This Notice of Privacy Practices (NPP) has been prepared to comply with the Health Insurance Portability and Accountability Act (HIPAA) and its implementing regulations. The purpose of this NPP is to inform you about how your protected health information (PHI) may be used and disclosed by Shine ABA Solutions and your rights concerning your PHI.
This NPP provides a general overview of our privacy practices as of the effective date indicated. It is not an exhaustive representation of all aspects of HIPAA regulations or all potential uses and disclosures of your PHI. Additionally, our organization may update its policies and procedures from time to time in accordance with changes in HIPAA regulations or our operational needs.
For the most current and detailed information about our privacy practices, how we use and disclose PHI, and your rights as a patient, please contact our Privacy Officer or refer to our organization's official privacy policy, which may be available on our website or provided to you upon request.
Shine ABA Solutions is committed to safeguarding the privacy and security of your protected health information (PHI). PHI includes information about your child's medical condition and treatment that identifies them. This Notice of Privacy Practices explains how we may use and disclose your child's PHI within our practice and their rights regarding their health information.
Shine ABA Solutions will permit individuals to exercise client rights.
Shine ABA Solutions must also adhere to the terms of the currently effective version of this Notice. In most cases, we can utilize this information as outlined in this Notice without requiring permission. However, there are specific situations in which we may only use it with our client's written authorization, as mandated by law.
Your Child's Rights:
1. Right to Access:
You, as a parent or legal guardian, have the right to inspect and obtain a copy of your child's PHI that we maintain. We may charge a reasonable fee for the costs of copying, mailing, or other
supplies associated with your request. We will provide access to your child's PHI within 30 days of your request.
2. Right to Amend:
If you believe that your child's PHI is incorrect or incomplete, you have the right to request an amendment to their record. We will respond to your request within 60 days. If we deny your request, we will provide you with a written explanation, including your right to appeal.
3. Right to Request Restrictions:
You have the right to request restrictions on certain uses and disclosures of your child's PHI. We are not required to agree to your request unless the restriction involves a disclosure that would otherwise be required by law.
4. Right to Request Confidential Communications:
You have the right to request that we communicate with you about your child's PHI in a certain way or at a certain location. We will accommodate reasonable requests whenever possible.
5. Right to an Accounting of Disclosures:
You have the right to receive an accounting of certain disclosures we have made of your child's PHI. This accounting will not include disclosures made for treatment, payment, or healthcare operations, among other exceptions.
Our Uses and Disclosures of Your Child's PHI:
We may use and disclose your child's PHI for various purposes, including but not limited to:
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Treatment
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Payment
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Healthcare Operations
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Public Health Activities
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Law Enforcement
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Legal Proceedings
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Research
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Workers' Compensation
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Health Oversight Activities
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Specialized Government Functions
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Marketing and Fundraising (with your authorization)
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We may share health information with a family member, relative, close personal friend, or another individual involved in our client's care under the following circumstances:
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When we receive verbal consent from our client to do so.
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When we provide our clients with the opportunity to object to such a disclosure, and they do not raise an objection.
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When, based on the circumstances, we reasonably infer that there is no objection. For instance, if a client's spouse contacts us on their behalf, we may assume that the client consents to the disclosure of their health information.
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In situations where our clients are unable to object due to their absence, incapacity, or a medical emergency, we may, in our professional judgment, determine that disclosing health information to a family member, relative, or friend is in the client's best interest. In such cases, we will only disclose health information that is relevant to that person's involvement in our client's care.
Any additional utilization or disclosure of PHI, beyond what has been described above, will require written authorization. This authorization must expressly specify the information we intend to use or disclose, along with the timing and method of the intended use or disclosure. You have the right to revoke this authorization in writing at any time, except to the extent that we have already relied on the authorization to use or disclose medical information.
Our Responsibilities:
Shine ABA Solutions will limit the use or disclosure of information for payment purposes to the minimum necessary amount required to achieve the intended purpose. We are responsible for ensuring the security and confidentiality of our clients' information, as required by the Secretary of Health and Human Services.
We are required by law to maintain the privacy of your child's PHI, provide you with this NPP, and follow the terms of the NPP currently in effect.
For healthcare operations: This encompasses various activities, such as quality assurance initiatives, licensing and training programs to ensure our personnel meet our care standards and adhere to established policies and procedures, securing legal and financial services, engaging in business planning, handling grievances and complaints, generating reports for data collection purposes that do not individually identify you, and conducting fundraising and specific marketing activities.
Notification in the Event of a Breach: Shine ABA Solutions is obligated by law to inform our clients if there is a breach of their unsecured protected health information. This notification occurs when there has been access, acquisition, or disclosure of this information due to a breach or when there is a reasonable belief that such a breach has occurred.
Notice Revisions: Shine ABA Solutions retains the authority to modify the contents of this Notice at any time, with such changes taking immediate effect and applying to the protected health information (PHI) we maintain. If substantial changes are made to the Notice, they will be promptly displayed in our facilities and, if applicable, on our website. Clients will receive a copy of the most recent version of this Notice during their next visit or by reaching out to the identified Privacy Officer below.
Your Legal Rights and Complaints: Our clients also possess the right to lodge a complaint with us or with the Secretary of the United States Department of Health and Human Services if they believe their privacy or security rights have been infringed upon. There will be no retaliatory actions taken against individuals for filing a complaint with either us or the government.
For any inquiries, comments, or complaints, please direct all correspondence to the Privacy Officer whose contact details are provided at the conclusion of this Notice. Filing a complaint will not result in any adverse consequences for individuals. If you have questions or wish to file a complaint or exercise any rights outlined in this Notice, please contact:
Privacy Officer
2307 Coney Island Ave, 2nd floor,
Brooklyn, NY, 11223
To complain to the Secretary of Health and Human Services please use the following information and address:
Region II - New York (New Jersey, New York, Puerto Rico, Virgin Islands)
Linda Colon, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278
Voice Phone (800) 368-1019
FAX (212) 264-3039
TDD (800) 537-7697
SHINE ABA SOLUTIONS
COMPASSIONATE BILLING POLICY
At Shine ABA Solutions, we understand that families seeking Applied Behavior Analysis (ABA) therapy for their loved ones are already facing numerous challenges. We believe that access to high-quality ABA therapy should not be hindered by financial constraints. Our Compassionate Billing Policy reflects our commitment to providing compassionate care and support to all families in need.
Shine ABA Solutions (“Provider”) generally follows a billing policy that involves billing and collecting patient co-payments. This includes various types of co-payments such as those mandated by health maintenance organizations at the time of service, point of service co-pays, deductibles related to conventional insurance plans or out-of-network benefits, and co-insurance amounts. These co-payments are collected as required by government-sponsored or private healthcare reimbursement programs.
However, we recognize that patient co-payments can sometimes pose barriers to accessing healthcare services and may create financial challenges for individuals. Therefore, the purpose of this policy is to ensure that all members of our community who receive services from Provider have access to our therapeutic and behavioral health services. This policy also outlines specific situations in which we may consider reducing or waiving certain patient co-payments.
1. Financial Consultations:
Our dedicated financial counselors are available to work with you one-on-one to assess your unique financial situation and determine the most suitable payment plan. We aim to make ABA therapy affordable and sustainable for all families.
2. Insurance Assistance:
Our team is committed to helping you navigate the complexities of insurance coverage. We will work closely with your insurance provider to maximize your benefits and minimize your out-of-pocket expenses.
3. Financial Hardship Assistance:
In cases of extreme financial hardship, we have a hardship assistance program in place to provide additional support. We understand that unexpected circumstances can impact your ability to pay for therapy, and we are here to help during such times.
On an individual basis, Provider may assess a patient's financial difficulties and choose to exempt them from a co-payment required under a government-sponsored or private healthcare reimbursement program in which Provider participates. It is important to note that such exemptions due to financial hardship will not be granted excessively or as a routine practice.
To request a waiver based on financial hardship, patients must submit a Financial Hardship application, which can be obtained by contacting our offices. Upon receiving the Financial Hardship application, Provider may also request relevant documentation from the patient. This documentation may include but is not limited to:
Proof that the patient's income falls at or below 200% of the current federal poverty guidelines. This proof can be in the form of W-2 withholding statements, pay stubs, income tax returns, forms from Medicaid or other state-funded medical assistance, or documents from employers or welfare agencies.
Provider may decide to reduce or waive a co-payment only if the following conditions are met: (i) we bill the patient and attempt to collect the Co-Payment in accordance with our ordinary billing and collection procedures(i.e. making no less than three (3) good faith and timely attempts to collect the Co-Payment), (ii) the patient account status is such that it would otherwise ordinarily be referred to our collection agency for delinquent accounts, (iii) the patient or other responsible party requests a hardship waiver, and the patient or other responsible party provides the information and documentation (as detailed above) required for Provider to conduct a financial screening, (iv) analysis of the financial screening
information substantiates the patient’s inability to pay the outstanding Co-Payments, (v) the foregoing steps are well documented and maintained (for a period of no less than seven (7) years and shall be made available to the applicable governmental agency upon its request) along with the patient’s financial records, and (iv) the waiver decision is approved by the director and the applicable payor is notified in writing.
Shine ABA Solutions may periodically assess the financial status of patients who have been granted hardship waivers. If a patient's financial situation improves, they are responsible for co-payments and promptly notifying Shine ABA Solutions.
4. Transparent Billing Practices:
We maintain transparency in our billing practices, ensuring that you fully understand the costs associated with ABA therapy. We will provide detailed invoices and explanations of charges to keep you informed.
5.Arrangements for Out-Of-Network Services
If you have insurance coverage with a carrier with which Provider is not currently in network, we may be able to enter into single case agreement (SCA).
If you hold insurance coverage with a provider that is not currently within our network, or if we are unable to secure an SCA (Single Case Agreement) with them, you can request an estimate of our charges for the services you require. We are more than willing to address any inquiries you may have regarding your insurance coverage.
In an effort to extend the benefits of our Compassionate Billing Policy to all members of our community, including both insured and uninsured individuals, and to enhance accessibility to behavioral health and related services in our area, we may opt to waive or reduce Co-Payments for beneficiaries of non-government-sponsored or supported health care reimbursement plans with which we do not have contractual agreements. This applies particularly when we are considered an out-of-network provider. We will adhere to strict compliance with the following principles:
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Our discretion remains paramount. We will not enter into any agreements or contracts with patients, patient representatives, employers, physicians, or healthcare providers that obligate us to waive Co-Payments or provide other out-of-network accommodations. However, we may enter
into agreements directly with third-party payors that maintain our out-of-network status but offer specific waivers or accommodations for network beneficiaries.
b) Provider will diligently attempt to collect Co-Payments owed by patients. Any discretionary waivers or accommodations will be granted solely on a case-by-case basis upon patient request (using the waiver procedures outlined above, as applicable), and never in advance of the provision of services by Provider. If discretionary waivers or accommodations are or will be applied, or could be applied, in a routine manner, the director's approval is required, and written notification to the relevant payor will be provided. Provider will also (i) make at least three (3) good-faith and timely attempts to collect Co-Payments from patients, (ii) maintain records of these attempts for a minimum of seven years, and (iii) make these records available to relevant governmental agencies upon request.
c) We will not publicly disclose discretionary waivers or accommodations, such as through local media advertising (unless otherwise agreed in writing with the applicable payor(s)), but we may share this policy or sections of it with community members who inquire about our billing and collection practices.
d) Discretionary waivers or accommodations may only be granted if none of the patient's healthcare benefits are funded or paid for by any government-sponsored healthcare reimbursement program, such as Medicare, whether as the primary or secondary payer.
To the extent that community members are beneficiaries of plans that do not include out-of-network benefits, we may, at our sole discretion, decide to apply a discount to the cost of services provided to such individuals. However, any such discount or accommodation must receive approval from the director. If the discretionary discount or accommodation is or will be applied, or could be applied, in a routine manner, it must be approved by the director, and written notification to the applicable payor is required.
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SHINE ABA SOLUTIONS
ASSIGNMENT OF BENEFITS AND CLAIMS
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PATIENT FINANCIAL RESPONSIBILITY
The Patient hereby assigns and transfers to Shine ABA Solutions ("Provider") all of the Patient's entitlements, rights, and benefits that are payable by the Patient's insurance carrier and/or benefits plan for the services provided by the Provider.
The Patient acknowledges that co-payments, co-insurance, and deductible payments must be settled in full at the time of service. Any accounts with outstanding balances beyond 60 days may incur an annual interest rate of ten percent (10%).
Should any amount owed in accordance with this agreement remain unpaid as per the agreed-upon terms, the undersigned understands and consents that Provider may, at its sole discretion, opt to transfer the undersigned's account to a third-party collection agency.
The Patient is aware that they may be subject to a fee under the following circumstances: if the Patient is not present at the scheduled appointment time for a service visit, or if the Patient cancels their appointment with less than 24 hours' notice from the scheduled appointment time.
The Patient hereby grants Provider authorization to submit claims to the Patient's insurance carrier or any intermediaries for all services administered by the Provider. Additionally, Provider is authorized to exercise any appeals and other rights under the Patient's policy or benefits plan on behalf of the Patient.
The Patient also authorizes and assigns to Provider the right to take legal actions, including arbitration or dispute resolution processes, on behalf of the Patient and/or in the Patient's name. This includes pursuing claims against the Patient's insurance carrier, Personal Injury Protection (PIP) carrier, Workers' Compensation carrier, plan administrator, payor, or third party. This authorization encompasses the right to seek declaratory, equitable, compensatory relief, or other legal remedies.
Furthermore, the Patient authorizes Provider to appoint an attorney to represent the Patient directly for the collection of PIP benefits, Workers' Compensation benefits, and all other insurance
benefits from the respective carriers, plan administrators, payors, or third parties. This authorization extends to allowing Provider to secure legal representation for the Patient's appeals to the appropriate Federal Agency in cases involving federal plans.
The Patient authorizes Provider to act on their behalf and to report any suspected violations of proper claims practices to the relevant regulatory authorities.
The Patient directs their insurance carrier or its intermediaries to issue payment checks directly to the Provider.
In cases where the Patient's insurance carrier will not make direct payments to the Provider, the Patient authorizes and instructs the insurance company to send all checks and copies of Explanation of Benefit forms related to services rendered, from the onset date of service to the present, to the Patient's home address, billing company, and/or the attorney representing Provider. This will enable these parties to forward the checks to Shine ABA Solutions, 2307 Coney Island Ave, 2nd floor, Brooklyn, NY, 11223.
If the Patient receives direct payment from their insurance carriers or benefits plan for any amounts owed to the Provider for services provided, the Patient commits to promptly forwarding any checks made out to them. The Patient also agrees to inform the Provider upon receiving such a check and to correctly endorse the checks with "Pay to the Order of Shine ABA Solutions." Subsequently, the Patient will promptly mail the check and any accompanying Explanation of Benefits to Shine ABA Solutions, 2307 Coney Island Ave, 2nd floor, Brooklyn, NY, 11223. Copies of both the check and Explanation of Benefits should be retained by the Patient for their records.
If the Patient's insurance carrier mandates a referral prior to initiating treatment, the Patient agrees to obtain this referral before any examinations or treatments.
In the event of a dispute between Provider and any third-party payor, Provider is responsible for managing the dispute on the Patient's behalf. Provider shall be solely responsible for reimbursing the third-party payor if it is determined that there has been an overpayment by the third-party payor for services provided to the Patient by Provider, provided that Provider has received all funds directly from the third-party payor that are due and owed to Provider for services rendered to the Patient.
