CHW Packet – Limits of Confidentiality & Client Rights

Community Connections, Community Health Workers services provides Medicaid billable services to individuals/ families who suffer a variety of Chronic and or Behavioral Health disorders that in need of support services to maintain community stability. For these services client must meet Eligibility requirements based on a Program eligibility assessment that consist of questions based on the four domains of Recovery, which include: Health, Home, Purpose and Community, as well as meet insurance eligibility. Clients who don't meet insurance requirements and are in need of services will be referred to other community service providers, if Community Connections can't work on a reimbursement format for services that need to be provided. The Medicaid eligibility assessment will be completed by the Family Connections Referral Coordinator or designed, and it will be reviewed, and Medicaid verified with-in forty-eight hours for approved staff assignment and Medicaid billable services.

Once you are assigned an appropriate Community Connections Community Health Worker, they will conduct a comprehensive intake and develop or review a developed Plan of Care with you, so that you may achieve your identified goals. Your Plan of Care will be developed with your Primary Behavioral Health Clinician if they have referred you for CHW scrvices and that plan will be reviewed with you widr your CHW. The Community Health worker will work with you on a daily or weekly basis based on the needs you may have and will monitor your progress as well as collaborate with your referral source and other providers as needed. At Commudty Connections your assigned stalimember will professionally support you regarding issues, advocate for you when you cannot do i1 for yourself and refer you to services that will attempt to meet your needs. In order to do this, information Cornmunity Connections will need to share informatio, as needed with refbrring partoeIs or other service providers in ordcr to provide you with the best possible services for success. All information received by Communilv Connections will be held in the strictest confidence in accordance with 42 CFR 2 and that no information will be disclosed without your wriflen permission to programs outside ofthc written records rcgarding your service activities (i.e., progress notes, Plan of Care) and other relevatrt documentation (i.e., personal identification, gtc.) are requiled and kept confidential.

The following are exceptions to thc above statements, as required by law (limits ofconfidentiality):

1. If you threaten to halm yourself or another person, or lhreaten 10 damage property, all Community Connections staffrvill take whatever action is deemed necessary under the circumstances to ensure your safety and the safety ofothers, including nolilication of appropriate persons/legal authorities and Community Connections administrators.
2. In any instances where any Comounity Connections staff suspect any child, disabled adult, or elder abuse, neglect or exploitation, past  or present or evidence of domestic violence, staff is mandated by law to investigate further and, in certain circumstancos, report such incidcnces to the appropriate authorities.
3. There may be situations in which written records are subpoenaed by a court of law and used as testimony in legal proceedings.
4. Community Comections will also be verifying and ifprovided services billing your insumnce using the EOHHS system. To veriry and summit for service reimbursement Comrrunity Connections needs to summit your personal demogaphical information such as your name, address, social security number, diagnosis and date, time of services received, and lhcse will idertiry you as a person rcceiving sevices at Community Connections in accordance with the Executive OIficc ofHealth and Human Services in the state of Rhode Island.

The above information has been explained to me in a manner and language that I understand by a Community Connections staff member and this is for your records.