Admission Handbook

Our Mission

To enable individuals who we support to access services, make choices, pursue aspirations, live and interact with dignity and respect in their communities.

Supporting individuals we serve in discovering and creating what they most want in their lives. Community Innovations assists individuals in finding the gifts in all aspects of themselves and focuses on what’s working and build on that. Community Innovations builds a bridge between where the individual is and where they want to be.

We realize that individual goals change as each person progresses in the journey of life. Everyone has a different starting point, and may be working towards a different end goal. This is why Community Innovations believes it is important that we provide a variety of services to meet the needs of persons we serve. Community Innovations works to maintain a positive working relationship with other service system providers to ensure that the individual is linked to needed supports and can assist individuals in selecting their recovery goals.

Community Innovations values human diversity and respects differences. We are committed to providing services in a manner that is sensitive to cultural differences and that do not discriminate against individuals on the basis of race, ethnicity, creed, religion, sex, age, sexual orientation, national origin or mental or physical disability.

Community Innovations continually searches for and develops community partnerships, natural supports, and advocacy involvement of community members and significant others to create an atmosphere of self-sufficiency and interdependence for the individuals we serve.

Thank you for choosing Community Innovations, Inc.

What can I expect at my first appointment?

People are often nervous on their first visit with an agency such as Community Innovations.  Sometimes not knowing what to expect can cause anxiety in many people.  We hope this information will decrease any anxiety you may have and help you begin your recovery process.

Your first visit with a Community Innovations staff member may vary in length depending on how you were referred to us.  However, the following information is consistent with everyone’s first appointment with us:

1. An assessment of your current needs is completed.  This assessment will include getting important medical and psychiatric information from you.  Please share any and all information that will assist in your treatment. It is important that you provide clear and concise information related to your current and past psychiatric history during the assessment process.

2. The completion of a registration form that provides Community Innovations basic information about you.

3. This handbook along including your Individual Rights, and HIPAA – Notice of Privacy Practices (a brief explanation of the federal laws that ensure the protection of your privacy) will be explained to you.

4. A person-centered-plan is your plan for recovery. The person-centered-plan that you develop with your team is a snapshot of what you would like your future to look like.  The plan will begin to be developed at or shortly after your first visit and will assist in identifying what services you may want to receive based on your individual needs. We will assist you in identifying individuals whom you would like involve in the person-centered planning process. Throughout your services with Community Innovations, staff will assist you in reviewing, updating and carrying out this plan. Ongoing review of the plan allows for continuing input and assessment of progress. Your plan, goals and/or services may be changed at any time you desire or as your needs change. 

5. Part of the person-centered plan is a crisis plan.  This crisis plan is developed with you and people who support you to identify potential health and safety issues and the services and supports needed to address these issues.  The crisis plan helps us all to know what works best in emergency situations.

6. We will make every attempt to help you select staff members who have expertise working with your identified needs.

How long do services last?

Some Community Innovations services are designed to be short-term. However, recovery is a unique and individualized process with NO specific time-frame for you to achieve wellness. Through the person-centered planning process, we will assist you in identifying ways to know when you have made progress toward your goals and no longer need services.  This process may also identify other services you may need.   While there are some time limited services provided by Community Innovations, we will continue to advocate for your needs and will assist you in securing services that are medically necessary.

Discussions of transitioning and discharge from services will begin soon after you start services and will continue throughout your recovery process. Community Innovations is an active member of the service provider network in each community we serve, and as such, we will proactively ensure that you are clinically transitioned to service providers in a manner that does not interrupt continuity of care. This will be accomplished through service coordination: active communication with the service provider and / or local LME and through the disclosure of treatment information, as authorized by you and/or the legally responsible person.

When applicable, Community Innovations, Inc. has a legal responsibility to report treatment outcomes to the Court / Judge if an individual does not enter participate or complete services as defined by out-patient commitment orders.

If you request a change in a staff member or if you choose to change provider agencies, Community Innovations will do its best to respond to your request.  If you feel the need to have a change in a staff member, please try to talk with the current staff member about the needed change or if that is not possible, please talk with a manager.  You have the right to change the provider agency you are receiving services from at any time.  If you choose to do so, please let your team know so they may assist you in the transfer process and ensure that you do not go without services for any length of time.

What are my Rights?

The State of North Carolina, your Local Management Entity (LME) and, in some cases, the Federal Government has developed rules and laws regarding your rights as a individual of Community Innovations.  Attached is a copy of these rights, which will be explained to you when beginning services and annually thereafter. Community Innovations staff will give you the opportunity to ask questions about your rights and will provide any additional information to help with your understanding of them. Any other time you have any questions regarding your rights, feel free to ask a Community Innovations staff member.  Please read these rights carefully, as you will be asked to sign a form stating that you have received and understand them. If at any time you feel your rights have been violated, you may use the grievance procedure described in this handbook.

What do I need to know about Community Innovations’ policies, general rules and expectations?

Typical Office Hours:   Monday – Friday, 8:30 AM – 5:00 PM.

We will make every effort to make appointments convenient for you.  Many of the individuals served by Community Innovations receive their services out of the office and therefore receive appointments after the typical office hours.

Access to After Hours Services: Community Innovations maintains a crisis system that includes a designated, after hours, on-call crisis clinician OR other responsible professional who is available to persons served, consumer’s families and/or other recognized supports and agencies, for direct telephone contact and possible face-to-face crisis management on a 24 hour, 7 days a week, 365 days a year basis.  The after hours staff member will have access to the consumer’s crisis plan to assist with the crisis.  During typical business hours, it is expected that persons served and other community agencies be able to directly contact a Community Innovations office for assistance.  In the event of a crisis, individuals can refer to the list of key contact telephone numbers and addresses provided at admission.

The after-hours phone is not to be used to cancel/make appointments or ask for a refill on medication.  This service is provided to respond to emergencies. See the back page for the afterhours phone number.

Smoking: Smoking is not allowed in any Community Innovations building.  Please ask office staff where designated smoking areas are located. 

Safety: Community Innovations tries to ensure that all offices, facilities, and vehicles are maintained and operated in a safe and clean manner.  If you witness anything that requires attention in this area, please notify a staff member.

Services may be provided to you in the community or in your home.  We ask that you be mindful of the safety of our employees.  Please keep pets secure and alert staff of any potential risks prior to their visiting your home.

When entering a Community Innovations facility, please take a moment to refer to the facility map, which identifies the location of first-aid kits, fire extinguishers and exits. If an emergency is announced or a warning siren is sounded while in our office, please follow the directions of the Community Innovations staff you are with at this time. 

Violence and threats of violence directed at staff will not be tolerated by Community Innovations, Inc. All acts or threats of violence directed at staff will be documented and reported to Community Innovations management, referring agencies and/or local law enforcement.

The following items are unauthorized articles and are not permitted on Community Innovations premises or in vehicles being used for or in the anticipation of Community Innovations business or service delivery:

1. Fire arms, spring loaded knives, or other items that can reasonably be considered a weapon.
2. Fire works
3. Stolen property
4. Illegal drugs
5. Alcohol

Community Innovations employees will not deliver routine services to individuals who exhibit symptoms or behaviors suggestive of being under the influence of alcohol / other illegal drugs. If, however, it appears that individuals' have potential dangerousness issues relative to the current use of drugs or alcohol, clinically appropriate interventions will be initiated, relative to the individual situations. In addition, Community Innovations employees will not deliver services to individuals who are known to be in possession of a weapon.

Transportation:  In some situations, transportation may be provided to assist you in your participation in services.  Community Innovations will request written permission to transport the individual and others that are actively participating in the individual’s plan for recovery. Please be assured that Community Innovations carefully reviews the driving record for all employees before they are hired. In addition, staff receive training in Defensive Driving skills upon employment and annually thereafter.

Emergencies:  Occasionally, accidents happen and may occur when a guardian is not present. Therefore, you will be asked to provide consent for Community Innovations to seek medical care for the individual in the event of an emergency. In preparation for a potential emergency, all Community Innovations staff is trained in First Aid and CPR and have access to First-Aid kits.

Upon admission, you are asked to provide emergency information including any allergies you may have.  Please complete this form as accurately as possible and notify Community Innovations of any changes to this information.   

Search and Seizure: All persons receiving services by Community Innovations shall be free from unnecessary invasions of privacy.  However, searches and/or the seizure of property may be required when there is good cause or the reasonable indication of possession of stolen property, illegal substances, items which may be health-threatening or dangerous, or other items not allowed by the facility.  Staff must follow the Community Innovations policies on search and seizure.  These policies are available to you at your request.

Suspension and Expulsion: All persons receiving services from Community Innovations are free from the threat or fear of unwarranted suspension or expulsion from services.  If program rules are broken or a person being served chooses to not engage in services, Community Innovations may choose to terminate services.  If you are suspended from programming, staff will meet with you to develop a specific plan of expectations and behaviors that must occur to be reinstated.  You will also receive a letter explaining your suspension or termination from the program and your right of appeal.

Use of Emergency Interventions: Community Innovations periodic service programs use emergency interventions only in the event of an assault or aggression that poses a risk to the individual served or others. Use of a physical hold will be a time limited, approved physical hold by designated, trained and competent staff. A physical hold will be used only as an emergency intervention until law enforcement or other emergency service provider can arrive.

Personal Valuables: Please be aware that Community Innovations assumes no responsibility for any personal items you may bring with you during your service.  This includes jewelry, money, or anything else which may get lost, stolen, or broken.

Service Records: Upon admission to Community Innovations, all of the services provided to you must be documented.  This documentation is kept in your service record.  Your service record is the property of Community Innovations and is maintained for the benefit of the individual, clinical staff, and the agency.  The service record will be protected against loss, tampering, and use by unauthorized persons.  At any time you wish to review your service record, please ask a Community Innovations staff member to assist you with this process.  He or she will provide you with the “Consumer Request to Access Record Form” and assist you in completing it.  The process for reviewing your service record is outlined on this form.

Medical Necessity: If your services are paid for by private insurance, Medicaid, or state funds you will need to meet certain criteria to receive services. This is called “medical necessity.” Upon admission, your diagnosis, history and needs will be reviewed to determine what services you are eligible to receive. The services that you qualify for will be discussed with you on your first visit and you will decide which of these services you would like to participate in.  Throughout your services with Community Innovations, you will be reassessed to make sure you are meeting the requirements for services. 

Outcome Measures: Community Innovations uses a variety of tools to measure the outcomes of the services we provide.  Community Innovations welcomes and values your feedback. We would like to know how we are doing and will routinely distribute a Satisfaction Survey to all persons served.  Please take the time to complete and return this survey.  This survey will assist us in identifying areas we need to improve and can be anonymous if you so choose.  Community Innovations also uses information gathered by the NCTOPPS (North Carolina Treatment and Program Performance System) or the NC SNAP.  The NCTOPPS is completed with the individual at admission, three and six months into services, annually and then at discharge.  The NC-SNAP is a needs assessment tool that is done annually or in the event of a significant change that measures an individual's level of intensity of need for developmental disabilities supports and services. It is expected that the individual will cooperate with this process, as it is a requirement of the Department of Health and Human Services for all persons served.

Complaint/Grievance Procedure: While it is the intent of Community Innovations to provide quality services, there may be times when you are dissatisfied with those services or have a disagreement with a staff member. You are encouraged to express your concerns, complaints, and grievances without fear of retaliation or unwarranted reduction, suspension or expulsion of services. To communicate a grievance, please take the following steps:

a.     The individual or the legal guardian is encouraged to resolve the concern directly with the staff member.  Any concern communicated by the individual or the legal guardian to a staff member delivering services will be addressed in a prompt and professional fashion. 

b.     The individual or the legal guardian may choose to communicate the complaint directly to the staff members’ direct supervisor or the Program Director.

c.      If the individual or the legal guardian is not satisfied with the initial efforts to resolve the complaint, Community Innovations staff will provide the individual or the legal guardian with an additional explanation of the formal grievance process and a Community Innovations grievance form.  

d.     At any time you can call our Compliance Hotline at 1-800-932-5378. Reports can be made anonymously. The Hotline is operated by an independent Hotline Vendor.  You can call the hotline to follow up on how Community Innovations handled the matter.

e.     At any time an individual or legal guardian may contact Carolina Legal Assistance (1-800-821-6922), the home-health hotline at the Division of Health Service Regulation (1-800-624-3004) and/or LME’s Customer Service Department (910-738-5261).

f.       Community Innovations staff and/or the supervisor will notify the Program Director of the presenting complaint.  This process will be carefully documented by the staff.

g.     The Program Director receives and reviews all written complaints and then will contact the individual or the legal guardian within 5 working days, in an effort to resolve the situation.

h.     If the Program Director is not successful in resolving the complaint, he or she will provide the Director of Quality Assurance with written notification of the grievance within 2 working days.

i.        The Director of Quality Assurance will contact the individual or the legal guardian and will address the grievance to attempt to achieve a mutual resolution within 2 working days.

j.       Similarly, if this effort is unsatisfactory to the individual, the same process will be initiated to involve Community Innovations’ CEO, or his or her designee, who will contact the individual or the legal guardian, to schedule a meeting within 5 working days.

k.     Decisions rendered by the Community Innovations President or his or her designee represent final authority within the Community Innovations, Inc. organization. Therefore, if resolution cannot be achieved, Director of Quality Management will re-inform the individual of their right to involve a third party mediator, such as the monitoring LME and/or the Division of Health Service Regulation.

l.        All complaints and grievances are reviewed by the Individuals served Advocacy and Human Rights committee and Quality management quarterly.  These committees may make additional recommendations for corrective actions and/or service improvements.

m.  If these steps do not resolve the grievances, the individual or legal guardian is encouraged to contact Carolina Legal Assistance or the local LME Consumer Rights Advocate.

Mental Health Advance Directives: At the back of this handbook there is additional information on Mental Health Advance Directives. If you already have a Mental Health Advance Directive, please give a copy to Community Innovations to place in your service record.   If you have questions about Mental Health Advance directives or need assistance in accessing Mental Health Advance Directive forms please ask a staff member for help.

Confidentiality / HIPAA: Information about you and the services you receive with Community Innovations are confidential. Community Innovations will only release information with your signed authorization. Your authorization may be withdrawn at any time, but will expire no later than one-year from the date you signed it. However, Community Innovations is bound by law to report any suspected abuse, neglect, exploitation of a child or any information shared with a staff member that may cause serious injury to yourself or others. Included in this handbook is a copy of the Community Innovations Notice of Privacy Practices. This Notice of Privacy Practices is also posted in the waiting area of each program. If needed, you may request a copy at any time or go to the Community Innovations website at: www.communityinnovations.com.

How can I help with services?

1. It is important that you attend your appointments as scheduled.  If you are unable to attend or will not be on time, it is important that you call to notify the individual with whom you have an appointment as soon as possible. Please be aware that staff will not typically hear messages left for them after business hours until the next work day. If an individual is frequently late or misses appointments without notification, they may be placed on “walk-in” status or administratively discharged from services. Please note that some Community Innovations services may provide support with your transportation needs. Therefore, discuss these needs with staff.  

2. All persons served by Community Innovations are expected to comply with routine paperwork requirements such as NC TOPPS, surveys, annual updates and more.

3. Various services have different fees.  Any fees you are required to pay will be discussed with you when starting a service. If you participate in programs that require a co-payment, you will be provided with a receipt. However, it is your responsibility to request a balance statement.

4. Community Innovations will need documentation verifying your insurance/Medicaid coverage upon admission and on a monthly basis.  If you have a change in insurance, it is important that you notify Community Innovations staff immediately. Any intentional misrepresentation of insurance may result in the termination of services. In the “Description of Community Innovations’ Person Centered Services” below, we provide a brief summary of the insurance companies that cover specific services. Please refer to this summary and feel free to ask any questions of Community Innovations staff.

5. Please keep Community Innovations updated on any changes in address or contact telephone numbers.

6. Please keep Community Innovations informed of the medications that you are taking. If your medication changes please make Community Innovations aware immediately. It is useful for us to have the following information: name, dosage, route in which medication is taken, and frequency of dosage. 

7. At times a reward or incentive plan or homework is part of the recovery process.  It is important that you follow through on homework or support and be consistent with efforts to reward progress.  If there is concern about any reward/incentive program or homework, please consult your staff member or a member of management.

8. Participation in an Individual served and stakeholder advocacy committee (ISSAC) which meets quarterly.  This group is intended to help promote the rights and wellbeing of the individual’s served by CI. This advocacy forum will help CI management improve service provision by reviewing incidents for trends and patterns, asking questions about specific incidents or company procedures and making recommendations for improvement.  This is an opportunity for participants to provide input as CI continues to refine and improve services, operations, evaluation methods, organizational structure, and policies. For more information call 1-800-783-1268

What can I expect from Community Innovations staff?

1. Community Innovations staff are expected to observe a professional Code of Ethics. The Community Innovations Code of Ethics call for staff to be professional, respect the rights, dignity, and value of all people, work as a team, and be responsible and fair in the services they provide. If you have any concerns or questions, you are encouraged to speak to member of Community Innovations Management.

2. You can expect the timely delivery of Community Innovations services. On occasion, emergencies come up with staff assigned to work with you.  The Program Director will make every attempt to arrange for alternate providers; however, this is not always possible.  A Community Innovations staff member will notify you as soon as possible of any changes of schedules or personnel. 

What services does Community Innovations provide?

Adult and Child Basic Services:

• Psychiatric Services: A licensed psychiatrist is available for evaluations and medication management. Psychiatrists are able to accept most major, private insurances, along with Medicaid, Medicare, Health-Choice, and IPRS (North Carolina funds for uninsured consumers).

·         Clinical Assessment: An intensive clinical and functional face-to-face evaluation of a recipient’s mental health, developmental disability, or substance abuse condition that results in the issuance of a diagnostic report with a recommendation regarding services and provides the basis for the development of a Person Centered Plan (PCP). It also evaluates the recipient’s level of readiness and motivation to engage in treatment and to meet clinical needs. For this service, Community Innovations accepts Medicaid, Medicare, IPRS and other limited private insurances.

• Outpatient Therapy: Community Innovations clinicians can provide assessment, individual, group, and/or family therapy. This service can be provided in the home or in an office setting. Community Innovations accepts Medicaid, Medicare, IPRS and other limited private insurances.

Adult and Child Enhanced Services:

The following services are covered by Medicaid, Health Choice (for children and adolescents) and by North Carolina State funds (IPRS). Please note: Local Management Entities (LME) determine what will be paid for by state funds for Mental Health Services. The distribution of these funds may vary, and may limit the amount of services you are able to receive. If you have any questions or concerns regarding these funds, please contact your local LME.

• Community Supports: A service delivered to both children and adults that focuses on assisting the individual, and often the family, in achieving and maintaining recovery goals. Community Support Services may be provided by a combination of a Qualified Professional, Associate Professionals or Paraprofessional workers and include a range of service activities, including arranging for and coordinating additional services and providing community based skill-building activities, in areas such as budgeting, social skills, work readiness and symptom management.

Recipients of Community Support are eligible for the service when experiencing difficulties in at least one of the following areas:

§         At risk for hospitalization or being placed outside the natural living environment  OR is currently placed outside the natural living environment;

§         Receives or needs crisis intervention services;

§         The Department of Social Services has substantiated abuse, neglect, or established dependency.

Adult-Specific Enhanced Services:

• Community Support Team: An intensive community rehabilitation service for adults that provides treatment and restorative interventions to assist individuals to gain access to necessary services, reduce psychiatric and addiction symptoms and develop optimal community living skills.

The service activities include: assistance and support for the individuals in crisis situations, service coordination, psycho-education and support for individuals and their families, individual restorative interventions for the development of interpersonal, community coping and independent living skills, development of symptom monitoring and management skills, monitoring medication and self medication.

Youth-Specific Enhanced Services:

• Intensive In-Home (IIH):  A time limited (3-5 months) program designed to provide youth and families with assistance diffusing current crises, improving parenting and coping skills, & enhancing relationships. Community Innovations' Intensive In-Home team provides skills and training to empower families through practices that lead to success.  The primary goal is to prevent out-of-home placement or to successfully transition the youth back into the family’s home. IIH is delivered primarily in the family’s home and requires participation from the entire family in order to achieve the most favorable results. Services are more intense in the beginning as families are asked to participate in 15-20 sessions during the first month each lasting approximately 2 hours.  Sessions are reduced as progress is made. IIH staff is available for crisis response 24 hrs a day, 7 days a week.  

Child and Adult Developmental Disabilities Services:

• Targeted Case Management (TCM):  Case management program provides assessment, service planning and coordination, and advocacy services. At admission, each individual receives a formal assessment. The assessment is used to develop an person centered plan, which includes the individual’s  needs and preferences around daily living, residential, work/education, social and other community-based services and supports. The plan is assessed and revised on an ongoing basis, according to the individual’s needs as they change over time.

• Community Alternatives Program for Persons with Developmental Disabilities (CAP MR-DD): CAP MR-DD offers specific services in the community for individuals of all ages who require an ICF-MR level of care. Services address the needs of individuals in their community and insure person-centered planning for each individual. Services provide for simplicity and ease of service delivery. The service promotes movement of individuals to the community from intermediate care facilities.

Individual Rights

Community Innovations, Inc. abides by policies of the State in assuring basic human rights to all persons served. It is contrary to Community Innovations, Inc. policy for staff to restrict rights or privileges of consumers. Below is a summary of rights which you, as our individual, will be guaranteed.

Your rights are guaranteed by law: You have the same basic civil rights and remedies as other citizens; including the right to buy or sell property, sign a contract, register and vote, access self-help and advocacy support services, access legal entities for representation, sue others who have wronged you, and marry or get a divorce.  You also have other rights guaranteed by North Carolina General Statutes 122C, Article 3, including the right to dignity, privacy, humane care, and freedom from physical punishment, abuse, neglect, and exploitation. If a court orders someone to have a legal guardian, some additional rights will involve that guardian. It is the responsibility of the program that you are receiving services from to provide you or your legal guardian with a written summary of your rights at the initiation of service delivery.

You have the right to investigation and resolution of alleged infringement of rights: If in the event you feel that your rights have not been respected, you have the right to file a formal grievance to Community Innovations, Inc. the managing LME or you may choose to contact other advocates to initiate the process of investigation. You have the right to receive a timely resolution to this alleged infringement. In addition, all alleged infringement of rights will be reviewed in Community Innovations, Inc. Individual Rights committees.

You have the right to a treatment plan:  A written treatment plan, based on your individual needs, must be implemented upon admission. You have the right to treatment in the most normal, age-appropriate and least restrictive environment possible.  You have the right to take part in the development and periodic review of this plan. You have the right to have access to information in a manner that allows you sufficient time to make an informed decision regarding your preferred treatment needs. You are entitled to review your treatment plan and obtain a copy of it from your therapist or medical records. 

You have the right to be informed about medications:  You have the right to have medication administered in accordance with accepted medical standards and upon the order of a physician.  When medication is needed, you have the right to receive it in the lowest possible therapeutic dose.  You cannot be treated with experimental drugs or procedures without your written permission and without being informed of the risks, benefits and alternatives.  You many refuse to take medication. If you choose to do so, you will be informed of the risks.  Medication cannot be used for punishment, discipline or staff convenience.

You have the right to refuse treatment:  Before you agree to your plan, you will be informed of the benefits or risk involved in the services you will receive.  You have the right to consent or refuse services, including involvement in research projects, and may withdraw your consent at any time.  If you have asked to receive services, you always have a right to agree to refuse any specific treatment. You have the right to consent or refuse treatment based on the composition of the service delivery team.  The only time you can be treated without your consent is in an emergency situation, when it has been court-ordered, or if you are a minor and your parents have given permission. Please note: the gravity of some emergencies may require law enforcement assistance or initiation of involuntary commitment procedures. 

You have the right to confidentiality: The confidentiality of your treatment is protected by law.  Except as required by law and agency regulations, your records and other information about you will not be released without your written permission.  Instances in which we may be required to share information with another party about the services you receive are if:

§            You give permission to share information about your care with your next of kin, a family member with a legitimate role in your service, or another person whom you name;

§            It is believed that it is in your best interest that your next of kin be informed that you are a individual;

§            An advocate needs to review your record when assigned to work on your behalf;

§            The court orders us to release your records;

§            Our attorney needs to see your file due to legal proceedings;

§            Another public agency needs to receive your files when your care is transferred;

§            You become imprisoned and the court orders us to share your file with prison officials;

§            In an emergency, another professional treating you requests your records;

§            It is found necessary for a physician or other professional who referred you to our facility to receive your files;

§            We believe that you are a danger to yourself or others; we could share information with law enforcement.

Special rules may apply if you have a legal guardian appointed, are a minor, or are receiving treatment for substance abuse.  Refer to the “Notice of Privacy Practices” for instances in which permission is and is not needed. You have the right to see your own records except under certain circumstances specified by law.  You have the right to have those circumstances explained to you.

You have the right to be informed of the rules: You have the right to be informed of the rules that you are expected to follow in a particular program, service or facility and possible penalties for violation of the rules.  This information will be provided when you begin services. You have the right to be free from unwarranted suspension or expulsion from programs and services.  If you are discharged from a facility, you are entitled to a copy of your discharge plan.

You have the right to know your treatment costs: Fees should be discussed with you prior to beginning a service. If this does not occur, please let us know. A listing of charges for services is available to you upon request. Community Innovations may bill specific private pay insurance companies, and will assist you with plans outside our network. However, it is your responsibility to make arrangements to pay your bill.

You have the right to privacy: You have the right to be free from any unwarranted search of your person or property.  Should search and seizure apply to a program from which you are receiving treatment, the specific procedures will be explained when you enter the program. At the time of admission to a 24-hour facility, staff may search you and your belongings to prevent dangerous or illegal substances from being brought into the facility.  The facility itself may be searched if dangerous or illegal substances are reasonably believed to be present, and staff may search individuals who are minors. 

You have the right to freedom from abuse, neglect, exploitation and humiliation:  You will not be subjected to the use of corporal punishment or the use of physical restraint or seclusion as a therapeutic treatment. At the time of admission to a specific program, you will be informed of the types of interventions that are approved for use by that program.  The program cannot administer any potentially painful or humiliating procedure or stimulus to reduce the frequency or intensity of a behavior. Employees must protect persons served from harm and report any form of abuse, neglect or exploitation.

Therapeutic interventions and devices may never be used as retaliation, for the convenience of staff, or in a manner that causes harm or undue discomfort.

You have the right to make instructions for your treatment in advance:  You may choose to plan in advance of becoming incapacitated and unable to make decisions about your treatment, you may prepare a document, which outlines your intentions for your treatment, and a person to make decisions based upon your instructions.  If you are interested in exercising this right, additional information and resources can be found on page 18.

You have the right to make a complaint:  If you are dissatisfied with a Mental Health, Developmental Disabilities and Substance Abuse service delivered through the LME or Community Innovations, you have the right to state a compliant or file a grievance at any time.  Before stating a written complaint, we encourage you to first discuss the matter with staff of the program providing the service and allow them an opportunity to help resolve it.  If this is unsuccessful, we encourage you to complete and forward to us a compliant form, which you may request from staff of any MH/DD/SAS program or contract affiliate.

You have certain appeal rights:  If you have Medicaid, you have the right to request an appeal hearing if you are denied a requested service, or if current services are reduced, suspended, or terminated.

Please feel free to contact your Community Innovations, Inc. representative for further clarifications of your rights.

You can also gain further information regarding your rights from:

LME Individual Rights Committee or other LME Liaison:

910-738-5621

Carolina Legal Assistance:

1-800-821-6922

National Alliance on Mental Illness (NAMI):

Consumer Helpline (800) 451-9682

Monday – Friday: 8:30 am to 5 pm.

http://www.naminc.org/

The North Carolina Careline:

1-800-662-7030

Division of MH / DD /SA Services Advocacy and Customer Service Section:

919-715-3197

Division of Health Service Regulation

Complaint Hotline: 1-800-624-3004

Complaint Hotline Hours: 8:30am - 4:00pm

A Summary of the Provisions of Article 3 of Chapter 122C of the General Statutes

Prepared December 17, 1996

North Carolina Area Programs and Medicaid Rights

In North Carolina, local management entities (LME’s) coordinate mental health, developmental disabilities and substance abuse services for children and adults. The

LME in your region works closely with the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services. The LME’s job is to evaluate your treatment needs. Sometimes, evaluations show that a person who requests a specific service may not benefit from or qualify for that service. Sometimes, evaluations show that a person who is receiving a service may

no longer need the service. When the LME makes either of these clinical decisions, they must inform you in writing. The letter contains:

�� The reason for the LME’s decision;

�� The laws that support your appeal rights; and,

�� The appeal steps and deadlines.

What Is a Medicaid Appeal?

You have the right to disagree with and appeal the LME’s clinical decision to:

�� Deny your request for services; and/or

�� Reduce, suspend or terminate a service you are currently receiving. You appeal the decision by following federal and state laws to resolve the disagreement. This brochure outlines the appeal rights available to people who receive Medicaid help. If you have questions, you can call the LME or the Customer Service and Community Rights Team of the Division. Their phone

numbers are shown on the back. You can call the NC CARE-LINE Information and Referral Service free at (800) 662-7030 and they will refer your call. Don’t delay.

Appeal Hearings

If you wish to appeal, you have the right to a review by someone who was not previously involved in the clinical decision you are appealing. This review is called a hearing. North Carolina offers two hearing choices.

Choice 1. A Hearing by the Division of Mental Health, Developmental Disabilities and Substance Abuse Services

1. Complete the appeal form attached to the letter sent by the LME. Follow the instructions.

2. File your appeal by the appropriate deadline. The Division office must receive the form within 11 days from the date of the LME letter.

3. If you want to discuss your appeal with the LME first, the Division will ask the LME to schedule a local review. If not, the Division will schedule a Division hearing.

4. Division hearing may also be held in your community. You are encouraged to attend. 5. If the disagreement is not resolved in a local LME review or in a Division hearing, you have the right to a higher state hearing. Note: If you lose the appeal, you may be asked to pay for the services you received during the appeal time, according to law.

Choice 2. A Hearing by the Office of Administrative Hearings in Raleigh

You have a right to appeal directly to this hearing office or appeal to it after a Division hearing decision.

1. Call the hearing office at (919) 733-2698.

2. Tell the office staff that you want to appeal the LME decision.

3. Ask for a petition form and follow the instructions.

Contact...

NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services, Customer Services and Community Rights Team

(919) 715-3197

NC CARE-LINE Information and

Referral Service

(800) 662-7030 (TTY/Voice/Spanish)

for direct connection to a state office Or call your local management entity.

Groups Who Offer Support and Advice

Governor’s Advocacy Council for Persons with Disabilities

(800) 821-6922 (TTY/Voice)

The National Alliance For the Mentally Ill in North Carolina

(800) 451-9682

The North Carolina Mental Health Consumers’ Organization, Inc.

(800) 326-3842

Alcohol/Drug Council of North Carolina

(800) 688-4232

The Arc of North Carolina

(800) 662-8706

Contact Your Local Management Entity

910-738-5621

The information on Appeals was developed by the Division of Mental Health, Developmental Disabilities and Substance Abuse Services 07/04.
 Medical Care Decisions and Advance Directives- What You Should Know

What are My Rights?

Who decides about my medical care or treatment?

If you are 18 or older and have the capacity to make and communicate health care decisions, you have the right to make decisions about your medical/mental health treatment. You should talk to your doctor or other health care provider about any treatment or procedure so that you understand what will be done and why. You have the right to say yes or no to treatments recommended by your doctor or mental health provider. If you want to control decisions about your health/mental health care even if you become unable to make or to express them yourself, you will need an “advance directive.”

What is an “advance directive”?

An advance directive is a set of directions you give about the health/mental health care you want if you ever lose the ability to make decisions for yourself. North Carolina has three ways for you to make a formal advance directive. One way is called a “living will”; another is called a “health care power of attorney”; and another is called an “advance instruction for mental health treatment.”

Do I have to have an advance directive and what happens if I don’t?

Making a living will, a health care power of attorney or an advance instruction for mental health treatment is your choice. If you become unable to make your own decisions; and you have no living will, advance instruction for mental health treatment, or a person named to make medical/mental health decisions for you (“health care agent”), your doctor or health/mental health care provider will consult with someone close to you about your care.

Living Will

What is a living will?

In North Carolina, a living will is a document that tells others that you want to die a natural death if you are terminally and incurably sick or in a persistent vegetative state from which you will not recover. In a living will, you can direct your doctor not to use heroic treatments that would delay your dying, for example by using a breathing machine (“respirator” or “ventilator”), or to stop such treatments if they have been started. You can also direct your doctor not to begin or to stop giving you food and water through a tube (“artificial nutrition or hydration”).

Health Care Power of Attorney

What is a health care power of attorney?

In North Carolina, you can name a person to make medical/mental health care decisions for you if you later become unable to decide yourself. This person is called your “health care agent.” In the legal document you name who you want your agent to be. You can say what medical treatments/mental health treatments you would want and what you would not want. Your health care agent then knows what choices you would make.

How should I choose a health care agent?

You should choose an adult you trust and discuss your wishes with the person before you put them in writing.

Advance Instruction for Mental Health Treatment

What is an advance instruction for mental health treatment?

In North Carolina, an advance instruction for mental health treatment is a legal document that tells doctors and health care providers what mental health treatments you would want and what treatments you would not want, if you later become unable to decide yourself. The designation of a person to make your mental health care decisions, should you be unable to make them yourself, must be established as part of a valid Health Care Power of Attorney.

Other Questions

How do I make an advance directive?

You must follow several rules when you make a formal living will, health care power of attorney or an advance instruction for mental health treatment. These rules are to protect you and ensure that your wishes are clear to the doctor or other provider who may be asked to carry them out. A living will, a health care power of attorney and an advance instruction for mental health treatment must be written and signed by you while you are still able to understand your condition and treatment choices and to make those choices known. Two qualified people must witness all three types of advance directives. The living will and the health care power of attorney also must be notarized.

Are there forms I can use to make an advance directive?

Yes. There is a living will form, a health care power of attorney form and an advance instruction for mental health treatment form that you can use. These forms meet all of the rules for a formal advance directive. Using the special form is the best way to make sure that your wishes are carried out.

When does an advance directive go into effect?

A living will goes into effect when you are going to die soon and cannot be cured, or when you are in a persistent vegetative state. The powers granted by your health care power of attorney go into effect when your doctor states in writing that you are not able to make or to make known your health care choices. When you make a health care power of attorney, you can name the doctor or mental health provider you would want to make this decision. An advance instruction for mental health treatment goes into effect when it is given to your doctor or mental health provider. The doctor will follow the instructions you have put in the document, except in certain situations, after the doctor determines that you are not able to make and to make known your choices about mental health treatment. After a doctor determines this, your Health Care Power of Attorney may make treatment decisions for you.

What happens if I change my mind?

You can cancel your living will anytime by informing your doctor that you want to cancel it and destroying all the copies of it. You can change your health care power of attorney while you are able to make and make known your decisions, by signing another one and telling your Doctor and each health care agent you named of the change. You can cancel your advance instruction for mental health treatment while you are able to make and make known your decisions, by telling your doctor or other provider that you want to cancel it.

Whom should I talk to about an advance directive?

You should talk to those closest to you about an advance directive and your feelings about the health care you would like to receive. Your doctor or health care provider can answer medical questions. A lawyer can answer questions about the law. Some people also discuss the decision with clergy or other trusted advisors.

Where should I keep my advance directive?

Keep a copy in a safe place where your family members can get it. Give copies to your family, your doctor or other health/mental health care provider, your health care agent, and any close friends who might be asked about your care should you become unable to make decisions.

What if I have an advance directive from another state?

An advance directive from another state may not meet all of North Carolina’s rules. To be sure about this, you may want to make an advance directive in North Carolina too. Or you could have your lawyer review the advance directive from the other state.

Where can I get more information?

NC Department of the Secretary of State Advance Health Care Directive Registry:

(919) 807-2167

http://www.secretary.state.nc.us/ahcdr/

National Resource Center on Psychiatric Advance Directives:

http://www.nrc-pad.org/

Duke University Program on Psychiatric Advance Directives:

(919) 682-8394

http://pad.duhs.duke.edu/index.html

The information on Advanced Directives was developed by the North Carolina Division of Medical Assistance in cooperation with the Department of Human Resources Advisory Panel on Advance Directives 1991. Revised 1999.
NOTICE OF COMMUNITY INNOVATIONS, INC. PRIVACY POLICIES

This notice provides consumers of COMMUNITY INNOVATIONS, INC. with information on its policies and procedures regarding the use and disclosure of individual health information. We are required by federal law* to provide you with this important information.

Uses and Disclosures

COMMUNITY INNOVATIONS, INC. uses and discloses the health information of individuals in accordance with state and federal laws. Under these laws, some uses and disclosures require prior authorization from the individual, while other uses and disclosures are required by law or permitted but not required. The health information policies of COMMUNITY INNOVATIONS, INC. follow the requirements of applicable state and federal laws. The following is a summary of these uses and disclosures:

1. Certain uses and disclosures can be made without individual authorization, including:

·         For purposes of treatment, payment or health care operations

·         Payment refers to the activities undertaken by or on behalf of a health plan to obtain premiums or to determine or fulfill responsibility of coverage and for provision of benefits under the health plan or a health care provider or health plan, to obtain reimbursement for the provision of health care.  Activities that constitute payment include determinations of coverage, including eligibility, coordination of benefits and a specific individual’s cost sharing amount, adjudication or subrogation of health benefit claims; risk adjustment; health care data processing related to billing, claims management, and collection activities; obtaining payment under a contract for reinsurance and utilization review activities including concurrent and retrospective review of services.

·         Health care operations include general administrative and business functions necessary for a covered entity to remain a viable business.  Business planning and development, such as cost management and planning related analyses related to managing and operating the entity and; business management activities and general administrative functions such as marketing of certain services to the extent permitted without authorization. Also included is the disclosure of protected health information for due diligence, internal grievance resolution and customer service to provide data and statistical analyses.

·         To a public health authority for specific purposes permitted by law, or a person or entity that demonstrates it is acting on instructions of a public health authority;

·         To a public health authority or other authority authorized by law to receive reports of child abuse;

·         To a person exposed to a communicable illness or at risk of spreading or contracting an illness who is authorized by law to be notified in the course of a public health investigation;

·         To a health oversight agency for lawful oversight activities;

·         In the course of any judicial or administrative proceeding in response to a court order, summons or subpoena;

·         To a coroner or medical examiner in the course of an investigation;

·         To law enforcement officials pursuant to a warrant, court order, summons, subpoena or similar process; or where the information disclosed constitutes evidence of criminal conduct;

·         For research purposes, subject to rigorous federal requirements;

·         In emergency situations when necessary to prevent or lessen a serious threat to health or safety;

·         To next-of-kin, consistent with their involvement in the individual’s care;

·         For information relating to Armed Forces personnel, to military authorities under certain conditions;

·         For information relating to Foreign Service personnel and other federal employees serving abroad, to federal authorities for medical clearances.

2. Some uses and disclosures are required by law. These include:

·         To you, when you request access to your individual health information for inspection or copying;

·         To government agencies, when required by the Secretary of Health and Human Services to determine our compliance with federal regulations.

3. Other uses and disclosures are permitted by law with your authorization:

·         Those uses and disclosures that you specifically authorize in writing.

Related Health Information Policies

Other uses and disclosures of your individual health information will be made only with your specific authorization, and you may revoke your authorization at any time.  If an authorization is revoked by you, COMMUNITY INNOVATIONS, INC. will make any adjustments to the use and disclosure of your PHI on a going forward basis only. 

You may request that certain uses and disclosures of your protected health information be restricted. We will receive and respond to your request, but we are not required to agree to such a request.  We will notify you of our decision. 

You have the right to request access to your health information for purposes of:

·         Inspection and copying of your individual health information.  If you request a copy of your “Designated Record Set”, COMMUNITY INNOVATIONS, INC. will respond to your request within 30 days and can take up to 60 days to provide you with a copy of your DRS;

·         Requesting amendment or correction of individual health information;

·         The right to receive information on how to obtain such access.

·         An accounting of disclosures of individual health information by COMMUNITY INNOVATIONS, INC.  An accounting of disclosures DOES NOT include:

·         Disclosures that occurred prior to April 14, 2003. 

·         Disclosures of PHI about the individual made directly to the individual; or made pursuant to an Authorization by the individual.

·         Disclosures used to carry out Treatment, Payment, or Health Care Operations;

·         Disclosures for national security or intelligence purposes; and

·         Disclosures to correctional institutions or law enforcement officials.

·         Disclosures of PHI information from a Limited Data Set in accordance with § 164.528(e).

COMMUNITY INNOVATIONS, INC. will provide one accounting of disclosures each year free of charge, every subsequent accounting within the year will be provided for a fee.  Copies of the Designated Record set will also be provided for a fee. 

COMMUNITY INNOVATIONS, INC. is required by law to protect the privacy of its individually identifiable health information, provide this notice of its policies and procedures relating to individual health information, and abide by the policies currently in effect.

COMMUNITY INNOVATIONS, INC. may change its health information policies and procedures at any time, and you would be informed of such changes through an update to your health plan consumership documents.

If you have questions or concerns about our health information policies or practices, please contact our Privacy Office by telephone at 910-642-5697 for more information.

You may file a complaint regarding COMMUNITY INNOVATIONS, INC.’s handling of individual health information with the Secretary of Health and Human Services. The complaint must be in writing and may be filed on paper or electronically. Your complaint should state that you are writing about COMMUNITY INNOVATIONS, INC. and should include a detailed description of the circumstances of the complaint. The complaint should be addressed to:

The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone: 202-619-0257
Toll Free: 1-877-696-6775

This notice of COMMUNITY INNOVATIONS, INC.’s health information policies is effective as of 4-15-03. If you have questions regarding these policies, please call our Privacy Office at 910-642-5697.

Emergency Preparedness

Community Innovations is a National Preparedness Month Coalition member. We are dedicated to providing the individuals we serve with information on the importance of emergency preparedness and encourage individuals to take action.

Please take the time to get your family together to make a plan. Being informed eliminates the fear of the unknown. When making your plan ask your local CI program what their plan is and we welcome you to share your plan with us. The health and safety of the individuals we serve and their loved ones is important to us.

Recommended Emergency Kit Items:

ü  Water – 1 gallon per person per day for at least three days, for drinking & sanitation

ü  Food – at least a 3 day supply of non-perishables, can opener and paper products; infant and pet food if applicable

ü  Battery-powered or hand crank radio

ü  Flashlight and extra batteries

ü  First Aid kit

ü  Whistle to signal for help

ü  Wrench or pliers to turn off utilities

ü  Prescription medications and glasses

ü  Important family documents, such as insurance and banking information

ü  Sleeping Bags or warm blankets for each person

ü  Complete change of clothing

ü  Fire Extinguisher

ü  Matches in a waterproof container

ü  Personal hygiene items

ü  Paper & pencil

ü  Activities for children

ü      Household bleach – 9 parts water to 1 part bleach can be used as a disinfectant

Recommended Emergency Contact Information:

ü      Name, Date of Birth, Soc. Sec. # & Important Medical Information for each family member

ü      Neighborhood Meeting Place & phone #

ü      Evacuation Location & phone #

ü      Out of Town Contact & phone #

ü      Family Work Locations & phone #

ü      Family School Locations & phone #

ü      Other Locations Family Spends Time & phone #

ü      Doctor(s)

ü      Pharmacist

ü      Insurance Information

For more information go to www.ready.gov

CONTACT NUMBERS

Mental Health Needs

If, during working hours (Monday through Friday, 8:30 am – 5:00 pm), you need to get in touch with either your Therapist _____________________ or Community Support Specialist _____________________________, you can try to call them directly at:

PHONE NUMBER (office/cell/pager): ___________________________________________

___________________________________________

OFFICE ADDRESS: ________________________________________________________

IF YOU NEED IMMEDIATE ASSISTANCE DURING THE DAY AND YOU CAN NOT REACH ME, PLEASE CONTACT MY SUPERVISOR, ___________________________ BY CALLING _______________________________.

If you need to get immediate services after 5:00 PM or during the week-end or holidays, our AFTER 5:00 PM CRISIS NUMBER is:  _____________________.

Physical Health Needs

IF YOU OR YOUR CHILD’S PHYSICAL HEALTH IS IN IMMEDIATE DANGER, YOU MAY WANT TO CALL 9-1-1 OR GO TO THE NEAREST EMERGENCY ROOM.

LOCAL HOSPITAL PHONE NUMBER: ________________________________________

ADDRESS:  ______________________________________________________________