Notices & Privacy Practices

Notice of Privacy Practices

This notice describes how medical and substance use disorder information about you may be used and disclosed, and how you can get access to this information. It also explains your privacy rights and how to file a complaint about a privacy or security concern. Please review it carefully.

Nova Clinical Services LLC is required by the Health Insurance Portability and Accountability Act (HIPAA) and, for substance use disorder treatment records, by federal confidentiality regulations at 42 CFR Part 2, to maintain the privacy of your protected health information, to provide you with this notice describing our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your information. We use and disclose health information to provide and coordinate your treatment, to bill and collect payment for services, and to run our practice (for example, quality assurance, staff training, and accreditation review). Substance use disorder treatment records are subject to additional federal protections under 42 CFR Part 2 and, with narrow exceptions such as a medical emergency or a court order meeting Part 2's requirements, may not be disclosed without your specific written consent — including to family members, other health care providers not involved in an active referral, and in most legal proceedings.

Your rights. You have the right to request a copy of your records, request that we amend your records, request an accounting of certain disclosures, request restrictions on certain uses and disclosures, request confidential communications, and receive a paper copy of this notice at any time, even if you agreed to receive it electronically.

How to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/complaints. You will not be penalized or retaliated against for filing a complaint.

Privacy Officer: Lindsey Lemmon, MSN, APRN · info@nova-cs.org · 234-260-4456

A complete copy of our current Notice of Privacy Practices is posted at our Fairlawn office and is available at any time on request, at no cost, by contacting the office (HHS Notice of Privacy Practices guidance; 42 CFR 2.22).

Your Right to a Good Faith Estimate

If you don't have insurance, or you are not planning to use your insurance, you have the right to receive a Good Faith Estimate of expected charges for any non-emergency item or service, including services related to your mental health or substance use care, before your scheduled service. This applies whether you are paying out of pocket or using our sliding fee scale.

• You can ask your provider or our front office for a Good Faith Estimate before you schedule an item or service, or at any time during your care.
• Make sure your Good Faith Estimate is provided in writing, at least 1 business day before your service for appointments scheduled at least 3 business days out.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

To request a Good Faith Estimate, contact our office at 234-260-4456 or info@nova-cs.org. For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.

A copy of our current Sliding Fee Scale is also available at our Fairlawn office and on request.

Notice of Nondiscrimination

Nova Clinical Services LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Nova does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Nova provides free aids and services to people with disabilities to communicate effectively with us, such as qualified interpreters and information in other formats, and provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact our office at 234-260-4456.

If you believe Nova has failed to provide these services or discriminated in another way, you may file a grievance with our Client Rights Officer (contact information below) or with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the OCR Complaint Portal, or by mail or phone at U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019 (TDD: 1-800-537-7697).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 234-260-4456.

تنبيه: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوفر لك بالمجان. اتصل برقم 234-260-4456.

Taglines above reflect two of the most common non-English languages spoken in Ohio; a full list covering additional languages is available on request. Source: Ohio language demographics, American Community Survey; sample notice language adapted from the HHS Office for Civil Rights Section 1557 model notice.

Website Accessibility Statement

Nova Clinical Services is committed to making nova-cs.org usable by everyone, including people with disabilities. We are working toward conformance with the Web Content Accessibility Guidelines (WCAG) 2.1/2.2 Level AA.

If you encounter a barrier while using this site, or need information in an alternate format, please contact us at 234-260-4456 or info@nova-cs.org and we will work with you to provide the information or service you need.

Reporting a Concern to The Joint Commission

Nova Clinical Services is preparing for accreditation review by The Joint Commission. Anyone — including clients, families, and staff — may report a patient safety event or quality-of-care concern about Nova directly to The Joint Commission at any time, without going through Nova first.

• Online: submit a report using The Joint Commission's Report a Patient Safety Event form (the preferred method).
• By mail: Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181.
• The Joint Commission does not accept reports by phone, fax, email, or in person.

Nova will not take disciplinary or adverse action against any client or staff member who reports a concern to The Joint Commission, in good faith.

Source: The Joint Commission, Report a Patient Safety Concern or File a Complaint.