Refferal and Enrollment

Referrals
Mains’l engages in conversations with the person requesting services.  We are committed to a collaborative approach when developing therapeutic supports for people.  

When a person contacts Mains’l about our services:

1. We gather basic information about the person, including therapeutic need/ presenting concern, funding type, personal information, availability, preferred characteristics and/or qualifications of therapeutic professionals.  
2. If during the conversation(s) it is determined Mains’l is a good fit for the person information sharing continues. The information gathered is used to assist with the development of the person’s therapeutic supports. Mains’l may ask for the following, as applicable/available:

• Person Centered Plan (Picture of a Life, MAP, Essential Lifestyle Plan, etc.)
• Support/program plan (i.e., Treatment Plan, Coordinated Service and Support Plan or Individual Program Plan)
• Personal Safety Plan (Individual Abuse Prevention Plan, Support/Program Plan)
• Individualized Education Program Plan – completed by school professional
• Medical and health care related information and/or assessments (psychological and/or psychiatric evaluation, diagnostic assessment, behavior assessment, physical therapy, dental, occupational therapy, audiology, etc.)
• Positive Support Transition Plan

1. If it is determined that the person and Mains’l are not a good fit and we are not going to provide services, the  therapeutic specialist will communicate the reason, give 3 possible sources for service and upon request provide written documentation of  the reason to the person, the person’s legal representative, and case manager. 
2.  When the person requesting services and Mains’l agree that we are a good match, 

a.    For waiver funded mental or behavioral supports the therapeutic specialist negotiates the service agreement with the case manager.  Upon receiving the service agreement, (or authorization that the agreement is in process), the therapeutic specialist begins developing services.

• For private health insurance funded mental or behavioral the therapeutic specialist provides the insurance information to the billing department to verify eligibility and check if for preauthorization of services is required. 

Enrollment for people using waiver funds 
When the person requesting services and Mains’l agree that we are a good match, the process of starting services begins. This procedure may vary, depending on the supports and needs of each person.

1. An enrollment meeting is scheduled by the therapeutic specialist, the person and/or their support team.  Meetings are held at a place agreed upon by the person and their circle of support. 

2. At the meeting, 

•  If a Person Centered Plan has not been created by/for the person, the team addresses who will be responsible to develop the plan, as appropriate.
•  All documents listed on the Enrollment Checklist will be reviewed and/or signed by the person and/or their guardian. 
• The therapeutic specialist offers a Mains’l Guidebook to Supports. The handbook includes policies and procedures on how we offer services. 
• A date when services will actually begin will be determined by the person and the support team
• The therapeutic specialist completes a Starting /Change of Service form to notify other Mains’l departments when services are starting.
• 3. The therapeutic specialist begins the process of developing a functional behavioral assessment, behavioral support plan and/or other assessments, as requested per referral. The requested document begins development as soon as possible (best practice 15 days but no later than 30 days after the initial starting services meeting) and is completed in the time frame agreed per team agreement (best practice no later than 150 calendar days from starting services date).

Enrollment for people using private health insurance 
When the person requesting services and Mains’l agree that we are a good match, the process of starting services begins.
An enrollment appointment is scheduled by the therapist. This appointment may include family members, care givers, significant others and/or legal representative.  

1.    At the enrollment appointment, 

• All documents listed on the Enrollment Checklist- private insurance will be reviewed and/or signed by the person and/or their guardian. 
• The therapist and person begin to develop the therapeutic relationship and treatment goals.  

2.    The therapist enters the person’s personal information into Therapy Notes and notifies the billing department when services are starting, when applicable. 

3.    The therapist begins the diagnostic assessment and/or treatment plan. These documents are developed within the first 2-4 meetings as appropriate to meet complexity of interrelated concerns and cultural needs.