CONSENT, DIAGNOSTICS & CRISiS INFORMATION
INFORMED CONSENT, THERAPEUTIC DIAGNOSTICS & LEVEL SYSTEM
The policies below are the informed consent with CCA Behavioral Health, PLLC and its affiliates, clients/members, insurance companies, providers, managed healthcare organization (MCO) and/or any other party. In executing contracts, agreements, and/or rendering services all parties agree and/or consent to the policies mentioned herein:
Section 1. Governing Authority and Providers
CCA Behavioral Health LLC provides counseling, psychotherapy, consulting, research, training, rehabilitation, and assessment services for individuals, families, agencies, and companies in the State of Texas. Some members of the company are designated as a significant traditional Texas Medicaid Providers; and the Company is registered as a professional company by the State of Texas. The company is owned and operated by Donald S. Chandler, Jr., Ph.D. The primary treatment provider(s) of the company are licensed professionals by the Texas Behavioral Executive Council (State Board of Examiners of Professional Counselors) and the Tennessee Health Related Boards. Volunteers, Life coaches, Interns, Practicum Students and other employees/contractors are qualified personnel approved by the company. The staff and personnel of the company may provide counseling-related assistance, life coaching, assessments, consultations, rehabilitation, and other specified duties according to agreements, contracts, and corresponding certifying agencies. Internal quality control standards are provided to meet specific standards.
Section 2. Confidentiality, Requests for Information, and Disclosure Policy
When applicable, all information regarding services including records pertaining to our services are confidential and protected by state and federal law. All communications to a third party regarding our client's records or information are prohibited without consent or agreement. A written HIPAA compliant request form and/or written consent must be provided to us in order to release information to a client or another parties. All requests for records should be emailed or provided in writing. There is also an administrative fee of $50.00 or more for clerical services (e.g. record copies, etc.). This administrative fee may also apply to authorized emails, faxes, and monthly summaries/information requests. The administrative fee may vary according to contractual agreements or state/federal law. If our providers are required to attend court hearing related to a disclosure of information, all court expenditures must be paid in full by the requesting party. According to Texas Family Code-611, we have the right to refuse the release of confidential information (e.g. psychotherapy information) which may result in psychological, emotional, or physical harm to our clients. Clients referred by state agencies should also note that their information may be subjected to full disclosure if court ordered to do so.
2(a). Telehealth & Online Communications:
Based on clinical necessity, limited times, distance and circumstances such as the COVID-19 pandemic, natural disasters, emergencies, or technical difficulties, CCA Behavioral Health, PLLC provides telehealth/telephonic communications and services in accordance to state, federal and professional guidelines. All clients give full consent to utilize electronic communications and services. With the verbal consent to services, all clients who register with TheraoyNotes.com or any other telephonic and/or telehealth system are giving consent and acknowledgment that they have received and/or reviewed the company policies. The company utilizes online, storage and forward technology (OhMD), TherapyNotes.com, and/or other platforms. Upon an initial screening, and verbal consent, clients may participate in telehealth and in office services. All clients agree to indemnify CCA Behavioral Health, PLLC and its affiliates from insecure communications such as SMS texting, Facebook, etc.
2(b). STATEMENT OF INFORMED CONSENT FOR CLIENTS
All clients who enroll and/or register for services with the providers of CCA Behavioral Health PLLC, have acknowledged and consented to the policies and procedures of CCA Behavioral Health, PLLC. Additional updates may be located on this site: https://ccabehavioralhealthpllc.info/. Documentation of the administration of this informed consent will be provided within the client's record. An Additional request to complete online consent, assessment, and record access may be forwarded to the client's email address and/or record. Clients must use the TherapyNotes.com and Client Portal aLao known as the Therapeutic Guide. Client may also use the Homepage Consent & Information to communicate with providers.
Overview for Telehealth:
CCA Behavioral Health, PLLC primarily provides coaching, counseling, psychotherapy, consulting, research, training, rehabilitation, and assessment services for individuals, families, agencies, and companies . The company is a Texas Medicaid Provider; and registered as a professional company by the State of Texas. The company is owned and operated by Donald S. Chandler, Jr., Ph.D. Dr. Chandler is the primary provider unless otherwise specified. The primary treatment provider(s) of the company are licensed professionals by the Texas Behavioral Health Executive Council (formerly Texas State Board of Examiners of Professional Counselors) and the Tennessee Health Related Boards. CCA Behavioral Health, PLLC is registered with the the Accreditation Council of Holistic Healers. Volunteers, Life coaches, Interns, Practicum Students and other employees/contractors are qualified personnel approved by the company. The staff and/or personnel of the company may provide counseling-related assistance, life coaching, assessments, consultations, rehabilitation, and other specified duties according to agreements, contracts, and corresponding certifying agencies. Internal quality control standards are provided that involves third parties to review the client's information.. Overall, the above agencies and organizations oversee compliance to ethical and professional standards of the counseling profession.
Telehealth & Online Communications and Expectations:
CCA Behavioral Health, PLLC provides communications and services through online media and programs such as text messages, emails, etc. Upon screening and/or registration, all clients give full consent to utilize electronic devices for client communications and services. The company utilizes industry standard platforms such as TherapyNotes.com for records, in office services, billing, telehealth program or other secure programs. Clients can register and text OhMD and/or TherapyNotes.com to participate in telehealth services. COVID and Pandemic Precautions: During COVID and/or pandemics, telehealth services will be provided primarily for services unless otherwise specified. Telehealth services may involve consultations, coaching, interviewing, and other services. Services may involve a combination of CBT and other therapeutic perspectives. Telehealth services are consistent with state and professional guidelines noted above. Methods and Modalities: These telehealth services are provided as a storage/forward method that may include a detailed message with or without an attached audio and/or file OR a video session. Both telehealth services are generally scheduled weekly and/or on specific times for clients to respond. Audios and other attached information are substantial to the modality of in office services. The clients are also responsible for responding and utilizing electronic medias and programs to secure confidential information and services. Follow up/repetitive messaging and contacts are provided routinely for active clients. Clients that communicate through Skype, Facebook, email indemnify and hold CCA Behavioral Health, PLLC and their affiliates harmless for any breaches of confidential information. Treatment Planning: A general treatment plan can be located on our company site. A specific treatment plan, interview/screening, diagnosis, and assessment may be provided within 90 day intervals. This clinical information is stored and signed within the client's record. Services are evaluated and/or completed within 6-month intervals unless otherwise specified. Parents/guardians are expected to participate in the facilitation of services with minor clients. Additional referrals can be made in Texas 211 or other resources. Limitations of Telehealth Services: For children and those under 18 years of age, the parent/legal authorized representative is responsible for the supervision and implementation of services in office or online. Those who have limited technology, intellectual, behavioral, or emotional functioning MAY NOT benefit equally from telehealth services in comparison to in office services. Follow up calls and messaging are expected during the course of services to assist with telehealth and online implementation. In addition, all clients can contact the provider for assistance. Registered clients and/or families are routinely evaluated on their progress and/or use on telehealth services. Clients who fail to comply or become non responsive may be terminated or deactivated from services. A crisis plan for telehealth services may involve utilizing online resources for 911, emergency, urgent care, or contacting the local mental health authority within the client’s geographical residence. In addition, clients may also agree to enroll in adjunctive programs designed to facilitate the goals and objectives of counseling, assessments, or consultations. Telehealth services are not a free service for communications only. The general fee is $100 per hour for counseling services. See
2(c). Online Recordkeeping:
The company utilizes TherapyNotes.com for recordkeeping. Clients may be required to complete intake, screening, and/or interview in telephonic format. All client records will be kept confidentially through and telephonic /online recordkeeping service determined by CCA Behavioral Health, PLLC.
Section 3. Appointments, Rescheduling, & Guarantees
3(a). Scheduling:
In addition, in-office clients are expected to re-schedule appointments within 72 hours in advance in order to continue services. During inclement weather, extenuating circumstances such as holidays or COVID-19, scheduled appointments may be rescheduled. All clients will be billed for same day cancellations unless otherwise determined by management. There are no guarantees for services provided. It is the client's responsibility to contact us regarding missed and rescheduled appointments. Same day cancellations are subjected to late fees. To maintain a safe and secure environment, all clients must contact the office at their scheduled appointment time to gain access to the facilities. A 15-minute grace period is required for all scheduled appointments. For Texas Department of Family & Protective Services (DFPS) and any/all other agencies, there are no guarantees for services, monthly summaries, and appointments without prior 2054 authorization, the referral, or approval from the DFPS Program Director Medicaid eligibility. The providers of this company reserve the right to cease referrals from DFPS and/or any other agencies within contractual guidelines. Clients that seek services privately for court ordered services are identified as private clients and not a referred client from the court or contracted state agency.
Section 4. Treatment or Life Coaching Planning and Therapeutic Level System
4(a). Diagnostic Levels &Treatment Approaches:
Generally, clients attend between 6-12 sessions for counseling or life coaching, assessed within a 90 day timeframe. Our Therapeutic Level System is designed to conceptualize counseling, life coaching and rehabilitation frequency. This frequency may also correspond to prior authorizations set forth by MCOs, insurance companies, and other entities such as the American Psychological Association, American Counseling Association, and the National Association of Forensic Counselors. .In general those with dual/comorbid or multiple diagnoses are placed on Level 1. Level 1 requires 1-3 sessions or services per week. Level 2 requires weekly or bi-monthly services. Level 3 requires monthly services only. The completion and termination of services are based on the completion of therapeutic goals, the level system, progress, outstanding expenditures, attendance, treatment and policy compliance. The level system, diagnoses and treatment plans of our clients are determined by the treatment providers of CCA Behavioral Health, PLLC.
4(b). GENERAL TREATMENT PLAN & SCREENING
The assessment of the risk and protective factors are essential to treatment treatment and coaching at CCA. Based on the therapeutic risk and compliance indicator (TRACI) by Donald S. Chandler, Jr., Ph.D.(2019), the following information below is the general screening, treatment/life coaching plan, and goals assessed within a 90-day timeframe. This measure is also used with permission of the author for case management and research purposes. The TRACI measures each on a rating system of 0=N/A, 1=Poor/Low, 2=Fair, 3=Good/Moderate, and 4=High/Obtained
1. Identify the triggers to the emotional/behavioral problems.
2. Improve knowledge & skills relative to mental health, parenting, anger management, domestic violence, rehabilitation, and/or substance use.
3. Improve relations, social, and/or family relations.
4. Improve prosocialization and/or self-sufficiency.
5. Improve community linkages & support networks.
6. Improve safety & supervision planning.
The conceptual basis of treatment and life coaching is based on Chandler (2019). “The Essentials of the Eclective Consciousness & Introspective Coaching”. This book may be found online for purchase at lulu.com.
Section 5. State Agency Reporting, Third Party Authorization, and Quality Management
5(a). CCA Behavioral Health, PLLC provides routine and/or monthly internal reviews of records and services. In addition, providers review the provider manuals and other third party resources required to produce authorizations and quality services. This may include the use of additional outcome assessment measures to determine the eligibility of services. Records and/or progress reports are inspected based on designated formats (e.g. SOAP notes). For electronic records, progress reports and other forms of documentation are time stamped with the electronic access or log in date and time when the record or notation was created and/or reviewed. Corrective actions and monitoring are determined based on internal review. Patient education and other continuing education are considered after the review of internal and/or external audits.
5(b). For clients who are seeking social security income (SSI), there is no guarantee that benefits will be provided based on attendance of services. SSI clients who have not been seen within 90 days, the clinical file will be “closed” and no current mental status information can be provided or guaranteed.
Section 6. Court Related Services and State-Agency Services
6 (a). Court Ordered Services:
CCA Behavioral Health, PLLC provides community rehabilitation and counseling services according to state guidelines and procedures. All clients referred by state agencies must also abide by the policies and procedures of the state agencies AND these company policies. The clients that are court ordered for services have waived their private communications and therefore confidentiality is null and void. If the company receives subpoenas for court, it is the responsibility of the client and/or legal representation to pay for court related services.
Section 7. Forensic Consultations
7(a). Forensic Based Services:
CCA Behavioral Health, PLLC provides mental health evaluations and diagnostic consultations utilizing clinical interviews and standardized assessment measures. Expert and fact witness testimonies are provided based on a contractual agreement and/or approval from a legal representative and/or state agency. An agreement with client’s legal representation is recommended in conducting forensic services. Contact us for more details. Diagnostic consultations and substance abuse assessments are based on Daubert and FRE 702. Forensic services are not generally reimbursed by insurance companies.
As an overview, the following forensic or court related services are offered at CCA Behavioral Health, PLLC:
a. Forensic Mental Health
b. Substance Abuse Evaluations
c. Anger Management and/or Parenting
d. Therapeutic Visitations
e. Individual or Family Counseling
f. Forensic Interviews
g. Subject Matter Consultations for Personal Injury
h. Expert Testimony for Family Courts
Section 8. CCA Behavioral Health, PLLC Other Business Agreements or Contracts Addendum Policies (1-6)
8. Contracting Agreement
CCA Behavioral Health, PLLC and its affiliates are required to have a contractor/subcontractor agreement with CPA and/or all other business agreements in order to ensure compliance. This agreement must be negotiated and aligned with the policies and procedures of CCA Behavioral Health, PLLC. All techniques, approaches, goals assessments are proprietary with CCA Behavioral Health, PLLC.
8(a) Compensation
Services performed by CCA Behavioral Health, PLLC and its affiliates (clinical and non-clinical) that are not reimbursed by Medicaid will be sent to the client and/or contracting entity for payment within 30 days. CCA will also reimbursed employees, contractors, etc. within 30 days and/or contracted timeframe.
8(b) General Agreement and Policies
All clients and/or other contracted entities (e.g. companies,, etc.) must abide by the client general agreement and policies of CCA Behavioral Health, PLLC.
8(c). Null & Void and Termination
CCA Behavioral Health, PLLC requires a minimum active census of five (5) clients in order to maintain a contract or subcontract with any other agency. If the census is below the minimum criteria for 30 days, CCA Behavioral Health, PLLC will consider the contract null and void, suspended, or on hold. Once null and voided, CCA Behavioral Health, PLLC is not required to provide credentials and requisite documents or consults if the contract is inactive.
8(d) Clinical Coordination & Requirements
Unless specified in a contractual agreement with third parties such as managed healthcare companies (MCOs), CCA Behavioral Health, PLLC ONLY consults and receives recommendations for clinical treatment, diagnosis, and/or clinical coordination with other licensed healthcare professionals or certified professionals who are able to provide education, prevention, coaching, diagnosis, treatment, and/or assessment for life coaching, health and/or mental health conditions. With this, collaboration from clients who are also seen with other agreed affiliates will also provide consent to these organization for clinical coordination.
8(d). VI. Progress Information and Other Protected Information
If applicable, CCA Behavioral Health, PLLC will provide a confidential progress information to other parties. This includes but not limited to an overview of diagnosis, goals, and recommendations. The progress information will be HIPPA compliant (e.g. we will not provide psychotherapy or detailed process information). Administrative fees will apply to additional notes or copies.
Section 9. Playhouse, LEEP, and Other
9(A). SEC is an academic and life coaching affiliate of CCA Behavioral Health, PLLC. It is accredited by the Accreditation Council of Holistic Healers to provide non-clinical services such as life coaching. SEC offers stress/anger management and meditation through the online meetup calendar.
9(B). SEC provides a mentoring program for at-risk children between the ages of 6-16. These services are educational enrichment services designed to improve prosocialization. The program is outlined on the SEC meetup.
9(C). SEC provides clinical supervision and certification for selected students. An interview, assessment, criminal background check, and contractual agreement may be established for official employment, training, or certification. The details are noted on the SEC meetup.
9(D). SEC provides life coaching services in accordance to the policies and procedures of CCA Behavioral Health, PLLC.
9(E). Life Enrichment Educational Program (LEEP)
The LEEP program is offered to at-risk children and families. The LEEP program is an intensive weekly program designed for children (and adults ages with emotional and behavioral problems who are also designated as special needs students and/or children with disabilities. Parents and families participating in this program are required to utilize online and in office sessions. Documentation of these services are indicated in the client's record.
Therapeutic Level System of LEEP
Level 1
6-12 sessions; individual/family counseling or coaching
Level 2
12-24 sessions; individual/family counseling or coaching
Level 3
24-48 sessions; individual/family counseling or coaching
Section 10. Fees, Complaints and Dispute Resolution Practices
10(1). Current Fee Schedule
The current fess are posted on Psychology Today. All fees, payments, and services are non-transferable and non-refundable unless determined by management. Paid services must be completed within 30 days, unless otherwise specified in a written agreement. Payment plan options are provided. PayPal may be used to make Cash payments. You may also contact us at 214-694-5834 for specific details regarding fees and payment arrangements.
Section 11: DISPUTE RESOLUTION, GRIEVANCE PROCEDURES, AND SETTLEMENT RESOLUTIONS
11(a). Phase 1 Resolution:
All concerns, complaints, and disputes arising out of or in relation to CCA Behavioral Health, PLLC shall first be handled informally with the therapists, staff, clients, and management of CCA Behavioral Health, PLLC. You may contact us at 214-694-5834 to address any concern.
11(a)1. Advisory Committee
Concerns and complaints may also be addressed by the company's advisory committee and/or legal representative.
11(b). Phase 2 Resolution:
If a dispute continues, mediation will be provided prior to the initiation of arbitration, third party, or any other legal proceeding. The mediator shall be a neutral third party chosen by agreement of us and the client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed.
11(c). Phase 3 Resolution:
In the event that mediation is unsuccessful, any unresolved controversy related to CCA Behavioral Health, PLLC will submit to and settle with binding arbitration in accordance with the rules of the American Arbitration Association which is in effect at the time the demand for arbitration is filed. Notwithstanding the foregoing, in the event that a client account is overdue (unpaid) and/or there is no agreement, CCA Behavioral Health, PLLC can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or a collection proceeding shall be entitled to recover a reasonable sum as and for attorney's fees.
11(d). AUDITS, AGRREEMENTS AND OTHER FINANCIAL RESOLUTIONS
11(d)1. AUDIT RESOLUTIONS
As of January 11, 2021, in an effort to resolve any clinical and/or financial dispute, CCA behavioral Health, PLLC and its affiliates may request an independent review of findings and/or data (e.g. audits) from contracted parties, including but limited to information from insurance companies (e.g. manage healthcare companies) to resolve any clinical and/or financial matter(s). The agreements, settlements, and /or any other resolution may involve the submission of a corrective action plan and/or a binding agreement with the acknowledgment of these policies and procedures of CCA Behavioral Health, PLLC, to utilize but not limited to compliance monitoring and overpayment repayment.
11(d) 2.Settlements and Reduction Plan Rider Conditions
As an eligible Historically Underutilized Business in Texas, financial settlements with prior and/or subsequent identified bias, unfair, excessive and/or inaccurate audit analysis or procedures (e.g. incorrect methodologies, inaccurate extrapolations, poorly developed sampling , limited random selection, restriction of transparency) with contractual agreements and/or provider audits, involving federal, state, or governmental funding (e.g. managed healthcare companies) , the parties will accept this rider condition to any settlement agreement with CCA Behavioral Health, PLLC and its affiliates, to comply with Title VI of the Civil Rights Act of 1964 and any other relevant jurisprudence. Title VI of the Civil Rights Act of 1964 states that entities, such as companies or corporations, receiving federal financial assistance shall not do any of the following based on protected status: • Deny an individual a service, aid, or other benefit • Provide a benefit that is different or is provided in a different manner • Subject an individual to segregation or separate treatment • Restrict an individual (or contracted provider)in the enjoyment of benefits, privileges, etc. • Treat an individual differently when determining eligibility (or financial audits) • Select sites or facility locations that exclude protected individuals Federal Executive Order 13166. As a corporation that involves federal, state, and governmental financial assistance, all settlements must must comply with Title VI of the Civil Rights Act of 1964 as well as Executive Order 13166, which sets forth that persons with limited-English language skills have meaningful access to services and fairness. In addition, the settlement must comply with the CLAS standards (e.g. number 14) of Department of Health and Human Services Office of Minority Health. In respects to the above standards, they serve as a requisite guide to the development and execution of any settlement and cultural competence program, and to ensure that underserved and at-risk populations entering the healthcare system receive equitable and effective treatment without hardships on the providers (e.g. CCA Behavioral Health, PLLC) who are identified as significant traditional Medicaid providers of those communities.
11(d) 3. Reduction Methodology Involving Audit Errors with State and Federal Funds (Rider Clause)
With a party's acceptance of any corrective action plan from CCA Behavioral Health, PLLC and its affiliates, herein states the rider, to resolve and remedy, upon the 90th day of any settlement agreement, the parties will agree and accept any and all payments to be deemed paid in full by CCA Behavioral health, PLLC and its affiliates for financial audit overpayments and/or audit findings that contained methodological and/or statistical errors or extrapolations -AND/OR-agree to an optional 50% reduction plan of the overall outstanding settled balance while maintaining an identified 50% at risk, crisis, and/or underserved members and/or demographic census within 90 day timeframe(s) or documentary of evidence of such within a prior three year timeframe. The options to pay in full each monthly adjusted outstanding balance will be accepted as paid in full and/or payment installments and/or extensions will be provided to not exceed 60 months unless otherwise agreed. Payments for settlements and/or reduction plans will be submitted by check and/or other agreed methods. If applicable, payments will be sent with overpayment notification forms or notations to a specified address provided. Other reduction plans can be created and modified above in good faith to reduce hardships on CCA Behavioral Health, PLLC and its affiliates working with at-risk and underserved communities.
Above are the policies and procedures of CCA Behavioral Health, PLLC. Updated on 10/11/21.
Donald S. Chandler, Jr., Ph.D.
Owner/Director of CCA Behavioral Health, PLLC
The company and affiliates reserve the right to correct or modify these policies and procedures.
ALL RIGHTS RESERVED
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