CORNERSTONE
BEHAVIORAL
HEALTH
CORNERSTONE
Behavioral Health
-A Division of Mountain Regional Services, Inc.-
195 Feather Way, Suite 1 * P.O. Box 6005
Evanston, WY 82931-6005
Policy & Procedure Manual
Copyright 2000 by
Mountain Regional Services, Inc.
All Rights are Reserved
No part of this manual may be duplicated in any form without prior written
consent of
Mountain Regional Services, Inc.
Written 1994 Revised: 1997 Revised: 2000 Revised: 2003 Revised: 2006 Revised: 2009 Revised: 2012TABLE OF CONTENTS - POLICY AND/OR PROCEDURE:
SECTION I: PROGRAM QUALITY
Service Delivery Plan 06 - 17
Consent for Services 18
Client Refusal to Sign Paperwork 18
Criteria for Admission/Re-Admission 18 - 19
Accessibility of Treatment 19
Developing a Waiting List 20
Order of Selection for Admission of Persons Awaiting Services 20 - 21
Ineligible for Services 21
Psychological Screening 21 - 22
Substance Abuse Evaluations 22
Client Rights 22 - 24
Confidentiality 24 - 25
Financial Agreement - Fee for Services 25 - 26
Sliding Fee Scale 26 - 28
Substance Abuse Quality of Life (QOL) 28 - 29
Client Orientation to Cornerstone Behavioral Health 29
Coordinating Client Services 29
Filing Grievance 30 - 31
Initial and On-Going Assessment 31 - 32
Client Duplicate Charts 32
Client Treatment Records 32 - 33
Time Frames for Making Entries Into Client Charts and Completing Reports 33 - 34 Direct Involvement of the Client in the Decision Making Process 34
Individual Plan for Client 34 - 37
Client Follow-Up 37
Transition/Discharge Planning 38
Transition/Discharge Summary Plan 38 - 40
Referrals of Needed Client Services 41 - 42
Release of Information 43
Obtaining Previous Diagnostic Medical & Other Reports 43 Coordination of Prevention, Treatment and Transition/Discharge Planning 43 - 45 Medication Use and Storage of Pharmaceutical Samples 45
Psychiatric Advance Directives 45 - 46
Special Needs 46 - 49
Use of Special Treatment Intervention 49
Crisis Intervention 49 - 51
Quality Assurance Records Review 51
Medicaid Quality Assurance Plan 52 - 53
Weapons and Violence 54
Nonviolent Practices 54
Smoking & Smokeless Tobacco Use 55
Alcohol and/or Other Drugs and Psychiatric Disabilities 56
Controlled Substances at Cornerstone 56
Child/Adolescent Being Suspended from School While in Treatment 57 Recruitment and Retention Plan for Psychologists 57 - 58
Staff Training 58 - 59
Supervision of Direct Service Personnel 59 - 60
SECTION II: MRSI-NOTICE OF PRIVACY PRACTICES 61 - 71
SECTION III: THE INTERNSHIP PROGRAM 72 - 94 The Internship Program Goals
Expectations for Interns Supervision
Didactics
Observational Learning/Technology-Assisted Consulting Administration of the Internship
Evaluations
Additional Educational Opportunities Vacation/Professional Leave
What if Problems Arise? Frequently Asked Questions Evanston/Rocky Mountains Cornerstone’s Staff
Internship - POLICIES AND PROCEDURES Intern Recruitment/Public Disclosure
Intern Selection
Administrative and Financial Assistance Intern Rights and Responsibilities Intern Performance Evaluations
Due Process and Grievance Procedure for Interns and Training Staff
Outline of Internship Program Goals, Objectives, Competencies, and Activities Allocation of Intern Hours
SECTION I
195 Feather Way Post Office Box 6005 Evanston, WY 82931-6005 Telephone (307) 789-0715 Fax (307) 789-4774
SERVICE DELIVERY PLAN
I. NEEDS FOR SERVICE AREA
Cornerstone Behavioral Health (hereinafter “Cornerstone”) is active in assessing the needs of the community by collecting and analyzing data from available resources. Examples include: Hearing Our Consumer Voice: The 2011 Consumer Survey; The 2010 Wyoming Prevention Needs Assessment: State of Wyoming Profile Report (WYSAC); and Wyoming’s 2011 Youth Risk Behavior Survey.
Our assessment of community needs is an ongoing process. Cornerstone collaborates with a wide variety of social service agencies by participating in regularly scheduled meetings, which keeps Cornerstone in touch with the needs of the community.
In addition to conducting ongoing needs assessment with other agencies and referral sources, we regularly survey our clientele, which provides another way to assess community needs, to which we respond in a constructive fashion. For example, we survey our clientele during treatment, as part of the required attendance of Family Week activities, State mandated surveys, after discharge, in our follow-up surveys, client satisfaction surveys, and a suggestion box located in the lobby. Consequently, our needs assessment, which focuses on both prevention and treatment, is a continual process that spans agencies, including social service agencies and State agencies, referral sources, the legal system, and our clientele. This information is continually analyzed, and the analysis is integrated into the business practices of the organization. The input is used to help determine if the organization is: Meeting the current needs of the persons served and other stakeholders; offering services that are relevant to the persons served and other stakeholders; and identifying potential new opportunities for the growth and development of programs and services. For example, the need for adolescent substance abuse treatment has again been identified by the community. As a result, Cornerstone has implemented a full array of treatment programs specifically designed for adolescents to include the following: Minor in Possession School (MIP) - Early Intervention, ASAM 0.5 Level of Care; Adolescent Outpatient Treatment Program (AOP) - ASAM I Level of Care;
Adolescent Intensive Outpatient Treatment (AIOP): Phase I (ASAM II Level of Care) and Phase II (Aftercare; ASAM I Level of Care).
The services outlined below reflect the ongoing needs assessment and are updated as the needs of the community change.
II. ABOUT CORNERSTONE BEHAVIORAL HEALTH
Cornerstone Behavioral Health (hereinafter “Cornerstone”) Wyoming's premier provider of nationally accredited outpatient mental health services and substance abuse treatment programs. Established in 1988, Cornerstone provides area residents with comprehensive, professional services in the comfort and privacy of a state of the art clinic located next to Evanston Regional Hospital. The professional staff at Cornerstone consists of a broad range of mental health providers, licensed psychologists, psychological interns, and board certified psychiatrists (via telehealth through Cheyenne Regional Medical Center).
Cornerstone’s outpatient treatment programs refer to a variety of services in the areas of mental health and substance abuse, which are designed to address the needs of the clients. Cornerstone offers a wide range of mental health services, including: Psychological testing and assessments, family and couples therapy, child and adolescent therapy, computerized testing for attention deficit hyperactivity disorder (ADHD), individual and group therapy, and telehealth psychiatry through Cheyenne Regional Medical Center. In the area of substance abuse services, Cornerstone offers substance abuse treatment programs that allow clients to remain with their families and at their jobs or school while receiving treatment. Substance abuse services include: Substance abuse evaluations, Cornerstone’s long-standing and successful Intensive Outpatient Treatment Program (IOP-Phase I, IOP-Phase II), Outpatient Treatment Program (OP), DUI School, individual, couples and family therapy, drug testing, breathalysers, and prevention education; and Cornerstone’s more recent Adolescent Programs that include Adolescent Intensive Outpatient Treatment Program (AIOP-Phase I, AIOP-Phase II), Adolescent Outpatient Treatment Program (AOP), and Minor in Possession School (MIP).
Cornerstone accepts most insurance plans, including Medicare and Medicaid. All fiscal operations are in accordance with generally accepted accounting principles. As part of the Wyoming Department of Health, Behavioral Health Division Contract, Cornerstone will charge clients, who are served under the contact, according to the sliding fee scale adopted from the Wyoming Department of Health, Behavioral Health Division Sliding Fee Scale Guidance for Treatment Providers as set forth in 2008. The sliding fee scale shall be posted in the lobby and made available to persons seeking services provided by the contract.
III. GOALS FOR CORNERSTONE BEHAVIORAL HEALTH
Cornerstone Behavioral Health is committed to developing and implementing services for each client to meet the following goals:
1. Support the recovery, health and well-being of the persons or families served; 2. Enhance the quality of life of the persons served;
3. Reduce symptoms or needs and build resilience; 4. Restore and/or improve functioning; and,
IV GENERAL ADMISSION CRITERIA
Cornerstone strives to provide the highest quality behavioral health and substance abuse services. The organization uses treatment interventions that are based on accepted practices in the field and incorporate current research and evidence-based practices. Unless otherwise stated, Cornerstone will accept individuals who:
Are medically stable enough to be in an ambulatory setting versus an inpatient facility; Are financially able to accept and pay for services as billed with or without the assistance of medical insurance. However, as part of the Wyoming Department of Health,
Behavioral Health Division - Block Grant, Cornerstone Behavioral Health will charge clients who are served under the contract, on a sliding fee scale adopted from the
Wyoming Department of Health, Behavioral Health Division Sliding Fee Scale Guidance for Treatment Providers as set forth in 2008. Cornerstone may not refuse services to clients who are served under the contract due to the client’s inability to pay.
V SERVICE DELIVERY – RANGE OF SERVICES
Psychological Screening
A psychological screening/assessment is the initial contact/interview with client. Information collected during this interview includes: Demographics, mental health history, medical history, social history, substance abuse history, legal history,
occupational history, mental status, etc. The assessment results in the preparation of an interpretive summary that is: Based on the assessment data; used to formulate treatment needs and development of the individual plan; identify any co-occurring disabilities and/or disorders and how they will be addressed in the development of the individual plan; assess whether the individual has other needs that might be better met by alternative treatment or providers.
Individual/Family/Couples Therapy
Individual/Family/Couples Therapy is for those individuals who demonstrate a need for psychotherapy during the psychological screening. The therapist, with client input, will determine the form of psychotherapy that would best serve the client’s needs. The client is seen individually if problems are primarily associated with his/her functioning or if family/significant others are unwilling to attend therapy. If problems are embedded within the couple’s dyad or family system, those therapies are provided.
Psychological Evaluation
When a psychological screening does not provide conclusive information about an individual’s problems, psychological testing is recommended to get a more complete understanding of the individual in order to facilitate treatment planning.
Substance Abuse Evaluation and Intake
Substance abuse services, including appropriate placement of clients and their continued stay, transfer, and discharge recommendations, are determined to the extent reasonably possible, through application of the current American Society of Addiction Medicine Patient Placement Criteria-Second Edition-Revised (ASAM PPC-2R; please see ASAM PPC-2R for additional information on ASAM criteria).
A. Substance Abuse Evaluations (clinical interview plus testing, including ASI) are designated for new clients or clients without a current evaluation. A current evaluation may be one that has been completed within the past six months to one year, as long as the evaluation is a valid indicator of the client’s current level of functioning.
This evaluation is the initial contact/interview with the client. Information collected during this interview includes: Demographics, mental health history, medical history, social history, substance abuse history, legal history, occupational history, mental status, risk assessment, etc. The assessment results in the
preparation of an interpretive summary that is: Based on the assessment data; used to formulate treatment needs and development of the individual plan; identify any co-occurring disabilities and/or disorders and how they will be addressed in the development of the individual plan; assess whether the individual has other needs that might be better met by alternative treatment or providers.
If an urgent need for treatment is apparent, a client may be admitted to the treatment program until such time as a substance abuse evaluation can be conducted. A clinical interview/brief intake will be conducted to determine the need for detoxification and appropriate medical referral prior to admission. As the schedule permits, a substance abuse evaluation will be conducted with testing, including ASI, with appropriate referrals if needed.
The substance abuse evaluations are designed to evaluate if the client has a substance abuse problem and to indicate which treatment modality, if one is needed, best serves his/her needs. In addition to the ASAM placement criteria and the ASI, the following testing instruments and protocols may be used in the evaluation/intake process, as indicated: AUP; SASSI-3; JASAE; PEI; SALCE; CIWA-AR; and, NEEDS Assessment Survey. In the case of the diagnoses of Substance Dependence or Abuse, per DSM-IV, treatment options include:
Detoxification, residential/inpatient, intensive outpatient, outpatient or transitional services. When the evaluation indicates a sub-critical substance use problem that would be better served with a preventative treatment focus, modalities such as MIP or DUI School may be recommended. While Cornerstone does not provide services for all levels of care, clients are informed of treatment recommendations and of services available both at our agency and other agencies.
B. Substance Abuse Intakes (Clinical Interview) are designed for individuals who have recently completed a treatment program, moved from another geographic area where they were receiving services, or had evaluations completed by another agency within the last six months.
VI CORNERSTONE’S SUBSTANCE ABUSE PROGRAMS
General Information
ASAM Criteria. Substance abuse services, including appropriate placement of clients, their continued stay, transfer, and discharge recommendations are determined, to the extent reasonably possible, by applying the American Society of Addiction Medicine Patient Placement Criteria-Second Edition-Revised (ASAM 2R). The ASAM PPC-2R is a guiding tool for determining placement, continued stay, and discharge of a client, spanning a broad range of intensity of care, from Early Intervention (Level 0.5, least intense level of care) to Medically Monitored/Managed Intensive Inpatient Treatment (Level III.7/IV, most intense level of care).
Cornerstone provides adolescent and adult outpatient care that spans ASAM Levels of Care 0.5, I and II, with groups as the primary method and modality of care. Our MIP and DUI schools are Early Intervention, ASAM 0.5 Level of Care; our Outpatient Programs provide services at the ASAM I Level of Care; our Outpatient Aftercare Programs, which are Phase II of our Intensive Outpatient Program, provide ASAM I Level of Care; and, Phase I of our Intensive Outpatient Programs provide ASAM II Level of Care.
Special Populations for Substance Abuse Services:
Criminal Justice Clients: Cornerstone Behavioral Health will maintain certification from the Wyoming Department of Health, Behavioral Health Division to provide treatment to criminal offenders.
For those clients that are involved in the criminal justice system, Cornerstone specifically addresses the person’s criminal behavior(s) and thinking. Cornerstone shall comply with all court orders and cooperate with probation and parole agents in sharing information reasonably necessary for both to fulfill their obligations. Drug and alcohol testing will be conducted with offenders in coordination with the legal system overseeing the client. Where possible, Cornerstone shall use restorative justice principles in the individualized treatment plans of offenders.
Clients are required to provide written consent in compliance with the 42CFR, Part 2 and 45CFR, Part 160 and 164, for the exchange of information between Cornerstone and the corrections system. This release per 42 CFR, Part 2, does not require an expiration of the release due to criminal justice status. If a client refuses to sign the release, Cornerstone may deny services.
The clinical staff providing treatment to criminal justice offenders shall demonstrate training, education, and knowledge in the treatment of the criminal population. If the client fails to attend required treatment without permission as prescribed by the court, Cornerstone must notify the court or its representative within three (3) days of the client not showing.
Cornerstone shall develop in collaboration with the court or its representative a case plan that identifies the roles and responsibilities of the client, program and court. In addition, a liaison from Cornerstone shall attend Uinta County Adolescent and/or Adult Drug Court staffing weekly.
Cornerstone shall utilize referral sources in the areas of: housing, employment, mental health, education, and other services, as needed.
Adolescent Treatment Services: Cornerstone Behavioral Health will maintain certification from the Wyoming Department of Health, Behavioral Health Division to provide treatment to adolescents.
Adolescent services are provided for clients age 13 through 17. If the individual started the program prior to turning age 18, they may complete the program after they turn age 18.
At a minimum, services shall include: Behavioral health services designed specifically to address the multifaceted needs of this population; in addition to general treatment
requirements, Cornerstone shall tailor services to the particular safety, developmental, educational, healthcare, family needs, and preferences of children and adolescents. A discharge/transition plan shall be developed prior to the client being discharged and should include information addressing educational needs of the client and the transition of the client back into school, if applicable.
Cornerstone shall comply with the program descriptions set forth in the ASAM Patient Placement Criteria Manual specifically relating to adolescent treatment services.
Co-Occurring Treatment Services: Cornerstone Behavioral Health will maintain certification from the Wyoming Department of Health, Behavioral Health Division to provide treatment to co-occurring clients.
At a minimum services shall: Address a high level of relapse potential with more intense levels of service; adapt program material and methods of counseling to individuals with mental disorders; provide and utilize skill building groups, as appropriate; provide case management, as necessary; emphasize motivation enhancement, including outreach for
clients with active substance abuse disorders and severe mental disorders who are disengaged.
SAMHSA TIP (Treatment Improvement Protocol) and Tap (Technical Assistance Publications Series): The manuals in the Treatment Improvement Protocol (TIP) and Technical Assistance Publication (TAP) series are best-practice guidelines for substance abuse treatment. The Division of Services Improvement at SAMHSA’s Center for Substance Abuse Treatment (CSAT) draws on the experience and knowledge of clinical, research, and administrative experts to produce the manuals, which are distributed to facilities and individuals across the country. Cornerstone’s treatment services are based in part on the SAMHSA’s TIP/TAP series (i.e., the treatment services for the criminal justice population are based in part on the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Improvement Protocol 44 (TIP) Series
publication, “Treatment of the Criminal Justice Client”; adolescent treatment services are based in part on the SAMHSA Treatment Protocol 32 (TIP) Series publication,
“Treatment of Adolescents with Substance Abuse Disorders”; and substance abuse services for individuals with co-occurring disorders are based in part on the SAMSHA Treatment Protocol 42 (TIP) Series publication, “Substance Abuse Treatment with Co-Occurring Disorders.”
Signing Documents, Discharge, Grievance. To participate in treatment, clients must sign all required documentation, including but not limited to: Consent for Services, Financial Agreement, Group Rules, Policy on Abstinence, Group Therapy, Agreement to Attend, Disease (TB, STD, AIDS) Reporting Requirements, etc. Basis for discharge include, but are not limited to: Refusal to sign all required documents, violations that endanger self or others, violations that interfere with treatment, or for lack of progress. Discharge may result in referral to a more structured program. If a client is dissatisfied with one or more aspects of services/treatment received, the client may file a grievance as outlined in the Policy/Procedure Manual (Filing Grievance).
Individual Psychotherapy: Treatment/Counseling/Consultation. Individual Psychotherapy Treatment, which is part of the Outpatient and Intensive Outpatient Treatment Programs, is tailored to the unique needs of the client, such as, but not limited to: Co-occurring diagnoses, grief and loss issues, crisis management, lack of satisfactory progress in completing program requirements, etc. The length and frequency of this intervention are determined on a case by case basis.
DUI School (Early Intervention, ASAM 0.5 Level of Care)
Program Description. Cornerstone’s DUI School utilizes Hazelden’s “Who’s Driving” DUI Curriculum. In addition, the provider of these services has demonstrated the ability, through education and training, to provide the services required according to Rules and Regulations for Substance Abuse Standards Chapter 4, Section 10. Cornerstone’s staff has completed the education curriculum developed by the Division. The DUI School is
an eight hour program that Cornerstone offers six (6) times per year. DUI School educates the individual about the seriousness of driving under the influence. The School also provides a basic education of alcohol and drugs, related abuse issues and high risk behaviors connected with acquiring HIV and STD’s. To complete the school
successfully, clients must satisfy requirements, including but not limited to: Complete a post test with a score of 70% or above as a measure of acquired knowledge; and, develop a satisfactory personal action plan setting forth actions he/she will take to avoid violations in the future. The provider will determine if all requirements have been met.
Who We Serve. DUI School is for adults, who are seeking education as a result of a court order and/or as required by the Department of Transportation. If a client has legal charges and/or is court ordered to attend a DUI School, an evaluation/assessment is required. The evaluation/assessment should include documentation of review of the record of blood alcohol level and driving record of the client. If Cornerstone did not complete the evaluation/assessment, a copy of the report including recommendations is required. If the evaluator recommends an educational modality, with the intention of preventing a more serious substance abuse problem, the client may attend the DUI School. If there are no legal charges and/or DUI school is not court ordered, an evaluation is not required to attend the DUI School.
Any participant in the DUI School must be able to make use of this process, be motivated, not be a danger to self or others, and not interfere with delivery of the DUI School.
MIP School (Early Intervention, ASAM 0.5 Level of Care)
Program Description. Cornerstone’s MIP School utilizes Prime for Life (PRI), which is a research-based curriculum addressing alcohol and other drugs.
Cornerstone’s staff has completed the training for the Prime For Life education
curriculum. The MIP School is an eight hour program that Cornerstone offers up to six (6) times per year. The curriculum can also be lengthened, depending on the needs of those being served. The MIP School educates the individual about the seriousness of high risk behavior and substance use to help people reduce their risk for alcohol and drug problems throughout their lives. The curriculum's nonjudgmental approach tends to decrease resistance to the life-saving information presented in the program and to increase the students' openness to change. To complete the school successfully, clients must
satisfy requirements, including but not limited to: Attendance for the duration of the School, satisfactorily completing a post test as a measure of acquired knowledge, and develop a satisfactory personal action plan setting forth actions he/she will take to avoid violations in the future. The provider will determine if all requirements have been met.
Who We Serve. Our MIP School is for individuals who have not reached majority and are seeking education as a result of a court order and/or as required by the Department of
Transportation. If a client has legal charges and/or is court ordered to attend a MIP School, an evaluation/assessment may be required as per Wyoming Law 31-5-233, “Driving or having control of vehicle while under influence of intoxicating liquor or controlled substances.” If an evaluation is required, the evaluation/assessment should include documentation of review of the record of blood alcohol level and driving record of the client. If Cornerstone did not complete the evaluation/assessment, a copy of the report including recommendations is required. If the evaluator recommends an
educational modality, with the intention of preventing a more serious substance abuse problem, the client may attend the MIP School. If there are no legal charges and/or MIP school is not court ordered, an evaluation is not required to attend the MIP School. Any participant in the MIP School client must be able to make use of this process, be motivated, not be a danger to self or others, and not interfere with delivery of the MIP School.
Outpatient Treatment Program-Adolescent (AOP) and Adult (OP) (ASAM I Level of Care):
Program Description. AOP/OP consists of one two-hour group session a week, for a total of twelve (12) sessions, and various treatment program requirements. Group members must arrive 15 minutes before group begins to take care of finances and testing (urinalysis or breathalyzer). Prime Solutions is an evidence-based interactive treatment program that includes standardized treatment measures based on The Transtheoretical Model of Change. The outpatient treatment programs will focus on the “Stages of
Change,” incorporating in-class activities as well as “take-away” experiential exercises to be completed at home.
Who We Serve. AOP/OP is designed for adolescents and adults who meet criteria for ASAM I Level of Care and typically, have a substance abuse diagnosis, with no
withdrawal, who are stable and able to make use of the group process, and whose needs are manageable in this program.
OP Alumni (Optional): Upon successfully completing the program, clients are considered lifetime alumni and are welcome to participate in AOP/OP sessions, at no charge and as needed, as long as this continues to be the appropriate level of care and the therapist and group members consent.
Intensive Outpatient Treatment-Adolescent (AIOP) and Adult (IOP): Phase I (ASAM II Level of Care):
Adolescent Intensive Outpatient Treatment (AIOP) and Adult Intensive Outpatient Treatment (IOP). Our Intensive Outpatient Treatment Programs (AIOP/IOP) consists of two phases, Phase I and Phase II, both of which a client must complete successfully to graduate from Cornerstone’s Intensive Outpatient Treatment Program (AIOP/IOP).
AIOP/IOP-Phase I Program Description. Phase I consists of nine (9) hours of
intensive group treatment per week for a minimum of 12 weeks for a total of 108 hours); a Family Week experience, and various treatment program requirements, including but not limited to completing the Prime Solutions treatment manual, regularly attending AA, NA or other support groups and regular sponsor contact, all of which must be satisfied to complete Phase I. The program must meet a minimum of three times per week with no more than three days between clinical services, excluding holidays. Upon completion of AIOP/ IOP-Phase I, the client graduates to Phase II, the Aftercare Program.
Family Week consists of three nights, three hours per session, with various treatment program requirements. Family Week is for clients in the Intensive Outpatient Treatment Programs and their family members, significant others, and friends. Typically, the client completes Family Week during Phase I of the client’s treatment program.
Who We Serve. IOP-Phase I is designed for adults and AIOP-Phase I for adolescents who meet criteria for ASAM II.1 Level of Care, who typically have a diagnosis of substance abuse and/or dependence, who are able to make use of the group process, and whose needs are manageable in this program setting, e.g., not a danger to self or others, not a firmly entrenched antisocial personality disorder, not with mental health problems or other problems that would undermine or inhibit group process or the integrity of the treatment program.
Intensive Outpatient Treatment-Adolescent (AIOP) and Adult (IOP): Phase II (Aftercare - ASAM I Level of Care):
AIOP/IOP-Phase II (Aftercare). Phase II Aftercare for adults (IOP) consists of one two-hour group session a week, for a minimum of 52 sessions; Phase II Aftercare for
adolescent (AIOP) consists of one two-hour group session a week for a minimum of 26 sessions. In order to satisfactorily graduate from Phase II Aftercare, the client must complete various treatment program requirements, including but not limited to: Regularly attending AA, NA or other support groups and regular sponsor contact, and a required minimum of six months of continuous abstinence.
Alumni (Optional) - AIOP/IOP-Phase III: Upon successful completion of AIOP/IOP-Phase II (Aftercare), clients are considered lifetime alumni and are welcome to participate in Aftercare sessions, designated Phase III, at no charge and as needed, as long as this continues to be the appropriate level of care and the therapist and group members consent.
Who We Serve. AIOP/IOP-Phase II are for individuals who meet criteria for ASAM I Level of Care, who typically have a diagnosis of substance abuse and/or dependence, who are able to make use of the group process, and whose needs are manageable in this
program setting, e.g., not a danger to self or others, not a firmly entrenched antisocial personality disorder or conduct disorder, not with mental health problems or other
problems that would undermine or inhibit group process or the integrity of the treatment program. Clients attending the intensive outpatient treatment program Phase I, who successfully completed all the requirements of Phase I, may graduate to Phase II, the Aftercare Program.
Furthermore, individuals who have successfully completed either an inpatient treatment program or intensive outpatient therapy for substance dependence or abuse elsewhere, and have maintained an appropriate period of sobriety following treatment may be considered for Phase II.
Charges & Readmission for AIOP/IOP-Phase II: As part of the Wyoming Department of Health, Behavioral Health Division - Block Grant, Cornerstone Behavioral Health will charge clients who are served under the contract, on a sliding fee scale adopted from the Wyoming Department of Health, Behavioral Health Services Division Sliding Fee Scale Guidance for Treatment Providers as set forth in 2008. The sliding fee scale shall be posted in the lobby and made available to persons seeking substance abuse services. For clients served under this contract, Cornerstone may not refuse to offer or provide services due to the client’s inability to pay. A client shall not be denied access to services for non-payment without it being addressed as part of the treatment plan with a reasonable time-frame for resolution of the issue. However, services may be denied to clients who fail to address financial responsibilities as indicated in the treatment plan and refuse or are unwilling to pay their agreed upon fee.
The following policy/procedure applies to only those individuals who completed Cornerstone’s Intensive Outpatient Treatment Program-Phase I (AIOP/IOP). If a client relapses during AIOP/IOP-Phase II (Aftercare) and the Treatment Team determines the appropriate level of care is readmission to AIOP/IOP-Phase I, the following criteria are applied regarding cost:
A. If the client is in good standing and has not received new legal charges, the client may return to AIOP/IOP-Phase I without new/additional charges for Phase I. When graduating to Phase II Aftercare, charges will resume.
B. However, if the client receives new legal charges and is required and/or
recommended to return to AIOP/IOP-Phase I, the new financial charges will be determined using a sliding fee scale based on household income and household size
A Closer Look: Further Criteria for Admission and Participation in Treatment Programs
In addition to criteria for program placement described earlier in this document, the following criteria and guidelines are used for placement, admission and participation in our treatment programs.
Outpatient Treatment Program (AOP/OP) and Intensive Outpatient Treatment Program (AIOP/IOP)
The client must:
a. Be eighteen (18) years or older in the case of IOP or OP;
b. Be thirteen (13) through seventeen (17) years of age in the case of AIOP of AOP. If the individual started the program prior to turning age 18, they may complete the program after they turn age 18. All possible admissions outside that age range will be assessed individually for appropriateness to the program;
c. Not need detox services. Clients on methadone maintenance must be detoxed from methadone before admission;
d. Agree to complete all treatment program requirements and to attend all sessions and appointments. Note: In the case of AIOP/AOP, Parents/Guardians/
Significant others will be asked to commit to being involved in the client’s recovery process through Family Week, and possible conjoint therapy/ consultation and/or parenting classes. In the case of IOP, clients will be
encouraged to involve their families, significant others and friends in the Family Week Experience;
e. Agree to remain free from any mood altering substances, such as alcohol and illicit drugs. Addictive prescription medication will be reviewed;
f. Agree, after signing releases, to obtain a letter from his/her physician if the client is on psycho-tropic medication and the therapist requests such a letter. The letter will state the appropriateness of the client for the program;
g. Sign all appropriate documentation (described earlier in this document). A client may be deemed inappropriate for admission if a client:
a. Failed two previous treatment experiences (inpatient, outpatient, or a combination of both);
b. Demonstrates an inability or lack of desire to remain clean and sober;
c. Has a current living situation that is considered too dysfunctional for the client to succeed in treatment;
d. Is deemed by staff or medical personnel to be in need of ongoing medical attention during the treatment process; or,
Consent for Services
Whenever a client comes into Cornerstone, a completed and appropriately signed Consent for Services form will be maintained in the client file. No services will be performed without this Consent for Services form being completed and signed by the appropriate parties.
Client Refusal to Sign Paperwork
Whenever a client comes into Cornerstone, required documents must completed and
appropriately signed (e.g., financial agreement, acknowledgment of privacy practices, consent for services, emergency treatment release, client rights, confidentiality, group rules, TB test
agreement, etc.). No services will be performed without these documents being completed and signed by the appropriate parties. These documents will be maintained in the client file.
Criteria for Admission/Re-Admission
Cornerstone maximizes opportunities for the persons served to gain access to the organization’s programs and services. Efforts are made to ensure that individuals who have the potential to benefit from services will be served. Need for behavioral health services will be determined through the screening/evaluation/intake procedure, with admission for treatment based on the client being diagnosed per the requirements of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) at admission with a disorder or with significant behavioral issues which are in need of treatment. The diagnosis will be determined by a clinician legally qualified to do so in accordance with all applicable laws and regulations. Clients who present with behavioral or substance abuse issues that do not fully meet the criteria necessary for a specific diagnosis, but which nevertheless results in significant impairment in functioning, are also considered candidates for treatment.Screenings/evaluations/intakes will be completed in a timely fashion. Information will be obtained from the client, family members/legal guardian (when applicable and permitted); and other appropriate and permitted collateral sources. This collateral information is obtained with the permission (signed release of information form) of the client unless a legal relationship indicated contact without permission. Individual and family services are based on the strengths, needs, abilities, preferences, desired outcomes, expectations, and cultural background of the person or family served. The intake process takes into account the individual’s age, development, and education.
Substance abuse services including appropriate placement of clients, and their continued stay, transfer, and discharge recommendations are determined to the extent reasonably possible, through application of the current ASAM client placement criteria. The ASAM PPC is a guiding tool for determining placement, continued stay, and discharge of a client. Refer to the ASAM PPC-2R for additional information.
Re-admissions are considered on a case by case basis following the admission criteria. If a mental health client returns prior to six months post discharge, a new assessment is not required. Any significant changes in the client, or his/her status, major life issues, accomplishment of significant goals, hospitalizations, etc. will be documented in the re-admission progress note. However, if the absence has been longer than six months, a new screening and supporting documentation will be required. If a substance abuse client returns after being officially discharged, the re-admission will be considered on a case by case basis. However, if new legal charges are present, a new evaluation/assessment is required.
Accessibility of Treatment
If a person seeking substance abuse services is not able to be seen within 24 hours of the person’s initial contact with the program (excluding weekends and holidays) the following options will be discussed with the individual:
1. Waiting list (if applicable).
2. Schedule appointment in first available time slot. 3. Referral to outside agency.
4. Schedule of Twelve (12) Step meetings in the community (if applicable) will be provided. 5. Individuals that are court ordered to receive substance abuse assessments/evaluations are
scheduled on a first come/first serve basis. However, individuals who are requesting substance abuse services and are NOT involved with the legal system are scheduled to meet with a substance abuse counselor immediately to determine level of care needed. If an individual is deemed to be appropriate for either Outpatient Group or Intensive
Outpatient Treatment, the individual will be admitted into the appropriate program immediately and scheduled for an assessment/evaluation as soon as possible.
6. If the client cannot be seen for an assessment and/or treatment within seventy-two (72) hours of the initial contact, the client will immediately be referred to an outside agency. 7. If an alternative provider is not available, Cornerstone will then engage the client in an
appropriate level of care (group and/or individual) and/or will provide information relating to Twelve (12) Step Meetings in the community until such time treatment services are available.
Developing a Waiting List
Cornerstone’s outpatient programs offer a variety of service modalities that are designed to assist individuals from the community to enhance their quality of life. Each clinician has a designated number of individual therapy hours available to provide services. If/when there are no available hours remaining, individuals who call will be informed that a waiting list has been implemented. Individuals are then taken/scheduled from the waiting list on a first come first served basis. For the substance abuse programs, priority is given to pregnant women and IV drug users. However, if the individual does not wish to be placed on the waiting list, the individual is informed of the other agencies in the area that provide like-services. If the individual caller indicates immediate services are needed/required, the individual is directed to call 911, go to the Evanston Regional Hospital Emergency Room, and/or call High Country Behavioral Health (the community mental health center responsible for crisis situations). Once a waiting list is implemented all contacts made to Cornerstone regarding screenings/intakes will be documented on the waiting list.
1. In the event a clinician whose areas of expertise are congruent with the needs of the client is unavailable, the person seeking services will be offered the option of placement on a waiting list.
2. The waiting list will indicate the name of the person seeking services, date o f placement on the list, symptom severity, age, preferences, identified need, or special needs and contact information. The administrative director will maintain the waiting list through ongoing review and updating of the list with regular input from the clinical director. 3. Documentation of any and all contacts with the person on the waiting list is maintained. 4. The waiting list information is obtained, analyzed and used in program planning,
performance improvement activities, strategic or community based planning, organizational advocacy efforts, financial planning, and resource planning.
5. Individuals placed on the substance abuse waiting list are encouraged to attend A.A., N.A., etc. and are asked to check in with Cornerstone frequently.
Order of Selection for Admission of
Persons Awaiting Services
Policy:
Once a person is placed on a waiting list, services will be provided in a timely manner to persons who have the potential to benefit from the services.
Procedure:
2. The list will be rank ordered according to first come first served basis.
3. Staff psychologists will be informed by the administrative director of any appointments scheduled for persons on the waiting list.
4. Upon scheduling of the appointment, the client will be removed from the waiting list.
Ineligible for Services
Should it be the case that the Clinical Director and the professional staff at the Mental Health or Substance Abuse Staffing meeting find that an individual is ineligible for services at
Cornerstone, it will be the presenting clinician’s responsibility to inform the individual (and/or referral source, family/support system) of the finding and make an appropriate
referral/recommendations for alternative services, if necessary.
In the circumstance that an individual is ineligible for services provided by Cornerstone, a list will be initiated and maintained by the Administrative Director to determine trends and patterns of ineligibility as well as to guide planning for future services.
Psychological Screening
Every individual who wishes to receive mental health services from Cornerstone Behavioral Health, must have a psychological screening. This screening is performed by a qualified
clinician and includes an interview (and testing, if applicable) with the person to be served and/or referral source to assess for the appropriateness of available services. Information may also be obtained from family members/legal guardian (when applicable and permitted); and other appropriate and permitted collateral sources. This collateral information is obtained with the permission (signed release of information form) of the client unless a legal relationship indicated contact without permission. The screening takes into account the individual’s age, development, culture, and education (i.e., correct form, testing instruments, etc.). The assigned clinician gathers sufficient information during the screening to develop an individualized, person-centered plan with the active participation of the client, and will include, but is not limited to the
following information: (1) Individualized goals and needs, if accepted for mental health
services; (2) Strengths, abilities, preferences, aptitudes, skills, and interests of the individual; (3) Presenting problems; (4) Suicidal assessment; (5) History of previous behavioral health services, including diagnostic and treatment information, psychiatric/psychological assessments,
pharmacotherapy, hospitalizations, alcohol and other drug services, co-occurring
disabilities/disorders, and use of community programs; (6) Medical history and status; (7) Diagnosis(es); (8) Mental status; (9) Current emotional and behavioral functioning; (10) Social History, including current and historical life situation; (11) Use of alcohol, tobacco, and/or other drugs; (12) Educational History; (13) Legal History, etc. (refer to screening form). The screening results in the preparation of an interpretive summary that is: Based on the screening data; used to
formulate treatment needs and development of the individual plan; identifies any co-occurring disabilities/ and/or disorders and how they will be addressed in the development of the individual plan; as well as to assess whether the individual has other needs that might be better met by alternative providers. The summary must be completed and, if applicable, distributed to appropriate individuals within fifteen (15) working days.
Substance Abuse Evaluations
Substance Abuse Evaluations (clinical interview plus testing, including ASI, ASAM Placement Criteria for the Treatment of Substance-Related Disorders and/or the Global Appraisal of Individual Needs-GAIN) are designated for new clients or clients who have not had a recent evaluation (six months to one year) that continues to be a valid indicator of the client’s current level of functioning. This evaluation is performed by a qualified clinician and includes an interview (and testing, if applicable) with the person to be served and/or referral source to assess for the appropriateness of available services. Information may also be obtained from family members/legal guardian (when applicable and permitted); and other appropriate and permitted collateral sources. This collateral information is obtained with the permission (signed release of information form) of the client unless a legal relationship indicated contact without permission. The evaluation takes into account the individual’s age, development, culture, and education (i.e., correct forms, testing instruments, etc.). The assigned clinician gathers sufficient information during the evaluation to develop an individualized, person-centered plan with the active
participation of the client, and will include, but is not limited to the following information: (1) Individualized goals and needs; (2) Strengths, abilities, preferences, aptitudes, skills, and interests of the individual; (3) Presenting problems; (4) Suicidal assessment; (5) History of previous behavioral health services, including diagnostic and treatment information,
psychiatric/psychological assessments, pharmacotherapy, hospitalizations, alcohol and other drug services, co-occurring disabilities/disorders, and use of community programs; (6) Medical history and status; (7) Diagnosis(es); (8) Mental status; (9) Current emotional and behavioral
functioning; (10) Social History, including current and historical life situation; (11) Use of alcohol, tobacco, and/or other drugs; (12) Educational History; (13) Legal History, etc. (refer to evaluation form). The evaluation results in the preparation of an interpretive summary that is: Based on the assessment data; used to formulate treatment needs and development of the individual plan; identifies any co-occurring disabilities and/or disorders and how they will be addressed in the development of the individual plan; as well as to assess whether the individual has other needs that might be better met by alternative providers. The evaluation must be completed and distributed to appropriate individuals within fifteen (15) working days.
Client Rights
Cornerstone Behavioral Health strives to protect and promote the rights, privacy and
confidentiality of all persons served. Cornerstone safeguards the rights of the persons served in a manner that is responsive to each person’s age or developmental level, gender, social
supports/preferences, cultural orientation/background, psychological characteristics, sexual orientation, physical condition, and spiritual beliefs. Cornerstone ensures that information and education are relevant to the needs of the persons served.
Cornerstone communicates and shares the Client Rights in a manner that is clear and
understandable to the client prior to the beginning of services and at least annually thereafter. The Client Rights are also posted in the lobby for review. If clarification is needed, the client may speak with their designated clinician.
Cornerstone Behavioral Health ensures that the sharing of confidential billing, utilization, clinical, and other administrative and service-related information is done so according to confidentiality guidelines that recognize applicable regulatory requirements such as the federal rules for addiction treatment programs (42CFR) and HIPAA. The organization also ensures that the persons served are protected from abuse (physical, sexual, psychological, and fiduciary abuse); retaliation; harassment and physical punishment; and humiliating, threatening, or exploitive actions.
Prior to the first meeting with one of Cornerstone’s staff members, each client is given an outline of the policies relating to client rights which states, “As a client of this center, you have the following rights: 1) To receive treatment regardless of sex, race, creed, ethnic origin, age, sexual preference, religion, socioeconomic status, handicaps, mental health/substance abuse disorder, or sources of financial support....” The client also receives a client handbook that contains information such as client rights and responsibilities; grievance policy/procedure; Notice of Privacy Practices, hours of operation, confidentiality, follow-up policy/ procedure, financial information, after hours emergency contacts, familiarization with the premises; program policies and procedure regarding smoking, illicit or licit drugs brought into the program, policy on controlled substances at Cornerstone, etc.
A client may request to examine and/or review the contents of their treatment records with their primary clinician unless clinically contraindicated. If a client’s rights under this section are limited or denied because of clinical contradictions, such limitations of denial shall be fully documented in the client record. All client treatment records are the property of
MRSI/Cornerstone and may not be removed from the premises.
Each client receiving services will be informed of their rights which are as follows:
1. To receive treatment regardless of sex, race, creed, ethnic origin, age, sexual preference, religion, socioeconomic status, handicaps, mental health/substance abuse disorder, or sources of financial support;
2. To participate in the development of their treatment plan and goals that are reviewed and updated periodically, and to include significant others in treatment;
3. Upon request, to examine and/or review their charts with their primary clinician unless clinically contraindicated;
4. The right to initiate a grievance and mechanism for requesting review of grievance;
5. Each client (or where appropriate, the client’s legal guardian) shall be informed of his/her rights in a language the client understands. The information shall be presented to the client, both orally and in writing;
6. If a client’s rights under this section are limited or denied because of clinical contradictions, such limitations or denial shall be fully documented in the client record;
7. Each client’s confidentiality, personal dignity, and privacy shall be recognized and respected in provision of care and treatment, except where otherwise prohibited by law (see confidentiality).
Confidentiality
Each client receiving services at Cornerstone Behavioral Health will be informed of the policy regarding confidentiality.
The confidentiality of client records maintained by this program is protected by Federal Law and Regulations. Cornerstone Behavioral Health ensures compliance with 42 CFR Part 2, 45 CFR Part 160 and 164, and other legal restrictions affecting confidentiality of alcohol, drug abuse, and other medical records. Generally, the program may not say to a person outside the program, that a client attends the program or disclose any information identifying behavioral health clients unless:
1. The client consents in writing, OR;
2. The disclosure is allowed by a court order after application showing good cause, OR;
3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation, OR;
4. The client commits a crime either at the program or against any person who works for the program, OR;
6. In the event of imminent life-threatening physical danger to the client or others. Violation of Federal Law and Regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs. Federal Laws and Regulations do not protect any information about a suspected child/adult abuse or neglect from being reported under State Law to appropriate State or local authorities. (See U.S.C. 290-ee-3 and 42 U.S.C. 290ff-3 for Federal Laws and 42CFR Part2 for Federal Regulations.) If the client is a moderate to heavy client of alcoholic beverages, or if they have ever used any type of IV drugs in the past, they are at a higher risk for contraction of tuberculosis and/or HIV/AIDS. The staff recommend such clients contact their personal physician or the local County Public Health unit for tuberculosis and/or HIV identification test.
The local health unit is Uinta County Public Health 350 City View Drive, Suite 101 Evanston WY 82930
(307) 789-9203
Financial Agreement - Fee for Services
Mountain Regional Services, Inc., d.b.a. Cornerstone Behavioral Health, is a non-profit
organization, established to help people with mental health and substance abuse problems and to provide consultation and education to community organizations. All fiscal operations are in accordance with generally accepted accounting principles.
Individuals receiving services at Cornerstone are expected to pay all insurance co-payments and deductibles at the time services are rendered. Clients who have no insurance are required to pay 100% for services rendered at each visit unless prior arrangements are made. Those individuals that have insurance that pays the insured directly (i.e., Blue Cross Blue Shield) are responsible for the entire fee at the time services are rendered.
The client’s insurance policy is a contract between them and their insurance company. Cornerstone is not a party to that contract. As a courtesy, this office will submit bills to
insurance carriers. In order to facilitate claims processing, the client must provide all insurance policy information and changes to our office. If, as often is the case, the insurance company pays less than 100%, the client will be charged for the remainder. If payment is not received from the insurance company within 60 days, the client will be expected to pay the fee. It will then be their responsibility to pursue reimbursement from their insurance company. The fees charged at Cornerstone reflect the usual and customary rates in the area. The clients are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates for services. The client’s bill is their responsibility whether their insurance company pays or not. Medicaid/Equality Care recipients are responsible for a $2.45 pay for each visit; this co-pay does not apply to recipients under 21 years of age or pregnant women. After 60 days, there will be a finance charge of 1.5% per month (annual rate of 18%) charged to the client’s account.
The standard fee is charged for missed appointments, unless they are canceled at least 24 hours before the scheduled appointment, or if an emergency or extenuating circumstances prevent the client from making their appointment. Cancelled or missed appointments by Medicaid/Equality Care clients cannot be billed to Medicaid/Equality Care, therefore, the client (and/or
parent/guardian) will be charged and responsible for missed appointment fees.
The administrative director (or designee) will be responsible for communicating regularly with insurance companies to ensure coverage and obtain benefit information; maintaining
preauthorization information and working with the clinician to provide necessary information for continued coverage; and keeping track of the clients’ account information to include copays, insurance payments, amounts due, etc.
If the client fails to make the payments as required, the administrative director (or designee) will inform the clinician of the situation. The clinician will then speak with the client to determine what action(s) should be taken (i.e. payment plan, referrals to Department of Family Services, Department of Vocational Rehabilitation, etc.) to address funding issues. If it becomes necessary to discharge a client for non-payment, the client will be referred to the community mental health center which provides mental health services on a sliding fee scale based on household income.
Delinquent accounts may be turned over to a professional collection agency or attorney for appropriate action. The client (and/or parent/guardian) will assume responsibility for all
collection charges incurred, including but not limited to: Legal fees and court costs. In the event that working with an outside party/parties for collection becomes necessary, the client authorizes release of information necessary to obtain full payment of their account by signing the financial agreement.
Sliding Fee Scale
As part of the Wyoming Department of Health, Behavioral Health Division - Block Grant, Cornerstone Behavioral Health will charge clients who are served under the contract, on a sliding fee scale adopted from the Wyoming Department of Health, Behavioral Health Services Division Sliding Fee Scale Guidance for Treatment Providers as set forth in 2008. The sliding fee scale shall be posted in the lobby and made available to persons seeking substance abuse services. The sliding fee scale rates will not be applied to agencies, organizations or third party payors. For clients served under this contract, Cornerstone may not refuse to offer or provide services due to the client’s inability to pay. A client shall not be denied access to services for
non-payment without it being addressed as part of the treatment plan with a reasonable time-frame for resolution of the issue. However, services may be denied to clients who fail to address financial responsibilities as indicated in the treatment plan and refuse or are unwilling to pay their agreed upon fee.
At the time of admission clients served under the contract will sign a financial agreement outlining the policies/procedures with regard to the sliding fee scale. The financial agreement will indicate the discount (if applicable) based on the household income (client, spouse, significant other, etc.). Proof of income is required prior to signing the financial agreement. Failure to provide proof of income may result in the implementation of the maximum rate per program until such proof is provided and at which time a new financial agreement will be
completed/signed. Once the client submits the proper documentation (i.e., check stubs for family members [self/spouse], previous tax returns, etc.), the sliding fee will be put into effect from that date forward. Financial agreements will not be backdated.
If a client (and/or spouse, if applicable) are unemployed, they may both be required to sign an unemployment verification. The client (and/or spouse, if applicable) may be required to submit an unemployment verification each week to maintain the specified discount. If a client (and/or spouse, if applicable) fails to submit an unemployment verification during any week of treatment, the original financial agreement may be void and the client will not be eligible for the sliding fee scale discount. If the client’s (and/or spouse, if applicable) employment circumstances change and/or they obtain medical insurance at anytime during treatment, they are required to notify Cornerstone promptly, at which time a new financial agreement will be signed and sliding fee scale discount adjusted according to the client’s (and/or spouse, if applicable) current income. They are required to provide proof of income as indicated above. If the client does not follow through with their responsibility of notifying Cornerstone promptly of changes in employment or insurance, Cornerstone reserves the right to balance bill for back charges beginning the first date of their employment/insurance. If the child is a minor, the parents/guardians will be responsible for signing and providing proper documentation.
In the event of a positive U/A test, the client and/or parent/guardian will be required to pay a fee to cover the cost of the laboratory testing. This fee is required at the time the service is provided. If the laboratory test results do not confirm the positive urinalysis results, the fee will be
refunded. A fee is charged and payment required prior to beginning treatment for books and program materials.
As part of the financial agreement, the client will be informed of the minimum weekly payment as determined by the sliding fee scale. Clients will also be informed that the discount will not be applied until insurance payments (if applicable) are received as the sliding fee scale rates are not applied to agencies, organizations, or third party payors as required by the State contract. In addition, if a client has insurance and medicaid, it is the client’s (or parent/guardian, if
applicable) responsibility to ensure that Cornerstone Behavioral Health receives the explanation of benefits (EOB) from the insurance company so that Medicaid be billed. If the client does not submit the appropriate EOB’s in a timely manner, the client will be financially responsible for those dates not billed/paid by Medicaid.
At the time of admission, clients served under the contract are informed that a minimum weekly payment is due EVERY WEEK, and they are instructed to call Cornerstone Behavioral Health and speak with the administrative director (or designee) if there are extenuating circumstances
that prevents them from making their payment as agreed upon. Clients will be informed that payments made by their insurance company do not go towards their minimum weekly payment. Cornerstone Behavioral Health will not deny and/or refuse services to clients served under the contract due to inability to pay. A client shall not be denied access to services for non-payment without it being addressed as part of the treatment plan with a reasonable time frame for
resolution of the issue. However, services may be denied to clients who refuse to pay their agreed upon fee and/or communicate extenuating circumstances as outlined above.
Substance Abuse Quality of Life (QOL)
Quality of Life (QOL) funds have been contracted to Cornerstone Behavioral Health for the purpose of supporting the basic clinical care provided to targeted and non-targeted substance abuse clients and for whom Cornerstone Behavioral Health has primary responsibility for the basic clinical care. Quality of life funds may be used for other populations if need can be demonstrated.
The use of QOL funds by Cornerstone will be specific to each individual client whose needs, as identified in that client’s treatment plan, require non-clinical supports and services in order to achieve the clinical outcomes of the client’s treatment plan.
QOL funds may not be used to pay for staff time unless the staff is a contracted provider for therapeutic foster care or respite care and is providing respite care for a client.
Quality of life funds may be used for the following needs:
a. Emergency Subsistence: (e.g. crisis shelter, food, clothing, essential personal supplies). b. Prescription Medication: (e.g. prescriptions for psycho-tropic and other medications). c. Health and Medical Supports: (e.g. lab, injections, medical supplies, health assessments,
health and dental care, dentures, eyeglasses, and other health and dental devices). d. Housing: (e.g. acquisition, retention, safety).
e. Transportation: (e.g. access to clinical services, medical, resources, development of recreation/socialization interests).
f. Recreation/Socialization: (e.g. development of interests consistent with current income and long-term lifestyle).
g. Respite Care: (Brief non-relative care from a trained provider for clients unable to care for themselves; provided because of the absence or need for relief of those persons
normally providing care, in the client’s home or place of residence, providers residence, or foster home).
h. Other: (These will be itemized on the form, after case-by case approval has been obtained from the Administrator of the Mental Health and Substance Abuse Services Division).
Client Orientation to
Cornerstone Behavioral Health
As soon as a client has been accepted for services at Cornerstone Behavioral Health, it will be the responsibility of the individual clinician to provide an orientation that is appropriate to the needs and type of services provided. The orientation which may include, but is not limited to: Ways in which input is given regarding the quality of care, achievement of outcomes and satisfaction of the client; services and activities; expectations; how individual plans are developed and the client’s participation in it; etc. The client will also receive a client handbook that contains information such as Client Rights; Grievance Policy/Procedure; Notice of Privacy Practices, hours of operation, confidentiality, follow-up policy/procedure, financial information, after hours emergency contacts, familiarization with the premises; program policies and procedure regarding smoking, illicit or licit drugs brought into the program, policy on controlled substances at
Cornerstone, etc. All orientation information should be presented by the designated clinician in a manner which is clear and understandable to the client.
Coordinating Client Services
In all cases, the clinician who conducted the psychological screening or substance abuse
intake/evaluation, will be responsible for coordinating client services. The primary clinician will ensure that the services provided are coordinated and integrated and address goals that reflect the person’s served informed choice; address emergent and ongoing issues; continuity of services; and decisions concerning the client. The individual who coordinates the services should: (1) Assume responsibility for developing and implementing the individual plan(s) and ensure the exchange of information regarding the plan; (2) Assist the person to become oriented to his/her services to include process for after hours contact/emergencies; (3) Enable the person’s
individual plan to proceed in an orderly, purposeful, and goal oriented manner; (4) Promote the program’s responsiveness to the strengths, abilities, needs, preferences and expectations of the client; (5) Promote the participation of the client in an ongoing basis in discussions of his/her plans, goals, and status involving family members, when applicable and permitted; (6) Identify and address gaps in services and provide information relating to community resources relevant to client’s needs; (7) Coordinate services provided outside of the organization, if applicable; (8) Participate and advocate consistently in team conferences concerning the client; (9) Facilitate the exit/discharge process and arrangements for follow-up and appropriate supportive services; (10) Communicate information regarding client’s progress to appropriate persons including family, legal guardian, or primary care physician, when applicable and permitted.
Filing Grievance
Policy:
On occasion, a client, may become dissatisfied with one or more aspects of services/treatment received. In most cases, a candid discussion with the client/client and the staff member involved may resolve the situation in a responsible and reasonable fashion. However, in some instances, additional action may be required. A document outlining the Grievance Procedure will be presented to each client upon admission to all programs offered at Cornerstone Behavioral Health. The client should read and sign the document which will be retained in the clients’ individual file. Questions regarding the grievance procedure may be discussed with the clinician during the orientation to Cornerstone Behavioral Health.
A review of formal complaints is conducted annually to determine trends, areas needing performance improvement, and actions to be taken.
Procedure:
The following document will be read and signed by all clients admitted to Cornerstone.
If you feel there is some impediment to your participation or that you have a legitimate grievance with the staff or other clients, a grievance procedure is available to you. The following grievance procedure is an upward process intended to promote and foster healthy conflict resolution and problem solving. The action of filing a grievance will not result in retaliation or barriers to services. At any point during the grievance proceeding(s), you may utilize counsel or other representation. An administrative record of all grievances is maintained for review by federal and state licensing and accreditation agencies.
INFORMAL
Step 1: In most cases, a candid discussion between the client and the staff member(s) involved may resolve the situation in a responsible and reasonable fashion. If the complaint is not resolved to your mutual satisfaction, you may proceed to Step 2.
Step 2: You submit your complaint in writing to the next level of authority (staff member’s supervisor). This should be done within ten working days after the completion of Step 1. Within five working days after receipt of the written complaint/problem, the next level of authority (staff member’s supervisor) will review the complaint/problem, meet with the individuals involved to gather information and assist the parties in resolving the
complaint/problem. If the complaint/problem is not resolved to your satisfaction at Step 2, you may consider accessing the Formal Grievance Procedure.
FORMAL
