Residential treatment options, from independent living programs to intensive wilderness therapy experiences, can help many young people who struggle with substance misuse. Many of these programs fall under the National Association of Therapeutic Schools and Programs. Participants can improve their problem-solving and communication skills and develop healthier living habits, often after traditional therapy models have not been successful.
However, the sensitive nature of these programs can also lead to safety issues for residents. Even the best providers must be prepared to respond to inquiries and investigations.
Reasons for Behavioral Health Safety Investigations
Behavioral health organizations may receive safety inquiries and undergo investigations for numerous reasons.
Licensing agencies may launch a routine investigation as part of a licensing application or renewal.
Payers may request information if they suspect fraud associated with billing.
Former clients or their families may accuse resident programs of mismanagement or abuse.
Data breaches may prompt investigations and audits.
Inquiries may come from licensing agencies, state protection and advocacy systems, payers, attorneys on behalf of client families, or independent organizations. Here’s how to respond.
Receiving a Medical Record Request
Any inquiry is likely to involve a request for client medical records. Before responding, make sure your facility is allowed to disclose records under HIPAA and state laws.
A few rules to follow:
In general, protected health information (PHI) cannot be used or disclosed without consent, except to the individual client.
Additional protections may apply to a mental health professional’s notes recorded during conversation in a counseling session.
If a state law is even stricter than HIPAA, then state law prevails.
Sometimes, you may disclose PHI without consent. These cases are limited and allowed only if there is a “serious and imminent” threat. Always refer to HIPAA and other federal and state laws that apply to your organization.
Responding to a subpoena
Behavioral health organizations under HIPAA law may only release PHI in response to a subpoena if certain conditions are met. The subpoena is accompanied by a court or administrative tribunal order and signed by a judge. The investigator must also provide you with “satisfactory assurance” that it has made “reasonable efforts” to give notice to the individual whose PHI is involved, or to secure an appropriate qualified protective order from the court or tribunal.
If you are subpoenaed, you must address it in some way, no matter what. This may involve contacting the requestor, appearing before a judge, or moving to quash the subpoena.
Declining a Medical Information Request
Your facility may not be able to fulfill all requests for medical information you receive. Be sure you understand the possible consequences if your organization does not disclose requested records.
If you must decline a PHI request in order to comply with federal or state law, do not acknowledge that the client involved was treated at your facility. However, if the request involves an individual who is not, and never has been, a client of your facility, you may say so.
Be sure to maintain and keep records for an appropriate length of time. If your state does not have specific laws for maintaining behavioral health records, consider following the American Psychological Association’s recommendations.
Whether you’re dealing with a routine audit or an unexpected investigation, maintaining appropriate documentation is crucial for behavioral health. The BestNotes EHR solution offers a documentation app that follows to federal, state, and accreditation standards, updating changes automatically, so you can maintain compliant records without anxiety. Contact us today to learn more, or schedule a free demo.