AthenaIBH Client Handbook Welcome Thank you for choosing Athena Integrated Behavioral Health for your mental health needs. We are excited to partner with you in this journey. At Athena Integrated Behavioral Health, we believe everyone has a unique set of strengths. Our provider aims at providing quality behavioral health care in a manner that is appropriate, determined to be necessary, efficient, and effective. Information provided in this handbook should be used as a tool to help you better understand what the clinic offers as well as the clinic’s policies and procedures. The client handbook should not be construed as providing rigid answers, except in those areas where the state and federal regulations exist. Our Goal My primary goal is to aid in the alleviation of your suffering. At your initial visit, I will meet with you to perform a thorough evaluation. By listening to your concerns and getting to know you, I will be able to formulate an assessment and together we will develop a treatment plan fit for your needs. You will have a key role in the development of your care plan. My approach may include referrals for therapy, nutritional counseling, ruling out environmental and medical problems that may cause symptoms, genetic testing when needed, and medications to target symptoms. I believe in prescribing medications conservatively when possible, using the least number and the lowest effective doses. Some issues are simple and straightforward to diagnose and treat, while others require patience and creativity to address. . Our Mission Here at Athena Integrated Behavior Health, we offer mental health care services to individuals ranging between the ages 6 to 100 years old. We strive to provide the highest quality of compassionate, holistic, client-centered, and evidenced-based care to all our clients. We believe in an individual’s ability to learn, grow, and heal even in the face of challenges. So, wherever you may find yourself in the healing process, our valued team will be able to assess and provide you with the correct diagnosis and tools to improve your wellbeing. Treatment Services Psychiatric Services, you will go through an initial assessment which will be conducted by a Psychiatry Provider to ensure proper diagnosis and treatment plan. Medication treatment plans will be developed to those deemed clinically necessary. Structure for Services Each client will receive a mental health assessment to aid in diagnosing and treatment planning. An individualized treatment plan will be discussed/determined by the client and the provider. Policies Your participation in treatment is important to us; however, it is necessary that you adhere to the clinical policies and requirements. Failure to do so may result in discharge from the clinic. Attendance Policies: Your success in treatment is dependent on your ability to engage in the treatment plan as well as adhering to the clinic program’s structure. It is your responsibility to keep all appointments. If you cannot attend your scheduled appointment, you must call to reschedule at least 24 hours prior to the appointment. If you do not call 24 hours in advance, you may be charged a late/no cancellation fee for the appointment. If you have a pattern of tardiness or not attending scheduled appointments, your provider will discuss your attendance with you. If the pattern persists, you may be discharged from the program. If you are more than 10 minutes late for your visit, your provider may be asked to reschedule. When you cancel or reschedule less than 24 hrs prior to your appointment, or do not show up for your appointment, you prevent someone else from seeking treatment. You also place a financial burden on the practice. As a small practice, we can’t stay in business and provide care, if patients repetitively miss, reschedule at the last minute, or continuously cancel appointments. We hope that you understand why we have to put this policy in place. Multiple reminders, in different modalities, are sent to you to remind you of your upcoming appointment. If you must cancel or reschedule an appointment, we require at least 24-hour notice (weekends not included). If your appointment is on a Monday, the cancellation must be made by the same hour on the preceding Friday. We do offer video/online appointments – with the exception of Medicare patients (Medicare does not cover online visits to your home at this time.) If you do not show up to your appointment, you will not get any refills until you see your provider. • Late Cancel less than 24 hours prior to appointment/No Show office visits: $50.00 In ONE calendar year - after the third less than 24 hour cancellation, less than 24 hour reschedule, or failure to show to an appointment you will be placed on a waiting list. You will not be able to self-schedule for three visits. A waitlist means you will be scheduled on a day to come in with other wait-listed patients. You will be worked in between other patients on the schedule. This will be on a first come, first served basis. There is no guarantee of how long you will have to wait to be seen. No refills will be called in until the provider sees you. Forms and Fees Forms are completed at the discretion of the provider. You must give a total of 72 hours during our normal business day for completion of forms. All forms require fee. This fee is the patient’s responsibility and cannot be billed to the insurance. Emotional Support Animal Letter $50.00 Forms/Letter Fee $50.00 Disability - short form $50.00 Disability - medium length form $100.00 Disability - complex/long form $150.00 Court Hearing/Appearance (4 hours minimum) $500.00 Court Hearing/Appearance (additional 4 hours) $500.00 5-10 minute Patient Initiated Phone Calls $15.00 (Not for billing or scheduling concerns) 11-20 minute Patient Initiated Phone Calls $25.00 21-30 minute Patient Initiated Phone Calls $50.00 Overdue Balance Fee (Greater than 30 Days) $50.00 New Patient Appointment No-Show Fee $50.00 Established Client No-Show Fee $50.00 Established Client - Less Than 24 Hr Cancellation Fee $50.00 New Client Appointment - Less Than 24 Hr Cancellation Fee $50.00 Medical Records Fee $25.00 Terms Involuntary Discharge Criteria There are certain situations that will lead to you being discharged from the care. If one of these situations occurs, excluding nonpayment of treatment fees, you will be given written notice of your discharge. In such cases, the notice will explain the reason for your discharge. The following behaviors are grounds for discharge from care here at Athena Integrated Behavioral health: • Physical violence involving you and any other person in the clinic or on the clinic property. • Client and/or Client's family is abusive or threatening in any communication; including verbal, text, voice, portal messaging, or email. • Registration at more than one treatment facility for the same services, excluding counseling services • Misusing psychotropic medication (e.g., not taking medication as prescribed, selling medication, having more than one prescriber for the same medication) • Treatment attendance while under the influence of alcohol and/or drugs • Possession of alcohol or illicit drugs on clinic premises • Within one calendar year – FOUR (4) - less than 24 hrs cancellations, less than 24 hrs rescheduling of your appointment, or failure to show up to your appointment. Will be grounds for dismissal from the practice with a referral to another practitioner. • If client has had no follow up visits within one calendar year from the date of last visit, the provider client relationship will automatically be terminated. The lack of attendance and absence of communication from the client will be grounds for automatic dismissal from the practice and no further refills will be provided. Referrals to a new practitioner may be provided on request. Client Rights Clients have the following rights: • To receive appropriate, humane treatment • To be protected from discrimination and harm as well as mental, physical, and sexual abuse • To an impartial and timely grievance procedure, which affords you the ability to exercise your rights as described in the Client Grievance Policy • To receive treatment in accordance with the applicable individualized treatment plan and a continuing care plan that conforms to the rules and regulations of the agency • To participate in the development and periodic update of your treatment plan • To receive in appropriate terms and language, explanation of the following: • Content and objectives of the treatment plan • Nature and significant possible adverse effects of recommended treatment • Name, title, and role of personnel directly responsible for carrying out your treatment and, when appropriate, other available alternative treatment providers in your area • To privacy and confidentiality of treatment and treatment records in accordance with Athena Integrated Behavioral Health’s “Confidentiality Notice”. • To access your treatment records in accordance with Athena Integrated Behavioral Health’s “Access to Clinical Record Policy”. • To have your information released only by your written consent, except for specified areas described in the Confidentiality of Client Records section of this document. • Upon initiation of care, to be informed in appropriate terms and language of your rights through written policies. Telephone Policy Our phone number is (712) 266-3577. If you need to contact our office to schedule, change, or cancel an appointment please call during normal business hours. Monday – Friday 8:30 am – 5:00 pm There is a turnaround time of 24 to 48 hours for messages left for your provider. Client Inclement Weather & Closure Policy Due to the advance in Tele-health our office will rarely close for weather. In the event of an office closure due to inclement weather or any other reason, our office will make every attempt to notify you in advance. All approved methods of communication will be attempted to notify you of our closure. If you are unsure whether our office is open, please call our office at (712) 266-3577 or check our website at athenaIBH.com Smoking Policy Athena Integrated Behavioral Health is committed to the health of our community, and we know that a smoke-free environment is cleaner and healthier for every person that visits our facility. Infection Control Policy Every reasonable attempt will be made to prevent the spread of infection at Athena Integrated Behavioral Health. All body and blood fluids will be considered infectious regardless of the perceived status of the source individual. Please remember to wash your hands after using the restroom. This eliminates direct contact transmission, which involves direct skin-to-skin contact and physical transfer of microorganisms from a source person to a susceptible host. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object. Masks should be worn to protect mucous membranes of the mouth and nose whenever you have a cough, cold, or possible flu. This eliminates droplet transmission, which requires close contact between source and recipient. *if you believe you are sick, please contact our office to either reschedule or change visit to telehealth. Medical Records Policy Athena Integrated Behavioral Health ensures that your medical records are protected health records and are maintained in a manner that is consistent with the legal requirements. Your records will be available to practitioners at each encounter. This facilitates coordination and continuity of care and permits effective and timely service. Retention of Medical Record Athena Integrated Behavioral Health must maintain medical records on you in accordance with accepted professional standards and practices. The medical records are completely and accurately documented, readily accessible, and systematically organized to facilitate retrieving and compiling information. Athena Integrated Behavioral Health recognizes the confidentiality of medical record information and provides safeguards against loss, destruction, or unauthorized use. Written procedures govern the use and removal of records and the conditions for release of information. Medical Records Request Medical Records Staff will never under any circumstances release Medical Record Information without a signed Authorization from you for use and/or Disclosure of Protected Health Information Form. You can review, inspect, and/or obtain a copy of your Protected Health Information in your Medical record. There is an administrative fee for copying medical records per your request. You do not have the right to immediate access to your medical record under the HIPAA Privacy Rule. All Medical Health Information requests will be completed within 10 business days. Client Requested Amendment to Protected Health Information The HIPAA Privacy Rule requires Athena Integrated Behavioral Health to act upon your request to amend Protected Health Information about you that you believe is incorrect or erroneous that we keep in a “designated record set,” medical health record. Requests for amendments to Protected Health Information must be acted on within 60 days of receipt of request. Up to an additional 30-day extension is allowable if Athena Integrated Behavioral Health is unable to act on the request within the deadline but Athena Integrated Behavioral Health must provide you a written reason for the delay and the date by which Athena Integrated Behavioral Health will complete the action on the request. This written statement describing the reason must be provided within the standard deadline. Athena Integrated Behavioral Health may only extend the deadline once per request for amendment. Confidentiality Breach Allegation Athena Integrated Behavioral Health assures you that the health clinic will honor your right to file a complaint and will not retaliate against you or deny services based due to the filing of a claim. Athena Integrated Behavioral Health Notice of Privacy Practices informs you of your rights under HIPAA’s Privacy Rule to file a complaint with our Medical Records Supervisor/Privacy Officer and the Office of Civil Rights (OCR) when you have reason to believe we have violated your privacy rights. The Medical Records Supervisor/Privacy Officer or appointed designee will take all complaints and/or allegations of non-compliance seriously and will fully investigate the allegations to determine what course of corrective action, if any, needs to be taken. The Medical Records Supervisor/Privacy Officer or appointed designee will notify you in writing the outcome of the investigation and what corrective action, if any, was taken within 60 days. Confidentiality of Client Records To provide practices protecting the confidentiality, privacy, and security of all Protected Health Information in compliance with your expectations, regulations, and community standards; including but not limited to the Confidentiality of Medical Information Act and Health Insurance Portability and Accountability Act (HIPPA.). The confidentiality of your records maintained by Athena Integrated Behavioral Health is protected by federal law and regulations. Athena Integrated Behavioral Health may not say to a person outside any of its programs that you attend a program or disclose any information identifying you unless: • You consent in writing • A court order allows the disclosure • The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation • You pose an imminent threat to yourself or others Suspected violations may be reported to appropriate authorities in accordance with Federal regulations. Federal law and regulations do not protect any information about a crime committed by you either when attending a program or against a person who works for the program or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities (see 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR Part 2 for Federal Regulations). (Approved by the Office of Management and Budget under Control No. 0930- 0099.) Destruction of Medical Record Protected Health Information may only be disposed of by means that assure that it will not be accidentally released to an outside party. Client’s Grievance Policy You are guaranteed certain basic rights while utilizing our services. Athena Integrated Behavioral Health has a responsibility to maintain a professional and ethical level of service within its varied programs and its personnel always. All complaints must be detailed in writing and given to the Athena Integrated Behavioral Health. What to expect after filing your grievance: • The practice manager will attempt to resolve the problem, will document the problem and/or solution reached. • It will be the responsibility of the practice manager to evaluate the severity of the grievance • The proprietor will carefully assess the professional, ethical, and/or legal aspects of the report • At each level, a detailed documentation of all action taken in the grievance will be made • Your report will indicate the who, what, when, where, why, and how of the incident • You will be informed of the outcome of their grievance. Laws, Rules, and Regulations The clinic you have enrolled in must maintain compliance with various federal and state laws that describes the standards of care and the privileges given to you when certain criteria. Final authority to grant individual "exceptions" to these regulations’ rests, not with the clinic staff, but with designated federal and state officials. If you wish to be enrolled for treatment, you must provide consent for treatment. These consent forms and other important paperwork will be part of your intake meeting. Address Change It is important that we have your correct address information on file. Please advise us anytime there is any change to your address, telephone, or other contact information. Co-payments, Deductibles, and Co-Insurance Co-payments, coinsurances, deductibles, and fees are due on the date of the appointment. We accept Cash, HSA card, PayPal, Venmo, and most major credit card (Processing fees may apply). Referrals and Authorizations Please be aware of and provide any required referrals or authorizations in advance of the appointment of service. If you do not provide these before care is provided, you will be responsible for the cost of the care. When in doubt contact your plan directly for clarification. Insurance It is important for you to be an informed Patient, who understands the specifications of your insurance policy (e.g., referral/authorization requirements for specialty care, laboratory tests, urgent care facility care). Your health insurance policy is a contract between you and your Health Insurance Company. Please note it is your responsibility to know if your insurance has specific rules or regulations, such as the need for referrals, pre-certifications, pre-authorizations, and limits on outpatient charges regardless of whether our providers participate. If your insurance carrier is not one of which we participate, you are responsible for payment in full. Insurance plans and Medicare consider some services to be “non-covered,” in which case you are responsible for payment in full. If you are uncertain about your current health insurance policy benefits you should contact your plan to learn the details about your benefits, out-of-pocket fees, and coverage limits. If we contact your insurance carrier regarding benefits or authorization on your behalf, we are not responsible for inaccurate information provided to us by your carrier. The information about your plan that we relay to you is in good faith. Fee for service schedule Fee for services is to be paid at the time of each visit. Initial Assessment $300 Follow Up medication check $150 Self-pay rates are based on financial hardship - if self pay is needed (Initial Assessment will be $200, and Follow up medication check will be $75) You are responsible for any financial obligations incurred because of services provided by Athena Integrated Behavioral Health. You should understand and agree that failure to pay assessed fee may result in termination from services and the use of legal recourse by Athena Integrated Behavioral Health to collect any outstanding balance. No Surprises Act You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. Still have questions? Visit www.CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059 for more information. TTY users can call 1-800-985-3059.