To understand behavior intervention, it helps to first understand behavior. The word behavior generally means the way we act. All day long we display a series of behaviors that are viewed by ourselves and others as positive, negative, or neutral. It is important to note that behaviors don’t just happen. A person’s behavior communicates a want or a need. We form beliefs and respond to people based on our view of their behavior. In simple terms, behavior intervention is to intervene or take action to prevent or change a behavior.
At Mains’l;
1. Employees act in ways that create positive environments.
2. Employees apply the agency’s values, policies and procedures to make decisions at work.
3. Positive support approaches are the first actions employees take when intervening in another person’s behavior.
4. Aversive or deprivation procedures are not used.
5. Employees do not perform an emergency use of manual restraint unless they have completed training on this policy and procedure and have been trained in person and demonstrated competence in the safe and correct use of manual restraint on an emergency basis according to the requirements of the state or program rules (see references on last page).
6. We require documentation that positive approaches have been tried and have been unsuccessful as a condition of implementing an emergency use of manual restraint.
7. Employees treat people with dignity, respect and are trained to build their skills and knowledge related to how to do this well.
In the course of your time with Mains’l and in your personal life, you will be performing behavior interventions and people will be performing them on you. The procedures below provide definitions and examples of what we can’t do, what we can do and what we should do when it comes to intervening in someone else’s behavior. Let’s start with the bad and end with the good.
The things we cannot do (also known as prohibited procedures)
The following are not allowed as a replacement for proper supervision or staffing, to reduce or stop a behavior, as punishment, or for staff convenience:
In summary, we do not do these things. Not only do they make people unhappy, they generally do not work well to help people appropriately get their wants and needs met. Prohibited procedures may stop a behavior, but they do not teach a person what to do differently the next time. Prohibited procedures may also make a behavior worse. In addition, prohibited procedures can result in mental or physical injuries. We have better options for you, so please keep reading. We will cover the things you can’t do first and end with the good stuff, positive supports. Here are the simplified and technical definitions of prohibited procedures along with some and examples. 1. Chemical restraint:
2. Mechanical restraint:
3. Manual restraint:
4. Seclusion:
5. Time out:
6. Any other aversive or deprivation procedure:
The things we can only do in certain circumstances (also known as restricted procedures) 1. Procedures identified in a positive support transition plan
Employees working with a person who has a positive support transition plan receive training before working unsupervised. In Minnesota, Mains’l develops a positive support transition plan on the forms and in the manner prescribed by the commissioner of DHS for a person who requires intervention in order to maintain safety when it is known that the person’s behavior poses an immediate risk of physical harm to self or others. The positive support transition plan forms and instructions will supersede the requirements in Minnesota Rules, parts 9525.2750; 9525.2760; and 9525.2780. 2. Emergency Use of a Manual Restraint:
A restricted procedure (one approved in a positive support transition plan or an emergency use of a manual restraint) cannot: The things that we can do (also known as permitted actions and procedures) 1. Physical contact or instructional techniques must use the least restrictive alternative possible to meet the needs of the person and may be used:
2. Restraint may be used as an intervention procedure to:
3. Use of adaptive aids or equipment, orthotic devices, or other medical equipment ordered by a licensed health professional to treat a diagnosed medical condition do not in and of themselves constitute the use of mechanical restraint. The things that you should do (positive supports)
By using positive support approaches, we show respect and honor the dignity of people. We are also more likely to see decreases in the behaviors we don’t want to see and increases in the behaviors we do want to see. Responding to a challenging behavior 1. If appropriate or possible, remove all people, whose safety is threatened, from the immediate area of the threatening person. The procedures listed above are not used to respond to challenging behavior with a person when it has been determined by the person’s physician or mental health provider to be medically or psychologically contraindicated for a person. Mains’l will complete an assessment of whether the allowed procedures are contraindicated for each person receiving services as part of the service planning process. Staff Training a. Before having unsupervised direct contact with a person receiving service and annually thereafter, all employees who provide direct support receive instruction on prohibited procedures that address the following: 1. what constitutes the use of restraint, time out, seclusion, and chemical restraint; b. For the limited situations where the emergency use of a manual restraint may be allowed, before those staff may implement manual restraints on an emergency basis they must also be trained on the following within 60 days of hire:
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Mains’l Services maintains a system to regularly, consistently and accurately bill through Therapy Notes program and Minnesota’s automated Medicaid Management Information System, MNITS on behalf of clients enrolled in medical assistance programs.
Mains'l Services receives updates from contracted private insurance agency’s regarding current contracts, contract renewal, claim submission or service provision.
Mains'l Services monitors the Minnesota Department of Human Services web site (www.mn-its.dhs.state.mn.us) for any updates and changes to the procedures, tasks or responsibilities of the Agent in billing through MNITS.
Mains'l Services subscribes to any and all automated updates from the Minnesota Department of Human Services regarding billing through MNTS.
NEW CLIENT Clinicians add new client’s information into Therapy Notes and will send an email to Accounts Receivable (AR) department to check eligibility. The AR department emails clinician back with eligibility information. Once it is determined that the client is eligible to be seen; the clinician schedules an appointment with the client. The clinician will enter session information into Therapy Notes to be sent in for payment.
CO-PAYS
Clinician verifies in the client profile for co-pay in Therapy Notes. If applicable the Clinician asks the client to pay the co-pay at the beginning of the session. Clinician collects the co-pay and provides a written receipt to the client. If client is unable to pay at the time of service a statement will be generated within 30 days and sent to their address on file. Mains’l only accepts checks or money order.
CLAIM SUBMITTION
Clinician enters in all private insurance information required for billing by Therapy Notes. Therapy Notes notifies AR on the billing screen that there are entries for payment submission. AR electronically sends claims through Therapy Notes.
REMITTANCE ADVICE
Once the 835 form is electronically submitted into Therapy Notes from the clearinghouse AR applies all payments to the client’s claims. As payments are received and posted in Therapy Notes the AR department will add the date of payment, the amount of payment and payer into the spreadsheet located on the T drive/month end/Mental Health Payments for the general ledger account. A report is printed out for exceptions that the system is unsure of how to handle the reconciliation. The AR manager will research and resolve those exceptions.
For clients using Medical Assistance (MA) once the state receives the files and processes the claims that were submitted for payment the State of MN DHS will create an 835 file to be downloaded and the remittance advice to coincide with the information in the 835 file. AR will download the 835 file and print off the remittance advice to reconcile the payments.
If claim is denied for any reason AR corrects and/or investigates the denial reason and follows up, as necessary, with clinician. AR resubmits 835 form with correction to third party payer.
REVIEWAL OF EXPENSE/REVENUE
At month end, the Finance Coordinator reviews the general ledger to ensure accuracy of proper revenue and expense recognition.
AR and Chief Financial Officer will review the aging monthly to review and research any and all outstanding billings that may have been denied.
SYSTEM UPDATES
System updates are performed regularly to be in compliance with any changes to the procedures, tasks, or responsibilities of Mains’l Services in billing.
835 Form
Mains’l protects people who receive services from maltreatment through education and clear expectations of what to do when you suspect a person has been harmed or is being harmed. Minnesota has multiple laws about maltreatment used to inform our actions.
Definition:
Mains’l Clinical Services defines abuse as an expression of the misuse of power and control in a relationship. Abuse is any action or inaction that jeopardizes the health or wellbeing of a person. This can include physical, emotional, psychological, financial/economic, sexual, and spiritual or medication abuse, as well as passive or active neglect.
Clinical employees and/or clinical trainees follow mandated reporting requirements according to their governing licensing board. Suspected maltreatment must be reported within 24 hours of confirmed suspicion by the clinical employee or clinical trainee.
To report:
For clients who receive multiple services from Mains’l for example; Community Residential Services (CRS) and Psychotherapy the clinical employee and/or clinical trainee follows both the reporting requirements according to their governing licensing board and Mains’l’ s policy and procedure on Responding to and Reporting Maltreatment in Minnesota. This may result in one or two reports being made on the same incident due to potentially different reporting guidelines.
Responding to and reporting maltreatment in Minnesota, policy and procedure
The Health Insurance Portability and Accountability Act (HIPAA) stipulates that an individual’s personal information may be released without consent for the purpose of eliminating or reducing a significant risk of serious bodily harm to a person or a group of persons.
Mains’l protects the confidentiality of information related to clients within limits. These limits are discussed with all clients prior to beginning service and clients are asked to sign the Informed Consent document acknowledging that they have had these limits explained to them. This document also outlines the types of situations in which Mains’l may breach confidentiality.
Mains’l reserves the right to breach confidentiality to notify authorities, persons who know the client and/or persons who are at risk of harm in situations where the individual presents a significant and imminent risk of harm to himself/herself or others. This right is known as “duty to warn”. Mains’l clinical employees are not under a duty to voluntarily inform authorities regarding a client’s past or intended criminal act, except where there is a risk of imminent physical harm. Involving authorities may lead to the determination that the client needs to be detained for an involuntary assessment.
MN state statute: 148.975 sets out circumstances in which a physician, justice of the peace or police officer may detain a person for psychiatric assessment (i.e., an involuntary assessment) and the procedures for doing so.
Wherever possible, Mains’l clinical employees will obtain the client’s voluntary agreement to seek medical assistance.
The criteria for determining whether a disclosure of information is warranted should be based on the following guidelines:
Once it is determined disclosure of information is warranted, follow the procedures below for the identified harm.
Suicidal Clients
Whenever possible, Mains’l clinical employees will obtain the client’s voluntary agreement to seek medical assistance.
When a client is not willing to seek assistance, Mains’l employees have a duty to disclose a client’s active suicidal ideation and/or plan to commit suicide. The employee’s disclosure may include, without being limited to:
Clients who present a clear risk of violence or harm to others
Mains’l clinical employees have a duty to warn the intended potential victims of threatened violence.
Assaultive Partners
Persons who are assaultive may be seen on a voluntary basis. Mains’l remains obligated to initiate contact with the partner (or others threatened) where there is a risk of imminent harm to the partner.
In all situations, Mains’l clinical employees document the situation, including
Health Insurance Portability and Accountability Act (HIPAA)
MN state statute: 148.975
Requests for mental or behavioral health service are accepted from people requesting supports for themselves, their caregivers, family members and guardians, other providers, and social service agencies. Mains’l accepts referrals from people without regard to race, gender, age, disability, spirituality, or sexual orientation, and our practices are consistent with service recipient rights afforded to all people.
Mains’l uses a person centered approach to discover if the person requesting services and Mains’l are a good fit, based on needs, and our ability to meet the person’s level of care. We do not refuse to offer services to a person based solely on the type of services the person is currently receiving, the degree of their emotional, physical or intellectual abilities, type of communication style, or past success rate. If we cannot meet a person’s service needs, documentation regarding the reason will be provided to the person, the person’s legal representative, and case manager, upon request.
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:
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.
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,
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,
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.
Enrollment Meeting Checklist- behavioral health waiver funded
Enrollment Meeting Checklist- private insurance
Starting Services/Change of Service form- waiver funded people
Mains’l Guidebook to Supports- waiver funded people