Page 1 of 5 SECTION: Recipient Rights SUBJECT: Services Suited to Condition DATE OF ORIGIN: 4/30/97 REVIEW DATES: 6/28/98, 7/1/01, 2/1/04, 3/1/05, 10/1/05, 6/1/08, 7/15/13, 10/4/14, 6/15/15, 5/27/16, 4/25/17 EFFECTIVE DATE: 6/1/18 APPROVED BY: EXECUTIVE DIRECTOR I. PURPOSE: To describe the process by which a second opinion is administered, to ensure a recipient s individual plan of service is developed using a person-centered process, and to ensure a recipient s right to choose mental health professionals in accordance with this policy. II. POLICY: A recipient will be given services suited to his or her condition. III. SCOPE: This policy applies to all directly operated and contracted providers of Network180. IV. DEFINITIONS: None V. REFERENCES/LEGAL AUTHORITY: MCL 330.1712 and 330.1713; Mich Admin Code, R 330.7199 VI. PROCEDURE: A. Second Opinions 1. Denial of Psychiatric Inpatient Hospitalization a. If an individual s request for hospitalization is denied, the individual, or his/her parent, guardian, or legal representative will be given written notice of the denial, including the right to request a second opinion from the Network180 Executive Director. The individual will be assisted as needed to complete Section II of the Second Opinion Request Form. b. If it is determined that other specialty mental health services and supports are needed, the individual will be offered an appropriate available alternate referral
Page 2 of 5 for services; however, he/she must still be given written notice of the denial of the hospitalization and offered a second opinion. c. After receiving the second opinion request, the Executive Director, or his/her designee, will arrange for an additional evaluation by a psychiatrist, other physician or licensed psychologist to be performed within three days, excluding Sundays and legal holidays. d. If the individual does not show for the second opinion evaluation, he/she may reschedule the evaluation if the request is made within the required three-day time frame. e. If the conclusion of the second opinion is different from the conclusion of the initial screening, the Executive Director, in conjunction with the Medical Director, will make a decision based on all clinical information available. The Executive Director s decision will be confirmed in writing to the individual who requested the second opinion. The confirming document will include the signatures of the Executive Director and Medical Director, or verification the decision was made in conjunction with the Medical Director. f. If the individual is found not to be clinically suitable for hospitalization, the Access Center will provide information regarding alternative services and the availability of those services, and make appropriate referrals. The individual will receive written notice of the outcome of. If the individual is a current recipient, he/she will also be notified of his/her right to file a Recipient Rights complaint alleging violation of the right to receive treatment suited to condition. 2. Denial of Access to Community Mental Health Services a. If an applicant for community mental health services has been denied mental health services, the applicant, or his/her parent, guardian or legal representative will be given written notice of the denial, including the right to request a second opinion. The individual will be assisted as needed to complete Section II of the Second Opinion Request Form. b. After receiving the second opinion request, the Executive Director, or his/her designee, will arrange for an additional evaluation by physician, licensed psychologist, registered professional nurse, master s level social worker or master s level psychologist, none of whom were involved in the original decision, to be performed within five business days, excluding legal holidays. c. If the individual completing the evaluation determines that the applicant has a serious mental illness, serious emotional disturbance or a developmental disability, or is experiencing an emergent or urgent situation, the applicant will be referred to the appropriate services. B. Individual Plan of Services 1. The individual plan of services (IPOS) is the fundamental document in the recipient s record. A provider will retain all periodic reviews, modifications, and revisions of the plan in the recipient s record. 2. A person-centered planning process will be used to develop a written IPOS in partnership with the recipient. The IPOS will consist of a treatment plan, a support
Page 3 of 5 plan, or both. A treatment plan will establish meaningful and measurable goals with the recipient. 3. A preliminary plan will be developed within seven days of the commencement of services or, if an individual is hospitalized for less than seven days, before being discharged or released from the hospital. 4. The plan will be kept current and will be modified when indicated. A formal review of the plan with the recipient and his/her guardian or authorized representative (if applicable) will occur not less than annually. 5. The individual in charge of implementing the IPOS will be designated in the plan. 6. The plan will identify, at a minimum, all of the following: a. All individuals, including family members, friends, and professionals that the individual desires or requires to be part of the planning process. An individual chosen or required by the recipient may be excluded from participation in the planning process only if inclusion of that individual would constitute a substantial risk of physical or emotional harm to the recipient or substantial disruption of the planning process. Justification for an individual s exclusion will be documented in the case record. b. The services, supports, and treatments that the recipient requested of the provider, and the services, supports, and treatments committed by the responsible provider to honor the recipient s request. c. The person or persons who will assume responsibility for ensuring that the committed services and supports are delivered. d. When the recipient can reasonably expect each of the committed services and supports to commence, and, in the case of recurring services or supports, how frequently, for what duration, and over what period of time. e. How the committed mental health services and supports will be coordinated with the recipient s natural support systems and the services and supports provided by other public and private organizations. f. A comprehensive assessment/analysis of a recipient s challenging behaviors will be conducted, as necessary. g. Any restrictions or limitations of the recipient s rights will be justified, timelimited, and clearly documented in the IPOS. Documentation will be included that describes attempts that have been made to avoid such restrictions as well as what actions will be taken as part of the plan to ameliorate or eliminate the need for the restrictions in the future. Restrictions, limitations or any intrusive behavior treatment techniques are reviewed and approved by a formally constituted committee of mental health professionals with specific knowledge, training, and expertise in applied behavioral analysis. h. Strategies for ensuring that recipients have access to needed and available supports identified through a review of their needs. Areas of possible need may include any of the following: i. Food ii. Shelter iii. Clothing iv. Physical Health Care
Page 4 of 5 v. Employment vi. Education vii. Legal Services viii. Transportation ix. Recreation i. A description of any involuntary procedures and the legal basis for performing them. j. A specific date or dates when the overall plan and any of its subcomponents will be formally reviewed for possible modification or revision. 7. The plan will not contain privileged information or communications. 8. Except as otherwise noted below, the IPOS will be formally agreed to in whole or in part by the responsible mental health agency and the recipient, his/her guardian, if any, or the parent who has legal custody of a minor recipient. If the appropriate signatures are unobtainable, then the provider will document witnessing verbal agreement to the plan. Copies of the plan will be provided to the recipient, his/her guardian, if any, or the parent who has legal custody of a minor recipient. 9. Implementation of a plan without agreement of the recipient, his/her guardian, if any, or parent who has legal custody of a minor recipient may only occur when a recipient has been adjudicated pursuant to the provisions of the Michigan Mental Health Code. However, if the proposed plan in whole or in part is implemented without the concurrence of the adjudicated recipient, his/her guardian, if any, or the parent who has legal custody of a minor recipient, then the stated objections of the recipient, his/her guardian, or the parent who has legal custody of a minor recipient will be included in the plan. 10. If a recipient is not satisfied with his/her IPOS, the recipient, the person authorized by the recipient to make decisions regarding the IPOS, the guardian of the recipient, or the parent of a minor recipient may make a request for a review to the designated individual in charge of implementing the plan. The review will be completed within thirty days and will be carried out in a manner agreed upon by all parties involved. 11. A recipient will be informed both orally and in writing of his or her clinical status and progress at reasonable intervals in a manner appropriate to his/her clinical condition, and reviews may occur at an earlier date with proper notification and participation in accord with person-centered planning practices. 12. Services will be provided in accordance with all applicable standards of care or treatment required by any of the following: a. All state or federal laws, rules or regulations governing the provision of community mental health services; b. Obligations of a provider established under the terms of a contract or employment agreement with Network180; c. Network180 policies and procedures; d. Written guidelines or protocols of a provider; e. Written directives from a supervisor consistent with any of the above; f. A recipient s individual plan of service
Page 5 of 5 C. Choice of Mental Health Professional 1. A recipient will be given the choice of mental health professional within the limits of available staff. 2. The recipient or guardian is notified of this policy and their choices are documented in the recipient s record. 3. Documentation will reflect the steps taken to accommodate the recipient s request or the reason why it is not therapeutically or financially appropriate or within agency resources to comply with the recipient s request. 4. If the recipient s requests cannot immediately be accommodated because of staff limitations, the option of a waiting list will be offered to the recipient whenever possible. 5. The provision of emergency and/or crisis treatment will take precedence over the recipient s preference for a mental health professional. VII. ATTACHMENTS: Second Opinion Request Form