about or exercise a California privacy right, contact us at intake@myhopematters.com or (833) 225-4673.

X. CHANGES TO THIS NOTICE

We can change the terms of this Notice, and such changes will apply to all the information we have about you. The current Notice will always be posted on our website at hopemattersinstitute.com and is available in our office and upon request.

XI. CONTACT / PRIVACY OFFICER

If you have questions about this Notice or our privacy practices, contact HMI’s Privacy Officer at 117 E Colorado Blvd STE 600, Pasadena, CA 91105, by phone at (833) 225-4673, or by email at intake@myhopematters.com.

Acknowledgement of receipt of this Notice may be requested at your first visit. Declining to sign an acknowledgement will not affect your ability to receive treatment.