CRT Client Handbook

Lamoille County Mental Health Services

08/09

CRT/Client Handbook 1008

Consumer Handbook Index

8/09/09

Agency Mission/Vision Consumers Bill of Rights Rights and Responsibilities Summary of LCC Ethical Code Program Overviews Community Rehabilitation Services (CRT) Children and Family Services Adult Outpatient Services Developmental Services Emergency Care Services CRT Program Ineligibility Notice and Rights to Appeal LCC Consumer Complaint, Grievance and Appeal Procedure Grievance Procedure Grievance Form Grievance Process Flow Chart Appeal Process Flow Chart Individuals Authorized Representatives and Their Authority Notice of Privacy Practices

2 3 4 5 6 8 10 11 11 12 14 16 17 18 19 20

Orientation for LCC Consumers

LCC is responsible for orientating you to the LCC Consumer handbook. At the completion of this process you will be asked to sign the orientation checklist form, which will be filed in your treatment record. See last page.

MISSION

Lamoille Community Connections is a non-profit organization providing quality developmental and mental health services to the Lamoille Valley area enhancing independence and quality of life.

VISION

A community with wellness at its core and clear access to a comprehensive continuum of quality care of services.

Consumers Bill of Rights

3

LCC will provide services to all consumers in a manner that is sensitive to their age, gender, social preferences, cultural orientation, psychological characteristics, sexual orientation, physical situation and spiritual beliefs. You have the right to receive available treatment and services which you believe best suit your individual needs. If you are denied services, you may file a grievance and/or contact one of the advocacy organizations. You have the right to refuse treatment, medication, and any other type of service offered to you by anyone, including mental health professionals. If someone attempts to impose treatment and /or Medication on you, and you refuse, a legal proceeding at which you have the right to legal representation must take place. A judge will then decide whether you are competent to make your own decisions concerning your treatment. If, however you are behaving in a way which obviously endangers yourself or other people, you risk being admitted to Vermont State Hospital or another designated facility on an emergency basis without a hearing. Threatening or attempting to commit suicide and physically assaulting someone else are examples of danger to you and others. You retain your right to refuse treatment, including medication, even if you are on an order of treatment. However, this order can be revoked if a mental health professional files a request for revocation and a court approves it after a hearing. If this occurs, you may be returned to Vermont State Hospital or other designated facility. Ultimately the, there is a risk involved when you refuse treatment or medication, but if you are convinced it is a risk you wish to take, you can. You have the right to an individualized, written treatment plan and the right to participate in the designing of the plan. You have the right to be informed about your treatment and medications so you can make informed decisions regarding your treatment. This means that you are to be given an explanation of the treatment being offered to you in a manner that you can understand, and you should be able to ask questions if you are not sure about what is being said. You should be told why a particular method of treatment is being recommended, how it will benefit you and how successful it has been for others with similar conditions Information you should be given includes why a particular medication is being prescribed, what kind of benefits should result from using it, and what adverse or bad effects (side effects) may result from using it. Are there other available alternative medications and treatment methods that may benefit you? Are there other providers of mental health services available to you and how do you arrange for these services? You have the right to review your treatment plan at any time and to request changes according to your needs and wishes.

Rights and Responsibilities

4

_________________________________________________
LCC will provide services to all persons in a manner that is sensitive to their age, gender, social preference, cultural orientation, psychological characteristics, sexual orientation, physical situation, and spiritual beliefs. LCC is committed to providing quality effective care and a welcoming atmosphere to consumers who are mentally ill and have co-occurring disorders.

As a consumer, you have the following rights: The right to receive information about eligibility criteria and funding priorities, available services, programs and practitioners, practice guidelines, utilization, management practices, and grievance procedures. The right to be treated respectfully with dignity and with recognition of the need for privacy. The right to participate in decision-making regarding our services and your treatment plan, and to have a comprehensive treatment plan that incorporates other relevant service agencies/services, if desired. The right to voice complaints or lodge and appeal without recrimination. The right to refuse or terminate services, except where services are required by court order. The right to all legal protection and due process for status as an outpatient and inpatient, both voluntary and involuntary, as defined under Vermont law. As a consumer you have the following responsibilities: The responsibility to provide information that is needed in order to provide appropriate services and supports.

The responsibility to follow the agreed upon treatment plan and work diligently towards established goals.

Summary of LCC Ethical Code

5

CONSUMER PREFACE The following Ethical Standards are ethical principles that employees of Lamoille Community Connections Inc. should adhere to in the fulfillment of their job duties. The Ethical Standards are summarized here and will be made available to anyone who requests it in its entirety. This summary is included in this handbook so consumers can better understand the ethical responsibility of staff members to the consumers they serve. ETHICAL CODE SUMMARY Counseling Relationship A) Promoting the General Welfare Staff will place the welfare of its patients/clients and their families in matters affecting them as its number one professional priority. Staff will deliver kind and humane treatment to all patients/clients. Staff will not engage in any activity that could be construed as exploitation of patients/clients. Staff will not attempt to use its authority over a client in a coercive manner to meet its own needs. Staff will help individuals to empower themselves. B) Beliefs and Values 1. Staff will promote positive changes in patients/clients only on their behalf and in the interest of promoting recovery from the illness we are contracting to treat. 2. Staff understands and agrees to support both the spirit and letter of LCC policy on patients/clients rights, the patients/clients bill of rights. Confidentiality Staff will respect the clients' right to privacy unless disclosure is required to prevent clear and imminent danger to the client or others, or when legal requirements demand that confidential information be revealed, or the client authorizes the disclosure. Staff Responsibility Staff will seek to maintain the highest standards of professional conduct, and to provide the highest levels of professional services within LCC' resources to those who seek services from LCC. As a LCC professional or treatment team member I will terminate services to clients, and the professional relationships with them, when the services and relationships are no longer benefiting the patient/ client's interests and needs. The termination with patients/clients should be done in a way that allows for the least amount of ill-effect in the clients experience. When termination of services is apparent, the LCC professional or team member should notify the client as soon as possible and seek the transfer, referral, or continuation of services according to the patient/clients' needs and preferences. Resolving Ethical Issues Staff will exhibit personal concern for the well being of peers, the LCC community, and themselves by not ignoring manifestations of illness or unethical conduct. It is also staffs professional obligation to report concerns to outside organizations, if such behaviors continue unabated. As a LCC employee, staff is expected to abide by the ethical codes and standards of practice that govern its profession, in addition to the standards listed above.

COMMUNITY REHABILITATION AND TREATMENT PROGRAM

MISSION: To provide a continuum of community based services that empower individuals with severe and persistent mental illnesses including those with co-occurring disorders to effectively manage their symptoms and to make meaningful choices to improve the quality of their lives. VISION: Lamoille Community Connectionss Community Rehabilitation and Treatment program is for consumers to fulfill their dreams and aspirations through living successful and productive lives. Community Rehabilitation and Treatment program provides community-based services for adults over the age of 18 with severe and persistent mental illness and those with co-occurring disorders involving substance abuse, severe personality disorders, severe anxiety disorders and chronic health problems. The program provides structure in the consumers lives by providing community supports and by teaching and practicing self-help skills. The programs primary focus is to establish a working partnership with each consumer that focuses on successfully achieving and maintaining personal life goals. The program promotes empowering consumers to improve the quality of their living, working and social lives by promoting consumer choice. Staff in the program facilitate consumers through the recovery process involving crisis stabilization, engagement, active treatment, maintaining stability, rehabilitation and recovery from their symptoms, so that each consumer may have a life worth living. SERVICES: Stabilization and outreach: Stabilization and outreach services are our most intense outpatient services focusing on community based crisis stabilization through medication supports, skill coaching, assistance with doctors appointments and daily living. Services include assessment and crisis stabilization planning; case management around housing issues, benefits, coordination of services with other health care providers and legal matters; psychiatric services around medication evaluation, prescription and monitoring; counseling around skill coaching, problem solving, and family psychoeducation; crisis support phone line and limited respite bed services without one-on-one staff supervision. Skill building: Skill building is a collaborative treatment process where the treatment partnership focuses on assessing the clients strengths and needs and developing a treatment plan to increase the clients skill competences given where the client is at in personal growth. The scope of our skill building curriculum is across 9 life areas managing symptoms, managing behaviors, substance use, physical health, social relations, community living, work and education, legal and recovery. Clients are encouraged to do a strength based self-evaluation and needs assessment along with identifying specific skills they would like to improve. Skill building occurs in both group and individual counseling formats. Other services available to supplement skill building include psychiatric services around medication evaluation, prescription and monitoring; counseling around skill coaching, problem solving, family psychoeducation and recovery; crisis support phone line for assessment and skill coaching; supported employment for competitive jobs in the community; assistance with education and Social Security payeeships; assistance with doctors appointments and daily living; case management around discharge planning, housing issues, benefits, coordination of services with other providers and legal matters; and recovery day services around participating in a recovery community. Relapse prevention: Relapse prevention services provide assistance for maintaining wellness and community connections. Clients are encouraged to do strength based self-evaluations and needs

assessments along with developing relapse prevention plans which are comprised of clinical services along with community based support network including peer supports. The scope of relapse prevention services include recovery day services around participating in a recovery community; supported employment for competitive jobs in the community; assistance with education and Social Security payeeships; counseling around relapse prevention, rehabilitation and recovery; crisis support phone line; psychiatric services for medication management; assistance with health care and daily living; case management around discharge planning, housing issues, benefits, coordination of services with other providers and around legal matters. Residential services: Our program offers two residential options the group home for transitional housing with the goal of moving to a more independent living situation, and Copley House for long term residential care with 24 hour supervision. The daily schedules for each program are in the client handbook folder. Our program has available assistance with community based housing subsidies through Section 8 and Shelter Plus Care. There is also community based housing assistance for people coming out of psychiatric hospitals and substance use treatment programs. A case manager will provide assistance around these community based services. Supported employment: Our program offers supported employment services to any client who wants to work. The scope of the services includes a vocational assessment and profile, rapid job development based on the clients choice of competitive employment in the community, benefits counseling, unlimited and individualized employment supports which are integrated into the mental health, physical health, and, when appropriate, substance use treatment plan. Family services: When the client gives permission, our family liaison works with family members around being a contact person for questions and concerns, updating families on services and events going on in our program; coordinates the family members annual satisfaction survey, as well as making referrals to NAMI. Family psychoeducation services involve both the client and family members. Services include assessment; collaborative relationships; problem-solving; enhancing communication; and education for mental illness, treatment principles and substance use. Family members are also invited to participate as Board of Directors members and/or CRT standing committee members, which is a subcommittee of the Board of Directors. Recovery day services: Clients are members of a recovery community where they are empowered to develop and carry out the by-laws, co-facilitate skill building groups with staff and run peer support groups. Groups are offered in the life areas of recovery, managing symptoms, substance use, physical health, social relations, community living and work. All members are encouraged to participate in at least 2 groups a day. The daily schedules for recovery day services are in the client handbook folder. There is a transitional work program for clients who are not ready for competitive supported employment where the clients can work, earn money and develop work skills so they can work in competitive jobs in the community.

Children and Family Services

8

Mission: The Children and Family Services Division of LCC provides a variety of community-based, comprehensive services to children, adolescents and families where the child or adolescent has a severe emotional disturbance or is at substantial risk of developing a severe emotional disturbance. Services are also provided to families who have a child or adolescent diagnosed with a developmental disability. Philosophy: The treatment needs of seriously emotionally disturbed children and adolescents can best be met in the community. Our services must be built upon the combined strengths of families, service providers, agencies and other natural supports. As part of the broader community, our services should support families in their caretaker role and broaden the scope of community in practice so that families are equal partners in the process. It is our view that the most successful outcome of receiving services is in becoming able to contribute, so that ultimately the child or adolescents best interest becomes identical to community interest. The program strives to provide services in a timely and responsive manner that respects the individual values and strengths of those served. Services Offered: Childrens Psychiatric Services: Three Psychiatrists are available to provide medication evaluations, medication follow-up and consultation. Clinical Outpatient Services: Provides clinical intake, diagnosis and assessment for children and adolescents, up to age 18, who are entering services. Individual, family and group therapy are available. Intake/ACCESS/Crisis Services: Provides follow-up to Emergency Services interventions with crisis support, shortterm therapy, and outreach to children and families. Primary focus of the program is to ensure that consumers coming in through Emergency Services are connected to services immediately. ACCESS Case Management: A collaborative effort between LCC and the Lamoille Family Center to provide case management services to youth at risk. Youth who enter services through the LCC Emergency Service program and the Lamoille Family Center LINK program receive immediate intervention to ensure that these youth and their families get connected to needed services. This population traditionally does not engage in services readily and chooses to engage the service system only when they are in crisis. The goal of the program is to assist these individuals in building coping skills and creating natural supports to minimize or eliminate the need for emergency intervention. Families In Transition Team (FITT): Family Therapist and Case Manager work together as a team to support families who are experiencing a high level of stress and/or are in a transition. This service is typically provided in the home/community. Treatment focuses on creating healthy family relationships through teaching parenting and communication skills and addressing primary stressors in the family unit. Childrens Upstream Services (CUPS)/Early Childhood Behavioral Health Services: The program focuses on the emotional and behavioral health needs of children (ages 0-6), their families and caregivers. Services are provided to young parents through individual and couples counseling, parenting support and psycho-education. Consultation is also provided to childcare centers, schools and other community based services. Jump On Board for Success (JOBS): Services are provided to 16 22 year old youth who are out of school and experiencing or have experienced emotional difficulties which interferes with their life. A small proportion of the JOBS caseload is devoted to youth at risk of school drop-out. The program assist youth in developing skills related to employment, problem solving and conflict resolution, making healthy life choices accessing competitive employment and fulfilling educational and career goals. Respite Services: Youth who are in need of mentoring, time away from home, or are in need of additional support during a difficult transition are eligible to receive one-on-one respite services. These services are provided according to the level of need. Respite services are provided in the childs home, community and in the providers home (for those receiving overnight services). Community Justice Project (CJP): A collaboration between LCC and Court Diversion to provided services and support to families who are involved or are at risk of becoming involved with the justice system. A case manager and nurse case manager team to provide services to children and their families. The teams focus is to ensure proper connection to services to provide families with the support they need to stop the cycle of justice system involvement with the family. The nurse case manager ensures that medical and dental needs are met. Family Specialist Services: The Family Specialist works one-on-one with children who are in need of a positive role model in their life. Services are provided in a recreational setting in the community. The Family Specialist works closely with the treatment team to ensure treatment focused issues are incorporated into the time spent with the youth; such as: behavioral issues, identified family dynamic issues, and helping the family develop natural supports within the family unit and community.

Therapeutic Case Management: Providing services to children and adolescents who have been diagnosed with severe emotional disturbance. The Case Manager coordinates services to ensure that youth are able to meet the various needs in their lives. This includes, but is not limited to financial, social, clinical, medical and school/vocational needs. Establishing a natural support network for the family and youth as well as developing the independent living skills of the family and youth are the primary goals of the program. Behavior Interventionists: The primary focus of this program is to work one-on-one with youth who need a behaviorally focused approach in school. Services are typically provided in the classroom setting where the interventionist can support the youth to be successful academically and socially. School Based Clinical Services: Counseling/therapy services are provided to youth in the school setting to develop students interpersonal skills, daily living skills, social skills, conflict resolution skills and coping skills to be successful in the academic and social realms. Childrens Developmental Services: Sister programs in Counseling/Therapy, Case Management and Behavioral Intervention are provided to children and their families experiencing developmental disabilities such as Autism, Aspergers and Pervasive Developmental Disorder. Referrals: Referrals for Childrens Outpatient Services, FITT and CUPS are made by calling the Clinical Coordinator at 8884914. Case Management and IFBS referrals are made to the Case Management Coordinator at 888-4914. JOBS, CJP, Family Specialist and Respite referrals should be directed to the JOBS/Respite Coordinator at 888-4914. Developmental Services referrals are made to the Developmental Services Coordinator at 888-5026. Psychiatric evaluations can be scheduled through the receptionist at the main clinic at 888-4914. Program Locations and Operating Hours: The Children and Family Services Clinic is located on the Copley Health Systems Campus on Washington Highway in Morrisville, Vermont. (888-4914). The operating hours for the clinic are 8:00 am 4:30 pm Monday Thursday, Fridays 8:00 am 3:30 pm. Evening appointments are scheduled as necessary. School-based staff are located in the schools. The IFBS and CJP programs are located at the local SRS district office. The JOBS program is located on Portland St. in Morrisville. Developmental Services are located at the LCC 2020 building on Brooklyn St. in Morrisville (888-5026). Many services are provided in the community to accommodate the needs of children and families.

Adult Outpatient Service

Mission: To serve persons (age 18+) who are experiencing depression, anxiety or any other such stress, which interferes with their daily life functioning. Services Offered: Psychiatric Services: Three Psychiatrists are available to provide medication evaluations, medication follow-up and consultation, developmental and psychiatric assessments. Diagnosis and Evaluation: diagnosis and assessment Interventions: Individual therapy, couples therapy, family therapy. Therapy is client focused. Referral: refer to hospitalization, residential or ongoing treatment with LCC or other local service providers Program Location and Operating Hours: Adult Outpatient Service is located on the Copley Health Systems Campus at 520 Washington Highway in Morrisville, Vermont. (888-4914). The operating hours for the clinic are 8:00 am 4:30 pm Monday Thursday, Fridays 8:00 am 3:30 pm. Evening appointments are scheduled as necessary.

Developmental Services

10

Mission: Dedication to working with individuals diagnosed with developmental disabilities and to develop and maintain quality supports that responds to their needs and that of their families. Services are provided through an interdisciplinary approach to develop an Individual Service Agreement with the consumer/guardian. The core services offered are case management, personal, social, living and community support, vocational and host family. Additional services are information and referral, assessment (eligibility determination, program planning), vocational referral services, contracted psychiatric services, counseling referral, respite/flexible family funding, and transitional liaison with local area school districts. Services Offered: Psychiatric Services: Two Psychiatrists are available to provide medication evaluations, medication follow-up and consultation, developmental and psychiatric assessments. Intake/Crisis Services: Provides consumer eligibility and Medicaid waiver eligibility. Develops initial assessments to direct consumers to appropriate area services. Develops budget to address needs based on eligibility. Crisis services are an on call service that responds to active consumers in crisis and refers them as needed. Services Coordination: Provides overall treatment coordination to consumers. Refers as needed to area resources. Transition: Works with area schools and families to help transition eligible youth in our area to adult services. Vocational Services: Works with eligible consumer with development of vocational sites, job evaluations, and initial and on going vocational supports. Residential Services: Helps to support consumers in appropriate residential settings. These include but not limited to developmental homes, independent and family settings. Developmental Childrens Services: Assesses eligibility for appropriate services delivery. Provides on going services coordination and treatment planning for children in the Lamoille Valley area. Program Location and Operating Hours: The Developmental Services Program is located at 2020 Brooklyn Street in Morrisville, Vermont. (888-6627). The operating hours are 8:00 am 4:30 pm Monday Thursday, Fridays 8:00 am 3:30 pm. Evening appointments are scheduled as necessary. Many services are provided in the community to accommodate the needs of children and families.

Emergency Services
Mission: To serve persons experiencing a present crisis (experiencing a danger to self/others; loss of ability to cope). Services Offered: Evaluation: assessment of situation and person(s)

Psychiatric Services:
Intervention: Provide proper services depending on assessment

11

Referral: Refer to hospitalization, residential or ongoing treatment with LCC or other local service providers Program Location and Operating Hours: Emergency Services is located on the Copley Health Systems Campus at 520 Washington Highway in Morrisville, Vermont. (888-4914). The operating hours for the clinic are 8:00 am 4:30 pm Monday Thursday, Fridays 8:00 am 3:30 pm. After office hours, call Copley Hospital 888-4231 and ask for the emergency service worker on call. We serve 24 hours per day, 7 days per week.

CRT Program Ineligibility Notice and Rights to Appeal

This notice informs you of your treatment rights if you disagree with the planned services in your individualized service plan
Individuals eligible for CRT program services experience major mental illness, significant impairments in social and living skills and require intensive treatment and support services in the community. The core services for Community Rehabilitation and Treatment (CRT) program include an array of rehabilitation, emergency, case management and community support services. These services are provided directly or contracted for by the community mental health center (also called the Designated Agency) providers. Services are provided to eligible individuals through an individualized service plan that is based on an assessment of consumer need, clinical appropriateness, and consumer choice. The community mental health center cannot refuse to serve eligible consumers requesting service.

You have the following rights available to you if you disagree with this determination: If you are denied CRT Program services and believe that you are eligible for
them, you have the right to request an appeal. You have up to 30 days from the date of this notice to request an appeal. If you request an appeal after 30 days, the agency may or may not choose to consider your appeal. Your appeal must be resolved within 45 days unless you agree to an extension of no more than 14 additional days to resolve the issue. The first step of the appeal process is an internal review at LCC which will take up to 15 days If the appeal is not resolved during the internal review, the second step is DMH hearing the appeal of LCCs internal review. The client has 14 days to request the LCC Grievance and Appeal Coordinator (Richard Lanza) they want their appeal to continue at DMH

12

You must request a Fair Hearing within 30 days of your final appeal decision from the community mental health center. If you request an appeal after 30 days, your rights to appeal may be affected. At any point during the DA internal appeal process or DMH appeal or if you disagree with the progress of the process, you may also request a Fair Hearing. If your appeal goes to a Fair Hearing and you are found eligible for CRT Program Services, the Division of Mental Health through the local community mental health center or designated agency must provide CRT program services.

If you need more information about appeals or assistance in asking for an appeal, you can contact the following people or agencies that can help:
The Grievance and Appeals Coordinator at the local community mental health center or designated agency. Richard Lanza is the Grievance and Appeals Coordinator for LCCs CRT program The Grievance and Appeals Coordinator at the Division of Mental Health at 1-802-652-2000, or for the State of Vermont only, call our toll-free number at: 1-888-212-4677, TTY Relay Service at 1-800-253-0191, or by mail to Department of Health, Division of Mental Health, 108 Cherry Street, P.O. Box 70, Burlington, Vt. 05402-0070 . Office of Health Care Ombudsman at 1-800-917-7787 or by mail to PO Box 1367, 264 N. Winooski Avenue, Burlington, Vermont 05402 Vermont Protection and Advocacy at 1-802-229-1355 or by mail to 141 Main Street, Suite 7, Montpelier, VT 05602 Vermont Psychiatric Survivors at 1-800-564-2106 or by mail to 1 Scale Avenue, Suite 52, Rutland, VT 05701

To Request a Fair Hearing at any time, write to:

Human Services Board 118 State Street Drawer 20 Montpelier, VT 05602

13

LCC Consumer Complaint, Grievance and Appeal Procedure

Purpose: To assure all CRT clients a systematic way to communicate and resolve problems around quality of services and a reduction or denial of services Policy: For the CRT program to provide all CRT clients the same process for complaints, grievances and appeals Grievance and Appeal Coordinator: Richard Lanza, CRT Director Complaints: A client expresses a dissatisfaction about aspects of interpersonal relations rudeness, failure to be respected, staff not conducting themselves properly and the quality of care the client receive The complaint is resolved in one response by staff Complaints may be made orally or in writing by the client to any CRT staff Grievance: A client expresses a dissatisfaction about aspects of interpersonal relations rudeness, failure to be respected, staff not conducting themselves properly and the quality of care the client receive The complaint is not resolved with one attempt by staff. The unresolved complaint automatically becomes a grievance. Grievances may be made orally or in writing by the client to any CRT staff Grievances must be filed by the client within 60 days of the incident Grievances have a 90 day time period to be resolved starting on the date the Grievance was requested If the client gets an adverse decision on their Grievance, they can request a Grievance Review by DMH Grievance Review The client has 10 calendars days from receiving an adverse decision to request a Grievance Review The purpose of the Grievance Review is to ensure that the Grievance process is functional and the resolution impartial The Grievance Review is not necessarily to reverse the Grievance resolution DMHs decision on the Grievance Review is final Reconsideration without an appeal A Reconsideration of the decision to terminate, suspend or decrease services is an informal way to ask the person making the decision to rethink it. A client may request a Reconsideration of a denial of services before filing an Appeal. During the Reconsideration, more information can be submitted that would clarify or add to what had already been sent in. If a Reconsideration is requested, an appeal can be filed up to 90 days from the denial of service notification Appeal A client disagrees with a notice stating termination, suspension or reduction of previously authorized course of treatment or service plan

14

Services continue until the appeal is resolved if the Appeal is filed within 10 days of the denial of service notification and the treatment plan has not expired Appeals must be filed within 90 calendars days of the notice of the denial of service notification If a reconsideration was requested, an appeal can be filed up to 90 days from the notification of action Appeals have two steps which must be completed within 45 days unless the client asks for a 14 day extension Appeal Internal Review Step 1 The first step of the appeal is an internal review conducted by LCC and will take up to 15 days If the appeal is not resolved during the internal review, the second step is hearing the Appeal of the internal review by DMH at the clients request Appeal at DMH Step 2 The appeal at DMH will review the information in the internal review plus any new information the client presents The continuation of the Appeal at DMH occurs within the remaining 45 days of the Appeal time frame The client may request an extension of 14 days DMH will notify the client of their decision in writing If a client is dissatisfied with DMHs decision after the Appeal, the client has 30 days to request a Fair Hearing in front of the Human Services Board Expedited Appeal Expedited Appeals occur when the standard time for implementing an Appeal would jeopardize the clients life or health or ability to maintain functioning DMH will decide all Expedited Appeal requests within 3 working days If DMH determines the Appeal does not meet the criteria for an Expedited Appeal, the Appeal will follow the standard Appeal process and the standard Appeal time frames of 45 days. Fair Hearing A client can request a Fair Hearing when they first file an appeal and up to 30 days after they receive an adverse notification from DMH hearing their appeal If the client requests a Fair Hearing before the Appeal process is over, the Fair Hearing process will not start until the Appeal process is completed The first steps in the Fair Hearing process is for DMH to review the Appeal documentation and try to resolve the service disagreement between LCC and the client If the service disagreement continues to be unresolved, a status conference will be held with a Hearing Officer and depending on the information presented at the status conference, the Fair Hearing may move forward and an advisory opinion may be offered by the Human Services Board. The Human Services Board will issue a Final Order to the Secretary of the Agency of Human Services (AHS) The AHS Secretary has 10 days to accept the Human Services Boards order or request a reversal of the order All parties must comply with the final determination

15

LCC GRIEVANCE AND APPEAL FORM

If you are dissatisfied with your agency, a member of its staff, or decisions about services that you receive, you may complete this form and give it to the agencys Grievances & Appeals Coordinator so that issues can be resolved reasonably quickly. This form is made available for your convenience, but you may write your concerns down in any way you choose. Or, if you prefer, you may talk to the Grievances & Appeals Coordinator about your concerns. Richard Lanza is the Grievance and Appeal Coordinator. We encourage you to express your dissatisfaction openly. Your concerns are considered confidential. Your services will not be affected if you file a grievance or appeal an action. No staff member will treat you poorly if you express your concerns. You are entitled to an agency decision regarding your concerns and reasons for the agencys decision. (required in order to provide a response) or e-mail (if preferred) Date:

Name: Address: Telephone #:

(X) What best describes your concerns? If your concerns are about a denial, reduction, or stoppage of service, please give as much detail as possible. If your concerns are about the agency or staff, please describe the issues. The following categories may help, but you are not limited to this list: Examples of Grievance Issues: 1. 2. 3. 4. 5. 6. 7. 8. Examples of Appeal Issues: 1. Denial or limited authorization of a requested covered service. 2. Reduction, suspension, or termination of an authorized service or service plan 3. Denial, in whole or in part, of payment for a service 4. Failure to provide services in a timely manner 5. Failure to provide clinically indicated covered services 6. Denial of request for covered services outside Medicaid network

Dissatisfaction with a staff/contractor Dissatisfaction with management Dissatisfaction with program decision Dissatisfaction with policy decision Dissatisfaction with quality of services Dissatisfaction with accessibility of services Dissatisfaction with timeliness of response Dissatisfaction with services not offered or not available

Describe your concerns and what steps you have taken to resolve the problem so far:

How would you like to see the problem resolved?

16

GRIEVANCE PROCESS FLOW CHART

17

APPEAL PROCESS FLOW CHART

18

Lamoille Community Connections Individuals' Authorized Representatives and Their Authority

Policy: LCC serves some individuals who, due to age or legal status, do not have the right to consent or authorize treatment or disclosures of their health information. In order to protect an individual's right to privacy it is imperative to identify those persons who have legal authority to make decisions on behalf of the individual. People 18 years and older are considered adults for this policy and as such can make their own decisions.

Authorized Representatives
Adult Guardianship - For an adult 18 years and older who has been deemed by the court to need a guardian to assist them in managing some or all aspects of their personal care or financial matters, their legal guardian must authorize the release of information. Since there are different powers for which a guardian may be appointed, LCC should require a copy of the guardianship orders before releasing any information. Minors - For individuals younger than 18 years of age, his/her parent, custodian or guardian is the authorized representative. As for those children 12 years of age or older seeking treatment for substance abuse, a physician's certification is a prerequisite to their having the authority to consent to such treatment (18 V.S.A. 4226) and authorize disclosure of that information. Please note children 14 years of age and older can apply for voluntary admission to a hospital and may seek assistance of LCC personnel in securing such a placement (18 V.S.A. 7503). Emancipated Minor - An individual under the age of 18 years who through the court system has become an emancipated minor has the authority to act as any individual 18 years of age and older. LCC must be provided with a copy of the court documents to confirm this status. Guardian ad litem - If the court appoints a guardian ad litem to an individual, this representative would have the authority to review the individual's records and discuss his or her condition with LCC workforce members. Deceased Individuals - If the individual is deceased, his or her personal representative or next of kin shall serve as the authorized representative unless otherwise informed by the court. (See the Agencys Policy and Procedure Regarding the Use and Disclosure of Protected Health Information of Deceased Individuals) Durable Power of Attorney - If an individual has executed a durable power of attorney for health care, then his or her agent has the authority to make any or all healthcare decisions on the individual's behalf that the individual could make, including authorizing releases of information. Prior to accepting the agent, the power of attorney document and the physician's certification (a doctor must certify that an individual lacks capacity to make health care decisions) must be submitted to LCC. Legal counsel for LCC must review the documents to ensure they have been properly executed and hence are to be honored. Once their validity has been established, LCC will treat the agent in the same manner as the individual. LCC may decide not to regard a person as the authorized representative of the individual if LCC has a reasonable belief that: The individual has been or may be subject to violence, abuse, or neglect by such person; or

19

Treating such person as the authorized representative could endanger the individual and, in the professional judgment of the agency, it is decided it is not in the best interest of the individual to treat the person as the individual's authorized representative.

These decisions should be made with a supervisor and legal advice may be sought.

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
If you have any questions about this notice, please contact the Kim McClellan, Compliance Officer at (802) 888-5026 ext. 169 WHO WILL FOLLOW THIS NOTICE This notice describes our practices and that of: Any health care professional authorized to enter information into your health record. All divisions and programs of LCC. Any volunteer we allow to help you while you are receiving services from LCC. All employees, staff and other personnel. All LCC entities, sites and locations follow the terms of this notice. Staff members at these entities, sites and locations may share health information with each other for treatment, payment or operations purposes as described in this notice. OUR PLEDGE REGARDING HEALTH INFORMATION We understand that health information about you and your health is personal. We are committed to protecting your privacy and health information about you. We create a record of the care and services you receive at LCC. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by LCC, whether made by LCC personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctors use and disclosure of your health information created in the doctors office or clinic. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. We are required by law to: Make sure that health information that identifies you is kept private; Give you this notice of our legal duties and privacy practices with respect to health information about you; and Follow the terms of the notice that is currently in effect.

20

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. For Treatment. We may use health information about you to provide you with treatment or services. We may disclose information about you to doctors, nurses, clinicians, case managers, interns, or other LCC personnel who are involved in providing services to you. For example, a clinician might be treating you for a mental health problem and need to talk with one of our psychiatrists or another clinician who has specialized training in a particular area of care. We may also disclose information about you to people outside LCC who are involved in your healthcare. For Payment. We may use and disclose health information about you so that the treatment and services you receive at LCC may be approved by, billed to, and payment collected from a third party such as an insurance company or developmental services funding committee. For example, we may need to give your health plan information about counseling you received at LCC so your health plan will pay us or reimburse you for a counseling session. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the service/treatment. For Health Care Operations. We may use and disclose health information about you for LCC operations. These uses and disclosures are necessary to run LCC and make sure that all individuals receiving services from us receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in serving you. We may also combine health information about many consumers to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, clinicians, case managers, interns and other LCC personnel for review and learning purposes. We may also combine the health information we have with health information from other mental health agencies to compare how we are doing and see where we can make improvements in the services we offer. We will remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning who the specific consumers are. Appointment Reminders. We may use and disclose information to contact you as a reminder that you have an appointment. Alternative Treatment and Benefits and Services. We may use and disclose information about you in order to obtain and recommend to you other treatment options and available services as well as other health-related benefits or services. Fundraising Activities. Should the need arise where information about you or where your participation is desired for fundraising activities, LCC would obtain your authorization. No information would be released for this purpose without your authorization. For example, if LCC was creating a fundraising brochure and picture of or comments from persons served were desired, LCC would inquire whether or not you would be willing to participate.

21

Participation would be voluntary and if you agreed, you would be asked to give us written authorization for this specific purpose. Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all consumers who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with consumers need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process, but we may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for consumers with specific health needs, so long as the health information they review does not leave LCC. We will always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at LCC. As Required by Law. We will disclose medical information about you when required to do so by federal, state or local law. In Vermont, this would include: victims of child abuse; the abuse, neglect or exploitation of vulnerable adults; or where a child under the age of sixteen is a victim of a crime; and firearm-related injuries. To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. SPECIAL SITUATIONS Military and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities. Workers Compensation. We may release health information about you as authorized for workers compensation or similar programs as authorized by Vermont law. These programs provide benefits for work-related injuries or illnesses. Public Health Risks. We may disclose health information about you for public health activities. These activities generally include the following: To prevent or control disease, injury or disability; To report deaths; To report child abuse or neglect; To report abuse, neglect or exploitation of vulnerable adults; any suspicion of abuse, neglect, or exploitation of the elderly (age 60 or older), or a disabled adult with a diagnosed physical or mental impairment, must be reported; To report reactions to medications or problems with products; To notify individuals of recalls of products they may be using; To notify an individual who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition

22

 Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, but are not limited to, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws. Legal Proceedings and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Public Health Officials and Funeral Home Directors. We may release information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information to funeral directors thereby permitting them to carry out their duties. Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. OTHER USES OF HEALTH INFORMATION Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the services that we provided to you. YOUR RIGHTS REGARDING INFORMATION ABOUT YOU Any assistance (physical, communicative, etc.) you need in order to exercise your rights will be provided to you by LCC. You have the following rights regarding information we maintain about you: Right to Review and Copy. You have the right to review and copy health information that may be used to make decisions about your care. This may include both health and billing records. To review and copy health information that may be used to make decisions about you, you must submit your request in writing to case manager or clinician. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny or limit access to your request to inspect and copy in certain very limited circumstances. If you are denied or limited access to health information, you may request that the decision be reviewed. Another health care professional chosen by LCC

23

will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for LCC. To request an amendment, your request must be made in writing and submitted to the author or health information department. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support that request. In addition, we may deny your request if you ask us to amend information that: Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; Is not part of the designated record set kept by or for LCC; Is not part of the information which you would be permitted to inspect and copy; or, Was determined accurate or complete by LCC.

Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of the disclosures we made of health information about you. To request this list or accounting of disclosures, you must submit your request in writing to case manager or clinician. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you for the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member. For example, you could ask that we not use or disclose information about a counseling session you received. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to your case manager or clinician. In your request, you must tell us (1) what information you want to limit; (2) 24

whether you want to limit our use, disclosure or both; and (3) to whom you want the 21 limits to apply, for example, disclosures to your spouse. Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to your case manager or clinician. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of the current notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer. Security of Health Information.
Due to the nature of community-based human service practices, LCC representatives may possess individually identifiable information beyond the physical security of LCC. In these cases, LCC representatives will ensure the security and confidentiality of the information in a manner that meets LCC policy, State and Federal Law.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in all LCC facilities. The notice will contain on each page, in the top right-hand corner, the effective date. In addition, should we make a material change to this notice, we will, prior to the change taking effect, publish an announcement of the change at every LCC facility, on its website and in the local paper. COMPLAINT NOTICE OF PRIVACY PRACTICE If you believe your privacy rights have been violated, you may file a complaint with LCC or with the Secretary of the Department of Health and Human Services. To file a complaint with LCC, contact: Kim McClellan, Compliance Officer at (802) 888-5026 ext. 169

25