HomeMy WebLinkAbout20233542.tiff RESOLUTION
RE: APPROVE STANDARD FORM FOR HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT(HIPAA)DISCLOSURE AND PRIVACY POLICY BETWEEN
DEPARTMENT OF HUMAN SERVICES,AREA AGENCY ON AGING (AAA),AND
VARIOUS CLIENTS
WHEREAS,the Board of County Commissioners of Weld County,Colorado,pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County,Colorado,and
WHEREAS,the Board has been presented with a Standard Form for the Health Insurance
Portability and Accountability Act(HIPAA)Disclosure and Privacy Policy between the County of
Weld,State of Colorado,by and through the Board of County Commissioners of Weld County,on
behalf of the Department of Human Services,Area Agency on Aging(AAA),and various clients,
commencing January 1,2024,with further terms and conditions being as stated in said form,and
WHEREAS,after review,the Board deems it advisable to approve the Standard Form of
said Health Insurance Portability and Accountability Act(HIPAA)Disclosure and Privacy Policy,
a copy of which is attached hereto and incorporated herein by reference,and to delegate standing
authority to the Department of Human Services to execute individual forms with various Area
Agency on Aging(AAA)clients.
NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Standard Form for the Health Insurance Portability and
Accountability Act(HIPAA)Disclosure and Privacy Policy between the County of Weld,State of
Colorado,by and through the Board of County Commissioners of Weld County,on behalf of the
Department of Human Services,Area Agency on Aging(AAA),and various clients,be,and hereby
is,approved.
The above and foregoing Resolution was,on motion duly made and seconded,adopted
by the following vote on the 6th day of December,A.D.,2023.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY,COLORADO
ATTEST: d.deitiA)
..elai;� Mi aan Cha,
Weld County Clerk to the`Board
C. -I-Gt./4
f►1 u � �T I. er L.Buc,Pro-Tem
BY: tw Zx— /
Deputy Clerk to the Board
.tt K.James
APP : ED AS : USED
.� �. n D.Ross
1861
'County Attorney r, .♦
I 2I -�I �'ri Saine
Date of signature: `I"'Z3`i►
Cc..1-15D,CTt CEEG/cw),C A(K►-t),Act(Gp/ciA 2023-3542
HR(XS) HR0095
of/oS/2y
BOARD OF COUNTY COMMISSIONERS
PASS-AROUND REVIEW
PASS-AROUND TITLE:Weld County Area Agency on Aging HIPAA Disclosure and Privacy Policy Form
DEPARTMENT:Human Services DATE: November 20,2023
PERSON REQUESTING: Jamie Ulrich,Director,Human Services
Brief description of the problem/issue:The Weld County Area Agency on Aging(AAA)is required by law to maintain
privacy of protected health information(PHI),and to provide notice of clients rights.The current HIPAA Privacy Policy
form used by the Single-Entry Point(SEP),soon to be Case Management Agency(CMA),does not include a release of
information.After consulting with several other SEPs,it was determined that the current HIPAA privacy policy and
release of information should be combined into one form.The Department is requesting approval to use the updated
Area Agency on Aging HIPAA Disclosure and Privacy Policy form for clients.
This form has been reviewed and approved by the Weld County HIPAA Privacy Officer,Jill Scott,and Legal(K.
McDougal).
What options exist for the Board?
• Approval to use the updated Area Agency on Aging HIPAA Disclosure and Privacy Policy form.
• Deny approval to use the updated Area Agency on Aging HIPAA Disclosure and Privacy Policy form.
Consequences:Weld County's Area Agency on Aging Division will not have an updated HIPAA Disclosure and
Privacy Policy form for use.
Impacts:Weld County Area Agency on Aging will be required to find a different form for use for the
Programs offered.
Costs(Current Fiscal Year/Ongoing or Subsequent Fiscal Years):
• This is nonfinancial.
• If approved,this form would be used beginning January 1,2024.
Recommendation:
• Approval of the Weld County Area Agency on Aging HIPAA Disclosure and Privacy Policy form and its use for
AAA clients.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L.Buck,Pro-Tern .g?4
Mike Freeman,Chair Yrf
Scott K.James
Kevin D.Ross
Lori Saine
Pass-Around Memorandum;November 20,2023—Not in 7636 2023-3542
IZIC� -A112--0090
Weld County Area Agency on Aging
HIPAA Disclosure and Privacy Policy
Client Name: Date of Birth: / /
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Weld County Area Agency on Aging(AAA)is required by law to maintain the privacy of your protected
health information(PHI),and to provide you with this notice.AAA is required to abide by the terms of this
notice,although it reserves the right to change the terms of this notice.If this notice is changed,you will
receive an updated copy of this notice.This notice is effective January 1,2024.
Use and Disclosure of your Protected Health Information
Your protected health information(PHI)may be disclosed without your authorization to process payments,
for health care operations,or to assist in treatment(for example,providing PHI to your physician to help in
diagnosis).AAA may contact you to provide appointment reminders,if necessary.Your PHI may also be
disclosed without your authorization under the following circumstances:as required by local,state,or federal
law;for public health activities(such as the prevention/control of diseases);if related to victims of abuse,
neglect,or domestic violence;for health oversight activities(such as internal audits and investigations);as
required in judicial or administrative proceedings;for limited law enforcement purposes(generally in
response to a court order);related to decedents;for organ donation purposes;for research purposes;in order to
avert a serious threat to health or safety;for worker's compensation purposes or for other specialized
government functions including to assist in facilitation of care planning,eligibility determination and service
monitoring.Any other uses or disclosures of your PHI require your written authorization.Your authorization
may be revoked in writing.
In addition to health professionals,providers,and Weld County Department of Human Services
employees,I authorize Weld County to receive and share my protected health information with:
Name Name
Address Address
Phone Number Phone number
Your Rights Regarding Your Protected Health Information
You have the following rights related to the protected health information(PHI)records created by AAA:to
inspect,copy,and receive an accounting of disclosures of your PHI;to request restrictions be placed on how
AAA uses and discloses your PHI(which may be denied);to receive confidential communications of PHI;to
request amendments to your PHI(which may be denied).If you have received this notice electronically,you
may receive it in paper by contacting the Department.
1
Weld County Area Agency on Aging
HIPAA Disclosure and Privacy Policy
Questions
If you have any questions about this notice,please contact Kelly Morrison at(970)400-6786,or
kmorrison@weld.gov
Complaints
If you feel that your privacy rights have been violated,you may file a complaint with AAA,the Weld County
Privacy Officer,or the Office for Civil Rights.Weld County is prohibited from retaliating against you for
filing a complaint.
Jill Scott,Weld County HIPAA Privacy Officer Office for Civil Rights
1150"O"Street, U.S.Department of Health&Human Services
Greeley,Colorado 80631 1961 Stout Street—Room 1426
Phone:970-400-4230 Denver,Colorado 80294
Email:jscott@weld.gov Phone:303-844-2024;Fax 303-844-2025
Consent Term and Acknowledgement
This consent will remain in effect for one year from the signature date below unless and until revoked by you
prior to one year.I certify this consent has been made voluntarily and the information is accurate.I acknowledge
I have read and received a copy of this privacy policy.
Your Signature: Date:
(Parent or Legal Guardian may sign on behalf of a Minor child)
(Legal Guardian or Power of Attorney may sign on behalf of an adult)
2
Hello