HIPAA Policy

Notice of Privacy Practices

Purpose

To ensure that all of the regulations of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that apply to Tobii Dynavox are followed by all associates.

It is the purpose of all Tobii Dynavox associates to ensure the standards described in our Notice of Privacy Practices, as related to our customers and potential customers, are properly followed.

Responsibility

Tobii Dynavox management has the overall responsibility for implementing this policy and must designate a Privacy Officer to be responsible for administering this policy. This notice describes how protected health information (PHI) may be used and disclosed, and how you can gain access to this information.

Our Commitment to Your Privacy

Tobii Dynavox is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and privacy practices concerning your protected health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time. To summarize, this notice provides you with the following important information:

• How we may use and disclose your protected health information
• Your privacy rights in your protected health information
• Our obligations concerning the use and disclosure of your protected health information

The terms of this notice apply to all records containing your protected health information that are created or retained by Tobii Dynavox. We reserve the right to request or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records that Tobii Dynavox has created or maintained in the past, and for any of your records we may create or maintain in the future. Our organization will post a copy of our current notice on our web site www.tobiidynavox.com and you may request a copy of our most current notice.

If you have questions about this notice, please contact:

Chief Privacy Officer at (800) 344-1778 ext. 7800

We may use and disclose your health information in the following ways:

The following categories describe the different ways in which we may use and disclose your protected health information.

• Funding Assistance - Protected health information is primarily used at Tobii Dynavox to assist in getting Medicare, Medicaid or private insurance funding for alternative and augmentative communications (AAC) devices and solutions or Speech Generating Devices (SGD’s).
• Release of PHI to Guardians, Caregivers, SLPs and Other Health Care Professionals - Tobii Dynavox may release protected health information to authorized individuals. This would include customers, relatives of customers, caregivers, SLPs, other medical professionals and various funding agencies including Medicare, Medicaid and private insurance.
• Referral to AAC Advocate - Material will be sent to our AAC advocate as required to facilitate alternate funding sources or appeal a denial of funding decision. Tobii Dynavox will obtain written authorization from our customers for disclosure of your protected health information for this purpose.
• Disclosures Required - Tobii Dynavox will use and disclose your protected health information when required by federal, state or local law.
• Other Uses and Disclosures - Other uses and disclosures of your protected health information for reasons not specified above will only be made with an individual’s written authorization. The written authorization will state:
  • Purpose or reason for the disclosure
  • Organization or individual to which the information is disclosed
  • Time period that the information may be used

An individual has the right to revoke authorization at any time upon giving written notice of such revocation.

Use and disclosure of your protected health information in special circumstances:

• Public Health Risks
  Tobii Dynavox may disclose your protected health information to public health authorities that are authorized by law to collect information for the purposes of:
  • Maintaining vital records, such as births and deaths
  • Reporting child abuse or neglect
  • Notifying individuals if a product or device they may be using has been recalled
  • Notifying appropriate government agency (ies) and authority (ies) regarding the potential abuse or neglect of an adult patient (including domestic violence). We will only disclose this information if the customer agrees or we are required or authorized by law to disclose this information
• Health Oversight Activities
  Tobii Dynavox may disclose your protected health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, license and disciplinary actions, civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the healthcare system in general.
• Research
  Tobii Dynavox may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy or de-identification of your protected health information.
• Lawsuits of Similar Proceedings
  Tobii Dynavox may use and disclose your protected health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceedings. We also may disclose your protected health information in response to discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
• Law Enforcement
  Tobii Dynavox may release protected health information if asked to do so by a law enforcement official:
  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
  • In response to a warrant, summons, court order, subpoena or similar legal process
  • To identify/locate a suspect, material witness, fugitive - or missing person
  • In an emergency, to report a crime (including the - location or victim(s) of the crime, or the description, identity or location of the perpetrator)
• Military
  Tobii Dynavox may disclose your protected health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.
• National Security
  Tobii Dynavox may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your protected health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations as required by law.
• Inmates
  Tobii Dynavox may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary for:
  • The institution to provide health care services to you
  • The safety and security of the institution
  • Protection of your health and safety or the health and safety of other individuals
• Workers’ Compensation
  Tobii Dynavox may release your protected health information for Workers’ Compensation and similar programs

Your rights regarding your protected health information:

You have the following rights regarding the protected health information that we maintain about you:

• Confidential Communications
  You have the right to request that Tobii Dynavox communicate with you about your health and related issues in a particular manner or a certain location.
• Request Restrictions
  You have the right to request a restriction in our use or disclosure of your protected health information for funding, treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of your protected health information to individuals involved in your care or the payment of your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by laws or when the information is necessary to facilitate funding. In order to request a restriction in our use or disclosure of your protected health information, you must make your request in writing to:
  
  Chief Privacy Officer
  Tobii Dynavox
  2100 Wharton Street, Suite 400
  Pittsburgh PA, 15203
  
  Your request must describe in a clear and concise fashion:
  • The information you wish restricted
  • Whether you are requesting to limit our company's use, disclosure or both
  • Whom you want the limits to apply to Inspection
• Inspection and Copies
  You have the right to inspect and obtain a copy of the protected health information that may be used to make a decision about you including: customer medical information, funding information and billing records. You must submit your request in writing to the Tobii Dynavox Chief Privacy Officer as instructed above in order to inspect and/or obtain a copy of your protected health information. Tobii Dynavox may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. Tobii Dynavox may deny your request to inspect and/or copy in certain limited circumstances.
• Amendment
  You may ask Tobii Dynavox to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as Tobii Dynavox keeps the information. To request an amendment, your request must be made in writing and submitted to the Tobii Dynavox Chief Privacy Officer as instructed above. You must provide us with a reason that supports your request amendment. Tobii Dynavox will deny your request if you fail to submit the request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is:
  • Inaccurate or incomplete
  • Not part of the protected health information kept by or for Tobii Dynavox
  • Not part of the protected health information which you would be permitted to inspect
  • Not created by Tobii Dynavox, unless the individual or entity that created the information is not available to amend the information
• Accounting of Disclosures
  All of our customers have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures Tobii Dynavox has made of your protected health information. In order to obtain an accounting of disclosures, you must submit your request in writing to the Tobii Dynavox Chief Privacy Officer as instructed above. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six years and not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but Tobii Dynavox may charge you for additional lists within the same 12-month period. Tobii Dynavox will notify you of the cost involved with additional requests, and you may withdraw your request before you incur any costs.
• Right to a Paper Copy of This Notice
  You are entitled to receive a paper copy of Tobii Dynavox’s Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact the Chief Privacy Officer at (800)344-1778 ext. 7800.
• Right to File a Complaint
  If you believe your privacy rights have been violated, you may file a complaint with Tobii Dynavox or the Secretary of the Department of Health and Human Services, (202) 619-0257. To file a complaint with Tobii Dynavox, contact the Chief Privacy Officer at (800) 344-1778 ext. 7800. All complaints must be submitted in writing. A complaint can be filed without reprisal from anyone at Tobii Dynavox or its associates.

Right to Provide an Authorization for Other Uses and Disclosures

Tobii Dynavox will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your protected health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your protected health information for the reasons described in the authorization. Please note that we are required to retain records of your funding and device information.

Patient Bill of Rights and Responsibilities

Bill of Rights

• The right to be fully informed in advance about service/care to be provided, including the disciplines that furnish care and the frequency of visits as well as any modifications to the service/care plan.
• The right to participate in the development and periodic revision of the plan of service/care.
• The right to be Informed consent and refusal of service/care or treatment after the consequences of refusing service/care or treatment are fully presented.
• The right to be informed, both orally and in writing, in advance of service/care being provided, of the charges, including payment for service/care expected from third parties and any charges for which the client/ patient will be responsible.
• The right to have one’s property and person treated with respect, consideration and recognition of client/patient dignity and individuality.
• The right to be able to identify visiting staff members through proper identification.
• The right to voice grievances/complaints regarding treatment or care, lack of respect of property or recommended changes in policy, staff, or service/care without restraint, interference, coercion, discrimination, or reprisal.

Grievances or complaints may be sent in writing to:

Complaint Department
Tobii Dynavox
2100 Wharton Street, Suite 400
Pittsburgh PA 15203

or

Office of Quality Monitoring The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, Illinois 60181
(800) 994-6610

• Have grievances/complaints regarding treatment or care that is (or fails to be) furnished, or lack of respect of property investigated.
• Choose a health care provider.
• Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information.
• Be advised on agency’s policies and procedures regarding the disclosure of clinical records.
• Receive appropriate service/care without discrimination in accordance with physician orders.
• Be informed of any financial benefits when referred to an organization.
• Be fully informed of one’s responsibilities, listed below.
• Be informed of provider service/care limitations.

Responsibilities

• Prior to receipt of equipment provider must be informed of any changes to medical insurance coverage.
• Upon delivery, all equipment must be inspected and any problems or issues with equipment reported to company within the 30 day return period. No returns or exchanges will be accepted beyond the 30 day return period.
• There will be no returns of custom ordered equipment such as non-stocked wheelchair mounting parts. You are responsible for providing us with correct information about your source of payment and ability to pay your bill.
• Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
• The client/patient is responsible for warranty information and expiration dates. Reminders may be provided as a courtesy only.
  
  

Supplier Standards

Tobii Dynavox adheres to the following standards as required by the Centers for Medicare and Medicaid Service:

1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements and cannot contract with an individual or entity to provide licensed services.
2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.
4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.
5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty.
7. A supplier must maintain a physical facility on an appropriate site. This standard requires that the location is accessible to the public and staffed during posted hours of business. The location must be at least 200 square feet and contain space for storing records.
8. A supplier must permit CMS, or its agents to conduct on-site inspections to a scertain the supplier’s compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.
9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.
10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.
11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from contacting a Medicare beneficiary based on a physician’s oral order unless an exception applies.
12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.
13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.
17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
18. A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.
19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
20. Compliant records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.
22. All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals). Implementation Date - October 1, 2009
23. All suppliers must notify their accreditation organization when a new DMEPOS location is opened.
24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.
25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.
26. Must meet the surety bond requirements specified in 42 C.F.R. 424.57(c). Implementation date- May 4, 2009
27. A supplier must obtain oxygen from a state- licensed oxygen supplier.
28. A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.F.R. 424.516(f).
29. DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare providers and suppliers.
30. DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions
    
    

30 Day Return Policy

All products sold by Tobii Dynavox are backed by a 30 day return policy. All returns require prior authorization by Tobii Dynavox Management within 30 days from the date the product was shipped from Tobii Dynavox Pittsburgh, PA. All approved returns must be shipped at Buyer’s cost, and all items must be properly packaged as instructed by Tobii Dynavox. Product returns which are not approved, will not be accepted by Tobii Dynavox.

This 30 day policy does not pertain to Special Ordered Parts. All products which are not considered a stocked item of Tobii Dynavox are considered a special order and are non-returnable, non-refundable unless expressly authorized by Tobii Dynavox Management. No exceptions will be made.

To return a device contact us at 1-800-344-1778 opt. 2.

Equipment Warranty Information Form

Every device (Eyemax included) sold by our company carries a 1–year manufacturer’s warranty. Tobii Dynavox will notify all clients of the warranty coverage, and we will honor all warranties under applicable law.

Tobii Dynavox will repair or replace, free of charge, equipment that is under warranty. In addition, when available, an owner’s manual with warranty information will be provided to clients for all durable medical equipment.