Access your client portal here. You can make a secure payment, check your balance, complete e-documents, upload/download documents, exchange secure messages with your CDS provider, and manage your schedule with your CDS provider.
If you wish to pay by credit card over the phone, or you have questions, please call 952-955-4714 (ext.1). Check payments should be mailed to: CDS, 9352 Oak Ave, Waconia, MN 55387 (make checks payable to Clinical and Developmental Services and indicate the patient’s first and last name on the check).
Important Information for CDS Clients: No Surprises Act and Good Faith Estimates
CDS providers comply with the federal No Surprises Act, which protects individuals from receiving unexpected medical bills. This includes: 1) the cost of any unexpected out-of-network services will not exceed the amount allowed for in-network services billed to the client’s insurance plan, and 2) any client who is uninsured, or knowingly elects to work with an out-of-network provider, or elects to private-pay for services is entitled to a Good Faith Estimate (i.e., an estimate of treatment/service costs, prior to starting services). Please ask CDS staff if you have any questions or would like to request a Good Faith Estimate (submit question here).
CLIENT BILL OF RIGHTS
By law, you, as a client, have the right to:
To expect that your provider has met the minimum qualifications of education, training, and experience required by state law for licensure;
To examine public records maintained by your provider’s licensing board that contain the credentials of the provider;
To report complaints to the appropriate licensing board;
To be informed of the cost of professional services before receiving the services;
To privacy as defined and limited by rule and law;
To be free from being the object of unlawful discrimination on the basis of age, race, color, creed, religion, national origin, gender, marital status, disability, sexual orientation, and status with regard to public assistance while receiving mental health services;
To have access to their records as provided in Minnesota Statutes, sections 144.291 to 144.298, except as otherwise provided by law or a prior written agreement;
To be free from exploitation for the benefit or advantage of the provider;
To terminate services at any time, except as otherwise provided by law or court order;
To know the intended recipients of psychological assessment results;
To withdraw consent to release assessment results, unless that right is prohibited by law or court order or is waived by prior written agreement;
To be informed prior to a photograph or audio or video recording being made you. You have the right to refuse to allow any recording or photograph of you that is not for the purposes of identification or supervision by the license holder.
To a nontechnical description of any assessment procedures; and
To a nontechnical explanation and interpretation of any assessment results, unless that right is prohibited by law or court order or is waived by prior written agreement.
To obtain a copy of the rules of conduct from: State Register and Public Documents Division Department of Administration, 117 University Ave., St. Paul, Minnesota 55155
MN Provider licensing board contact information (choose for your specific provider):
Board of Psychology, 335 Randolph Avenue, Suite 270, St. Paul, MN 55102 612-617-2230 https://mn.gov/boards/psychology/
Board of Behavioral Health & Therapy, 335 Randolph Avenue, Suite 290, St. Paul, MN 55102 (651)201-2756 https://mn.gov/boards/behavioral-health/
Board of Marriage and Family Therapy, 335 Randolph Avenue, Suite 260, St. Paul, MN 55102 Phone: 612-617-2220 https://mn.gov/boards/marriage-and-family
Board of Social Work, 335 Randolph Ave, Suite 245, Saint Paul MN 55102-5502 612.617.2100https://mn.gov/boards/social-work/
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have questions about this notice, please contact CDS Compliance Officer (Dr. Egli) at 952-955-4714.
Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI as applicable by law. It also describes your rights regarding how you may gain access to and control your PHI.
We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by sending a copy to you in the mail (upon request) or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment/Evaluation: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with licensed mental health providers at this location, clinical supervisors, graduate level assessment trainees, or other treatment/assessment team members. We may disclose PHI to any other consultant only with your authorization. We may also contact you to remind you of your appointments or to provide information to you about treatment alternatives or other health-related benefits and services that may be of interest to you.
For Payment: We may use and disclose PHI so that we can receive payment for the treatment services provided to you/your child. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.
For Health Care Operations: We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For educational or teaching purposes PHI will be disclosed only with your authorization.
We may also use and disclose private health information for the following purposes:
• To remind you that you have an appointment for services;
• To assess your satisfaction with our services;
• To follow-up with you regarding treatment options;
• For law enforcement purposes as required by law or in response to a valid subpoena
• To business associates with whom we have contracted to perform agreed upon services and the related billing for those services.
Without Authorization: The following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations.
Required Disclosures permitted without your authorization: State and federal laws allow for some situations in which your health information may be disclosed without your consent. Some situations include:
• Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of suspected abuse or neglect of a child, maltreatment of a vulnerable adult, and in the event that a client is at risk of harm to him/herself or another;
• Public Safety. We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
• Public Health. If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.
• Health Oversight. If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payers based on your prior consent) and peer review organizations performing utilization and quality control.
• Judicial and Administrative Proceedings. We may disclose your PHI pursuant to a subpoena (with your written consent), court order, administrative order or similar process.
• Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
• Deceased Patients. We may disclose PHI regarding deceased patients as mandated by state law. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate.
• Medical Emergencies. We may use or disclose your protected health information in a medical emergency situation to medical personnel only in order to prevent serious harm.
• Specialized Government Functions. We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.
• Family Involvement in Care. We may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.
• Research. PHI may only be disclosed after a special approval process.
• When required to comply with workers’ compensation laws; and
• For purposes of organ donation.
Refer to http://www.health.state.mn.us/divs/hpsc/dap/notice.pdf for more detailed information about other situations.
With Authorization: Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you.
Required by Law: Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Verbal Permission: We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to C. Joe Egli, Ph.D., L.P. or Andrea K. Egli, Ph.D., 9352 Oak Avenue, Waconia, MN 55387.
Telephone Number: 952-955-4714 * Fax Number: 952-955-6213 * Email Address: admin@clinicalanddevelopmentalservices.com
Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record set”. A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. We may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI.
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy. Please contact your provider or Dr. Egli if you have any questions.
Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction.
Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
Breach Notification. If there is a breach of unsecured protected health information concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.
Right to a Copy of this Notice. You have the right to a copy of this notice.
COMPLAINTS
If you believe we have violated your privacy rights, you have the right to discuss your concerns or file an official complaint in writing with C. Joe Egli, Ph.D., L.P. or Andea K. Egli, Ph.D., 9352 Oak Avenue, Waconia, MN 55387, Telephone Number: 952-955-4714, Fax Number: 952-955-6213, Email Address: admin@ClinicalAndDevelopmentalServices.com. You may also contact your provider directly, via email or phone (952-955-4714). If you feel your concerns have not been addressed after notifying your provider, C. Joe Egli, Ph.D., L.P., or Andea K. Egli, Ph.D., you may contact your provider’s licensing board (e.g., Minnesota Board of Psychology, Board of Marriage and Family Therapy, Board of Behavioral Health and Therapy, or Board of Social Work) or contact the Secretary of Health and Human Services at 200 Independence Avenue, S.W., Washington, D.C. 20201 or by calling (202) 619-0257. No retaliation will be performed against you for filing a complaint.
