Notice of Privacy Practices - Massachusetts

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

Kacie LaChapelle, PhD, LMHC

Effective Date: 1/1/2026

I. SUMMARY:

This is a summary of how we may use and disclose your protected health information and your rights and choices when it comes to your information. We will explain these in more detail on the following pages.

*Please keep in mind that this information contains both protection under the Health Insurance Portability and Accountability Act (HIPPA) and Massachusetts State law (including but not limited to 262 CMR 8.00, G.L. c. 112 §§ 163-172 and c. 13, § 88-90) which may give individuals greater protection.

You Have The Right To:

  • Get a copy of your paper or electronic protected health information.

  • Correct your protected health information.

  • Ask us to limit the information we share, in some cases.

  • Get a list of those with whom we've shared your information.

  • Request confidential communication.

  • Get a copy of this privacy notice.

  • Choose someone to act for you.

  • File a complaint if you believe we have violated your privacy rights.

You have some choices about how we use and share information as we:

  • Communicate with you.

  • Tell family and friends about your condition.

  • Provide disaster relief

  • Provide mental health care

  • Market our services

We May Use And Disclose Your Information As We:

  • Treat you.

  • Bill for services.

  • Run our organization.

  • Do research.

  • Comply with the law.

  • Respond to organ and tissue donation requests.

  • Work with a medical examiner or funeral director.

  • Address workers' compensation, law enforcement, and other government requests.

  • Respond to lawsuits and legal actions.

II. PURPOSE:

Dr. Kacie LaChapelle (“or “I”) respect your privacy. I am also legally required to maintain the privacy of your protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) and other federal and state laws. I follow state privacy laws, including when they are stricter or more protective of your PHI than federal law.

As part of my commitment and legal compliance, I am providing you with this Notice of Privacy Practices (Notice). This Notice describes:

  • My legal duties and privacy practices regarding your PHI, including my duty to notify you following a data breach of your unsecured PHI.

  • My permitted uses and disclosures of your PHI.

  • Your rights regarding your PHI.

Contact:

If you have any questions about this Notice, please contact: kacie@gracehappenstherapy.com

PHI Defined:

Your PHI is health information about you:

  • Which someone may use to identify you; and

  • Which we keep or transmit in electronic, oral, or written form.

It includes information such as your:

  • Name

  • Contact information

  • Past, present, or future physical or mental health or medical conditions

  • Payment for health care products or services

  • Prescriptions

The therapeutic process often involves discussing personal matters, which may evoke uncomfortable emotions such as anger, guilt, or sadness, distress, intensified emotional triggering, or increased awareness of past trauma. Conversely, potential benefits may include improved personal relationships, reduced emotional distress, and effective problem-solving for specific challenges.

Engaging in the use of distance counseling, technology, and/or social media within the counseling process (i.e. Telehealth):

Telehealth services provide convenience and flexibility, but it’s important to understand some potential risks and limitations. While every effort is made to protect your privacy, electronic communication can be vulnerable to issues such as hacking or unauthorized access.

Additionally, confidentiality laws may vary depending on where you and your therapist are located, which could affect how your information is handled. Technical issues like internet disruptions or software problems could interrupt sessions, and the lack of in-person cues may sometimes lead to misunderstandings or incomplete communication.

Telehealth may not be the best option for everyone, especially in urgent or critical situations where in-person care is necessary. Your therapist will work with you to determine if telehealth meets your needs or if a local referral is more appropriate. It’s also important to verify your identity, and if you’re a minor or a vulnerable individual, your guardian’s consent may be required.

We want you to feel fully informed about the process. You will receive clear information about fees, billing practices, and your therapist’s qualifications upfront. We will also provide guidance on how to contact your therapist if they are offline and discuss the steps in place to address any challenges unique to telehealth services. By understanding these aspects, you can decide whether telehealth is the right choice for you.

PAYMENT AND BILLING:

I am committed to transparent, ethical, and lawful billing practices. All fees, including co-pays, are due at the time of service. Services are provided at a rate of $175.00 per 55 minute session, payable prior to each session.

If you are using insurance, I will submit claims on your behalf in accordance with all contractual and legal requirements. As a healthcare provider, I am obligated to bill accurately and truthfully, ensuring that all charges reflect services actually provided. I strictly adhere to relevant laws and will never misrepresent fees or bill for services that did not occur. If you are not using an insurance plan and prefer to file your own claim, full payment is required at the time of service, and I will supply a detailed statement for your records. If you have private insurance with out-of-network benefits, I can provide a superbill (an itemized receipt with required information) upon request, which you may choose to submit to your insurance company. Please note that: (1) I cannot guarantee reimbursement, and (2) You are responsible for understanding your plan’s out-of-network benefits. If your insurance changes or is cancelled, you are responsible for notifying me immediately. You are also responsible for all payments in full for services rendered.

Most insurance plans only cover medically necessary mental health treatment for an identified patient with a diagnosis, and may cover individual or family sessions only when that patient is present and the service meets plan requirements. Couples therapy or relationship-focused sessions not tied to an identified patient’s treatment plan (such as a Therapeutic Disclosure Session) are typically not covered and must be paid out of pocket at our private-pay rate. This also includes fees for reviewing and editing documents, travel time, collateral communication with other providers, or other non-clinical services your plan excludes. I will inform you whenever a service appears non-covered, provide fee information in advance, and offer a Good Faith Estimate upon request (or if you are uninsured/self pay). You are responsible for verifying your benefits, understanding any prior authorization or referral requirements, notifying us of insurance changes, and paying cost-sharing or private-pay fees. If insurance denies or reverses payment, you are responsible for the unpaid amount. We will bill accurately, inform you of coverage issues, and provide itemized receipts or superbills as needed. For questions about coverage, fees, or network status, please contact the practice.

USE OF TESTS AND INVENTORIES

It may be necessary for your Therapist to utilize assessment tools (tests and inventories) during the course of treatment, and for purposes of assessment and diagnosis. These tools will be selected, administered, and interpreted in accordance with applicable Codes of Ethics and standards set forth in both the American Counseling Association and the American Mental Health Counselors Association. Your therapist will provide you with appropriate information regarding the reason for assessment tools and to whom (if anyone) the report will be distributed to. There may be out of pocket costs for the use of certain tools and/or assessments.

CONFIDENTIALITY AND ITS LIMITS

The session content and all relevant materials to your treatment will be held confidential unless you, the client, requests in writing to have all or portions of such content released to a specifically named person/persons. This applies to all information you share and all communications, including electronic communications, shared between you as the client and myself as the therapist. I will never communicate, verbally or in writing, with others about you without your express written consent except in certain situations.

Generally, with your written advance consent, given to me by signing this Notice, I may use and disclose your PHI to the extent necessary for treatment, payment, and health care operations. This includes activities such as filing insurance claims, participating in credentialing reviews, and complying with licensure audits. Additionally, the law may allow for disclosure of your information, without your consent in circumstances including but not limited to:

  • Potential harm to the client or significant or deadly harm to others by the client; 


  • Mandatory reporting of suspected abuse/neglect of children, elders, or persons with disabilities; 


  • Court orders or other legal mandates.

I may also seek consultation from professional colleagues to enhance your care or for my own learning purposes. I will use my best efforts to safeguard your privacy by not disclosing your name or other identifying demographic information, or any other information by which you might be identified by the consultant.

If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately and/or legally kept confidential.

Additional Limitations of such client held privilege of confidentiality exist and can be found in detail in the HIPAA Notice of Privacy Practices you received.

CLIENT BILL OF RIGHTS

  1. Informed Consent: By typing/signing my name below, I am signing this Client Informed Consent Form as the Client and I acknowledge that I have read, understand, and agree to the terms and conditions contained in this form. I have been given an appropriate opportunity to address any questions or request clarification for anything that is unclear to me. I am voluntarily agreeing to receive mental health assessment, treatment and services (or for my child if said child is the client) and I understand that I may stop such treatment or services at any time.

  2. Grievance Process: You have a right to file a complaint with the Bureau of Health Professions Licensure if a health care professional or facility violates standards of professional conduct. 


  3. Client Respect: You have the right and ultimate responsibility to determine the best course of treatment for yourself, to disagree with therapist recommendations, and to work in collaboration with your therapist. Despite past actions due to addiction or other reasons, you are entitled to respect and dignity in the therapeutic relationship. 


  4. Right to Terminate: You have the right to stop treatment at any time, for any reason. I may recommend or initiate ending therapy when clinically or ethically appropriate, including when:

  • treatment is no longer necessary, effective, or aligned with your goals,


  • services you need are outside my scope of practice or competence, or a conflict of interest arises, 


  • safety concerns exist, including credible threats or harassment toward me or others in the practice, 


  • there is persistent nonattendance (e.g., repeated late cancellations or no-shows) or loss of contact despite reasonable outreach, 


  • there is persistent nonpayment for services or material changes in coverage/benefits that you elect not to assume, 


  • you decline or are unable to participate in treatment in a way that allows me to provide effective, ethical care.

Scope:

I create a record of the care and health services you receive, to provide your care, and to comply with certain legal requirements. This Notice applies to all the PHI that I generate and that I receive or maintain. I follow the duties and privacy practices that this Notice describes and any changes once they take effect.

Changes to this Notice:

I can change the terms of this Notice, and the changes will apply to all information I have about you. The new notice will be available on request, in our office, and on our website.

Data Breach Notification:

I will promptly notify you if a data breach occurs that may have compromised the privacy or security of your PHI. I will notify you within the legally required time frame, no later than 60 days after a breach is discovered. Most of the time, I will notify you in writing, by first-class mail, or I may email you if you have provided me with your current email address and you have previously agreed to receive notices electronically. In limited circumstances when I have insufficient or out-of date contact information, I may provide notice in a legally acceptable alternative form.

III. YOUR RIGHTS:

When it comes to your health information, you have certain rights. This section explains your rights and some of my responsibilities to help you. You have the right to:

1. Get a copy of your PHI. You can ask to see or obtain an electronic or paper copy of the PHI that I maintain about you (right to request access).

Clarifications about your access rights under Massachusetts law (262 CMR 8.02):

During your course of treatment, treatment records will be maintained for a minimum period of seven (7) years from the date of our last professional contact. The following provisions inform you of the manner in which you or your authorized representative may inspect treatment records in accordance with Massachusetts State law. In the event that the client is a minor, I will maintain treatment records for at least one year after the client has reached the age of majority as defined by statute (18 years old), but in no event shall the record be retained for less than seven years.

  • Upon written request and within a reasonable period of time, I will provide you or your authorized representative a copy of your requested treatment records.

  • I may only decline to permit you or your authorized representative to inspect or obtain a copy of your treatment records if I, in the reasonable exercise of my professional judgement, believe that allowing you or your authorized representative to inspect or copy your records would adversely affect your physical or mental well-being. In this case, I will provide you with a treatment summary in lieu of the full treatment record. If after receiving the treatment summary you still wish to request a copy of your full treatment record, I will provide a full copy to an attorney or other authorized person, designated by you.

  • I am prohibited from requesting payment of any balance due for prior therapy services rendered to you as a pre-condition for making the treatment records available.

  • I may, however, charge a reasonable fee for the copying of treatment records and postage, where applicable.

  • I will comply with all applicable regulations and laws in the creation, maintenance, storage, transfer and disposal of client records and in the event of withdrawal from practice or my death.

2. Ask me to correct your medical record. You may ask me to correct or amend PHI that I maintain about you that you think is incorrect or inaccurate. For these requests:

  • you must submit requests in writing or electronically, specify the inaccurate or incorrect PHI, and provide a reason that supports your request

  • I will generally decide to grant or deny your request within 60 days. If I cannot act within 60 days, I will give you a reason for the delay in writing and include when you can expect me to complete my decision, which will be no longer than an additional 30 days. I will only ask for an extension once in response to a request.

  • I may deny your request for an amendment if you ask us to amend PHI that is not part of our record, that I did not create, that is not part of a designated record set, or that is accurate and complete.

3. Ask us to limit what we use or share. You have the right to ask us to limit what I use or share about your PHI (right to request restrictions). You can contact me and request that I not use or share certain PHI for treatment, payment, or operations or with certain persons involved in your care. I may require that you submit this request in writing. For these requests:

  • I am not required to agree;

  • I may say “no” if it would affect your care; but

  • I will agree not to disclose information to a health plan for purposes of payment or health care operations if the requested restriction concerns a health care item or service for which you or another person, other than the health plan, paid in full out-of-pocket, unless it is otherwise required by law.

4. Get a list of those with whom we've shared your PHI. You have the right to request an accounting of certain PHI disclosures that I have made. For these requests:

  • I will respond no later than 60 days after receiving the request. I may ask for an additional 30 days during this 60-day period, but if I do, I will only do it once, provide a written statement of why, and indicate the date by which I intend to send the response.

  • I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked me to make; and

  • I will provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months. I will notify you about the costs in advance and you may choose to withdraw or modify your request at that time.

5. Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI. I will confirm the person has this authority and can act for you before I take any action.

6. Request confidential communications. You have the right to request that I communicate with you about health matters in a certain way or at a certain location. For example, you can ask that I only contact you at work or at a specific address. For these requests:

  • I will not ask for the reason;

  • you must specify how or where you wish to be contacted; and

  • I will accommodate reasonable requests.

7. Make a Complaint: You have the right to complain if you feel I have violated your rights. I will not retaliate against you for filing a complaint. You may either file a complaint:

  • directly with us by contacting [your preferred contact information for clients]. All complaints must be submitted in writing; or

  • with the Office for Civil Rights at the US Department of Health and Human Services. Send a letter to U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F HHH Bldg. Washington, D.C. 20201; or click here.

Gender Affirming Care and Privacy:

Massachusetts lawmakers affirmed that access to reproductive and gender-affirming

Health care is a legal right protected by the state constitution and laws, through the passage of legislation commonly known as the “Shield Law.” Among the provisions passed in the Shield law are several that grant you as a client certain rights. As your provider, we support and uphold the following rights:


  • Your right to care is protected by state law. Interfering with your access to gender-affirming or reproductive health care is unlawful in Massachusetts.

  • We will not share your information with law enforcement or courts if the request relates to legally protected gender-affirming health care within the State. Massachusetts law protects providers and clients from out-of-state investigations related to this type of Care.

IV. YOUR CHOICES:

For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your information in the situations described below, please contact me and I will make reasonable efforts to follow your instructions.

In these cases, you have both the right and choice to tell me whether to:

Share information, such as your PHI, general condition, or location, with your family, close friends, or others involved in your care.

Share information in a disaster relief situation, such as to a relief organization to assist with locating or notifying your family, close friends, or others involved in your care.

V. USES AND DISCLOSURES:

The law permits or requires me to use or disclose your PHI for various reasons, which I explain in this Notice. I have included some examples, but have not listed every permissible use or disclosure. When using or disclosing PHI or requesting your PHI from another source, I will make reasonable efforts to limit my use, disclosure, or request about your PHI to the minimum we need to accomplish our intended purpose. PHI that the law permits or requires us to disclose may be further shared by recipients and is no longer protected by law or the safeguards and restrictions in place when it is in our possession

In non-emergency situations, no PHI will be disclosed without direct prior permission being given by you except in limited circumstances, as outlined in section VI. If permission is given, this will be documented and included in your file. Permission can later be revoked at any time. If I receive a release asking for your PHI from another party I will first verify this with you and ask for your permission to release your PHI. If you do not give permission, I will not release your PHI.

Additionally, in the following cases, I will not share your information unless you give me your written permission:

  • Most sharing of “psychotherapy notes” as defined by 45 CFR § 164.501;

  • For marketing purposes;

  • Selling or otherwise receiving compensation for disclosing your PHI;

  • Certain research activities; and

  • Other uses and disclosures not described in this Notice.

For more information on permitted uses and disclosures, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. For example, other uses and disclosures may involve:

Uses and Disclosures for Treatment, Payment, or Health Care Operations

Treatment: I may use or disclose your PHI and share it with other professionals who are treating you, including doctors, nurses, technicians, medical students, or hospital personnel involved in your care. For example, I might disclose information about your overall health condition to physicians who are treating you for a specific injury or condition.

Billing and payment: I may use and disclose your PHI to bill and get payment from health plans or others. For example, I share your PHI with your health insurance plan so it will pay for the services you receive.

Running our organization. I may use and disclose your PHI to run my practice, improve your care, and contact you when necessary. For example, I may use your PHI to manage the services and treatment you receive or to monitor the quality of my health care services.

VI. OTHER USES AND DISCLOSURES:

Under HIPAA and Massachusetts state law, the following are circumstances in which I may legally waive confidentiality, without your consent.

  • If I become a defendant in a civil, criminal, or disciplinary case related to my

  • services to you, confidentiality may be waived, but only to the extent necessary

  • for that specific legal proceeding.

  • Where you are a defendant in a criminal proceeding and the use of the privilege

  • would violate your rights to present testimony and witnesses on your behalf.

  • Cases of potential harm to yourself or significant or deadly harm to others.

  • Responding to certain legal actions including but not limited to: determining that you need hospitalization for mental illness or pose an imminent danger to yourself or others; in the initiation of kinship placement searches under G.L. c. 119 § 23(7)(c); or to give testimony under G.L. c. 119 § 24 regarding emergency orders transferring custody and investigation of "abandoned children”.

Complying with the law. For example, we will share your PHI if the Department of Health and Human Services requires it when investigating our compliance with privacy laws.

Helping with public health and safety issues. For example, we may share your PHI to:

  • report injuries, births, and deaths;

  • prevent disease;

  • report adverse reactions to medications or medical device product defects;

  • avert a serious threat to public health or safety.

Responding to legal actions. For example, we may share your PHI to respond to:

  • a court or administrative order or subpoena;

  • discovery request; or

  • another lawful process.

Working with medical examiners or funeral directors. For example, we may share PHI with coroners, medical examiners, or funeral directors when an individual dies.

Responding to organ and tissue donation requests. For example, we may share your PHI to arrange an authorized organ or tissue donation from you or a transplant for you.

Addressing workers' compensation, law enforcement, or other government requests.

For example, we may use and disclose your PHI for:

  • workers' compensation claims;

  • health oversight activities by federal or state agencies;

  • law enforcement purposes or with a law enforcement official; or

  • specialized government functions, such as military and veterans' activities, national security and intelligence,

  • presidential protective services, or medical suitability

The following are circumstances in which I am required to waive confidentiality, without your consent, as mandated by Massachusetts state law:

  • Mandated Reporting: As a Licensed Mental Health Counselor (Allied Mental Health and Licensed Human Services Professional) I am a mandated reporter. Massachusetts law requires mandated reporters to immediately make an oral report to the Department of Children and Families (DCF) when, in their professional capacity, they have reasonable cause to believe that a child underthe age of 18 years is suffering from abuse and/or neglect.

  • Duty to Warn: I am required to take reasonable precautions to warn or in any other way protect potential victims if you communicate to me, or I am aware of an explicit threat to kill or inflict serious bodily injury upon a reasonably identified victim or victims and you have the apparent intent and ability to carry out the Threat.