Transformations hope for today’s families
To promote mental, emotional, social, and behavioral health for adults, children and families.
Supporting and sustaining families is fundamental to the healthy development of both children and adults. Children’s needs are best addressed within their community setting. Parents are equal partners in decision making at every level. Greater progress and growth is achieved when strengths are acknowledged and interventions are designed to build on an individual’s identified strengths. A cross-disciplinary team approach enriches creativity, problem-solving, and intervention. Collaboration among agencies creates enhanced resources, improved quality, and greater accountability in the community.
Clients and their families have the right to be treated with dignity and respect: Transformations does not discriminate on the bases of race, ethnic group, religion, gender, sexual orientation, political ideation, ability, educational level or previous life condition. You have the right to contribute to the goals, objectives, and interventions of your service plan. You have the right to complain and to expect resolution. You have the right to refuse to continue services at any time. You and your family have the right to confidentiality. Information about your treatment or services with Transformations can be released to you or others only with your written consent. Exceptions to this law apply when the client or family member is in danger of causing injury to self or someone else. In limited circumstances the courts can force a therapist or service provider to release records to the legal system.
As a client or client guardian, you have the responsibility to provide accurate and complete information and to report any changes in the client’s well-being.
You have the responsibility to keep all appointments to the best of your ability and to give 24 hour notice to the provider if you are unable to keep an appointment.
You are responsible to maintain the client’s insurance card and to report any lapse in coverage to the service provider.
You are responsible to contribute to the formulation of a treatment plan with its goals and objectives and to follow through with your agreed upon interventions.
You are responsible to pay any copays, deductibles or coinsurances that you have agreed upon with your insurance company.
Fees for Services
Transformations seeks to comply with the No Surprises Act, title 45, section 149.610 of the Code of Federal Regulations enacted with the primary goal of protecting clients from unexpected medical bills. Please click here to see a list of the types of services we provide and the fees we charge. Each client will be invited to participate in a Diagnostic Evaluation session (billing code 90791) that will result in written recommendations for treatment. Clients who wish to pay for their therapy directly will be given a Good Faith Estimate for the cost of treatment. Clients may request that Transformations submit charges for their services to their insurance plan. Medicaid and the Medicaid Managed Care Plans pay 100% for services. Most other insurance plans have copays, coinsurance and deductibles. Transformations will seek to verify your insurance coverage and your provider’s network status, but we cannot guarantee the information we are provided because the insurance companies do not guarantee the information they provide. It is the client’s responsibility to know the limits of their coverage and to pay Transformations directly for the unpaid portion of the fees. Transformations does not practice balance billing which means we will honor the contracted rate with your insurance plan even if we are both surprised to discover that our provider is not in your plan’s network.
Collaborative Care and Important Information Regarding Behavioral Health Medications
Transformations believes in a holistic approach to client care that recognizes the relationship between mental health and physical health. Collaboration of care with a client’s primary care physician and medical professionals will enable better outcomes. If you are taking a prescribed medication or are considering medication, we encourage you to discuss the following recommendations with your physicians.
ADHD medications require a follow up appointment 30 days after the start of medication and two follow up appointments in the following nine months.
Psychotherapy must be provided 90 days prior to referral for an antipsychotic medication unless diagnosis is schizophrenia, bipolar or a psychotic disorder.
All clients receiving psychotropic medications including an anti-depressant should be regularly monitored by a physician for health related side effects, benefits and safety.
You must complete and sign an Authorization to Share Protected Healthcare Information form, before your providers can share your healthcare information.
If you are prescribed a behavioral health medication and do not have a follow-up appointment scheduled, contact your healthcare provider now.
Kentucky Healthcare Information Exchange (KHIE)
Transformations is a participant in the KHIE program. Please read the following carefully.
The Kentucky Health Information Exchange (KHIE) makes patient healthcare information available electronically to healthcare providers who are covered by HIPAA and participate in KHIE (KHIE Participants). KHIE Participants agree to KHIE’s terms and conditions, including its security and privacy requirements, and agree to access the information for purposes of treatment, payment, and healthcare operations, according to applicable federal and state laws. A detailed description of KHIE can be found at http://khie.ky.gov.
Making patient healthcare information available to participating healthcare providers through KHIE promotes efficient and quality healthcare for patients. We are a KHIE Participant. As such, we are able to obtain more complete information about our patients’ medical histories when their health care information is available through KHIE. We make our patients’ healthcare information available to other KHIE Participants who have a need to know for purposes of treatment, payment, and healthcare operations. Participation in KHIE is not a condition of receiving care. You may choose not to allow your information to be available through KHIE. However, if you decide not to make your information available to KHIE, it may limit the information available to your healthcare providers. Your information may be stored in KHIE, but is only available to participating healthcare providers who are treating you and request your information. Please let us know if you have questions about KHIE or desire not to make your information available through KHIE.
Telehealth Services of Transformations hope for today’s families
Definition of telehealth services: Telehealth includes the delivery of HIPAA compliant health care services and public health via information and communication technologies or use of other electronic media to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care and includes remote patient monitoring, synchronous interactions and asynchronous store and forward transfers of images an data.
Transformations may offer telehealth services in conjunction with regularly scheduled in-person therapy for the purpose of enhancing our ability to provide a supportive wraparound service.
Telehealth, without regularly scheduled in-person sessions, are not appropriate for the client who experiences reoccurring crises or emergencies; is suicidal or likely to become suicidal, is violent or likely to become violent, or otherwise poses a risk to themselves or others.
Your provider will perform an ongoing assessment for the appropriateness of telehealth and will refer you for face to face services if needed.
Transformations providers will use a secure encrypted HIPAA and HITECH compliant synchronous video conferencing service for all telehealth services. Social media, Facetime and phone calls are not eligible for telehealth services.
Telehealth sessions are not recorded unless the client signs a form consenting to the video taping of sessions.
Telehealth services are subject to disruption due to the nature of communication technology. The client and provider shall develop a plan to manage disrupted sessions and the rescheduling of the service.
The provider will ask for the client’s location and address at the start of each session.
Inorder to protect your privacy, your provider will ask for the names of others who are present in your room or home. Your provider may ask to pan the room you are in with your camera to protect your privacy. You and your provider may also agree upon a code word you can use to alert your provider to a potential breach of your privacy.
The service provider will document the telehealth session in the client’s medical record located in a secure electronic system.
The provider shall meet all the requirements of his or her licensing board for education, training, and practice of telehealth services.
The client may not be eligible for telehealth services across state lines or international boundaries.
The client is required to produce a valid photo identification.
Client’s receiving telehealth services must have a crisis plan and a treatment plan that identifies in-person emergency services and coordination of care with other professionals. Telehealth services shall be added to the treatment plan for services provided.
Your provider will ask you to designate an emergency contact person as part of your crisis plan.
You will be asked to sign forms to authorize the sharing of your private healthcare information with you primary care physician and other healthcare providers.
Kentucky Medicaid and the associated Managed Care Organizations may provide payment of telehealth services for eligible members. Co-pays apply as indicated in the client plan. Eligibility and coverage will vary with commercial insurance plans. We recommend you call your insurance company to check your benefits for telehealth services. Your Transformations providier will ask for your credit card or debit card number to be kept on file in a secure location for the payment of any applicable copays, co-insurance and deductible
The service provider shall provider the client with alternative means of contact including the provider’s phone number and email address. Texting is not a secure encrypted form of communication and should only be used by the client with this understanding.
The providers office for all correspondence is Transformations 4010 Dupont Circle, Suite 582, Louisville, KY 40207.
The service provider shall provide the client with his or her education and training, license type, license number, and state board. This information is available on the home page if our website at www.transformationsllc.net
Phone and email address will be provided to you by your therapist. You should discuss tine zone differences for routine calling hours as well as ways to contact your provider during a crisis.
Complaints maybe filed with the providers licensing board or directly to Transformations clinical director, Teri Lloyd,LMFT at Tlloyd@transformationsllc.net or 502-905-9494.
Licensing Board addresses
Board of Licensure for Marriage and Family: MFT@ky.gov
Kentucky Board of Social Work: 125 Holmes Street, Suite 310 Frankfort, KY 40601
Professional Counselor Licensing Board: LPC@ky.gov
Board of Licensure for Professional Art Therapists: PAT@ky.gov
Board of Examiners of Psychology: PSY@ky.gov
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY BEFORE SIGNING.
- Understanding your health information
When you/your child begins working with Transformations a record of treatment is made. Typically, this record contains you/your child’s history, assessment, medical information, diagnoses, treatment, a plan for future treatment, etc. This information often referred to as you/your child’s health or medical record, serves as:
*Basis for planning your/your child’s care and treatment
*Legal document describing the care you/your child received
*Means by which you or a third-party payer can verify that services billed were provided
*A source of data for health officials charged with improving the health of the nation, or needed services for the area
*A tool by which future or continual services can be approved
Understanding what is in this record will help you to ensure its accuracy, better understand who, what, when and why others may access you/your child’s information and help to make more informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS
Although the health record is the physical property of Transformations, the information belongs to you. You have the following rights:
Right to Request a Restriction
You have the right to request a restriction on our use and sharing of you/your child’s protected health information. Transformations can deny the request if it is unreasonable or would be detrimental to your/your child’s treatment.
Right to a paper copy of this Notice
You have a right to obtain a paper copy of this notice. You may obtain a copy by notifying Transformations office at 502/899-5411 or mailing a request to 4010 Dupont Circle, Suite 582, Louisville, KY 40207.
Right to amend your/your child’s health information
You have the right to request the agency to amend the health information we maintain about you/your child if you feel it is incorrect or incomplete for as long as the information is kept by Transformations. To request an amendment, you must submit a request in writing and state the reason that supports your request. The disputed information will remain in the record along with the amended information. Transformation may deny your request if the request is not submitted in writing, does not contain a reason to support the request, the information that is being questioned was not originated by Transformations, it is not part of the information which you are permitted to inspect or copy, or it is currently accurate and complete.
Right to an accounting of disclosures
You have the right to obtain an accounting of the disclosures Transformations made of health information about you/your child. This does not include disclosures made for treatment, payment, or health care operations, made directly to you, made for national security reasons, or made to corrections or law enforcement personnel. Your request must state a time period that must be no longer than (6) six years and may not include dates before April 14, 2003. The first list requested within a (12) twelve-month period will be free. For additional lists, you will be charged for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred.
Right to request alternative means of communication
Transformations’ staff may seek to communicate with you through general common practices such as your cell phone, text messages, email, voice mail, the U.S. Postal service, etc. It is our policy to take reasonable measures to secure electronic communications. You have the right to request communication of your/your child’s health information by alternative means or alternative locations. For example, you could request Transformations only contact you at work or by mail. To request communications by alternative or restricted means, you must submit your request in writing. You will not be asked the reason for your request and your request will be accommodated. Your request must indicate how or where you want to be contacted.
Right of access to protected health information
You have the right to request, either verbally or in writing your/your child’s health information with certain exceptions. Transformations will respond to you within (30) thirty days (or (60) sixty days if extra time is needed). If your request is denied you have the right to have the request reviewed by a reviewing official who did not participate in the original decision to deny access. In accordance with Kentucky State Law 422.317, Transformations will provide, without charge to the client, a copy of the client’s medical record. There will be a charge for any additional copies after that based on cost.
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
Transformations will use your/your child’s health information for treatment. We will use and disclose your/your child’s protected health information in providing treatment and services. We may disclose your/your child’s protected health information to agency and non-agency personnel who may be involved in your/your child’s treatment. This will include any one you designate to be apart of the child’s service team including a Targeted Case Manager, Therapist, Community Support Associate, Psychiatrist, or Physician providing care to your child. We may also disclose protected health information to individuals who will be involved in your/your child’s treatment after you are no longer associated with Transformations. This will guarantee the continuity of care.
Transformations will use and disclose you/your child’s protected health information so that billing and payment for services for the treatment of you /your child can occur. For billing and payment purposes we will disclose information to Medicaid, Medicaid’s billing agent, or an insurance or managed care company, the DMHMRS, or any other designated third-party payer. This disclosure for billing will continue after services are ended in order to secure reimbursement for services. Transformations will also disclose your/your child’s health information to a managed care company or peer review organization designated by Medicaid or your third party payer, in order to secure and maintain authorization for treatment. Transformations will use your/your child’s health information for regular health care operations. Transformations may use data separated from identifiable information for researcher and program development purposes. These uses and disclosures are necessary to manage the agency and our quality of care.
EXAMPLES OF USES AND DISCLOSURES FOR OTHER SPECIFIC PURPOSES
As required by law we will disclose you/your child’s protected health information.
*Disaster Relief-to an agency organizing disaster relief efforts
*Public Health Activities-such as: reporting to a public health or government authority for preventing or controlling disease, injury, or reporting child abuse or neglect
*Food and Drug Administration (FDA)-concerning adverse events or problems with products or medications for tracking purposes to enable product recalls or to comply with other FDA requirements
*to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition
*for certain purposes involving workplace illnesses or injuries
*Reporting victims of abuse, neglect or domestic violence-information will be disclosed as required by law
*Judicial and Administrative proceedings-information may be disclosed in response to a court or administrative order, subpoena, discovery requests, or other lawful process. Efforts will be made to notify you about the request or to obtain an order or agreement protecting the information
*Health oversight activities-information may be disclosed to a health oversight agency for activities authorized by law, such as, audits, inspections, investigations, licensure actions or other legal proceedings.
*Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations
*to avert a serious threat to health or safety-any disclosure would be made only to someone able to prevent the threat of safety to you/your child, the public or another person
*research-only under your/your child’s specific disclosure
*Law Enforcement-as required by law to comply with reporting requirements including, but not limited to: complying with court orders, warrants, subpoenas, summons, identifying or locating a fugitive, missing person or material witness, when information is requested about the victim of a crime if the individual agrees, to report information about a suspicious death, to provide information about criminal conduct occurring at the agency, or information about emergency circumstances about a crime. *National Security and Intelligence Activities, Protective Services for the President and others.
*Only data that has been separated from my identifiable information may be used for research and program development purposes, pursuant to 45 CFR 46.101(b.2). Protected health information is may only be used for research only if authorized through written release of information.
YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES
OF PROTECTED HEALTH INFORMATION
Transformations will use and disclose protected health information (other than described in this Notice or required by law) only with your written authorization. You may revoke your authorization to use or disclose protected health information in writing, at any time. If you revoke your authorization, we will no longer use or disclose your/your child’s protected health information for the purposed covered by the authorization except where we have already relied on the authorization.
OUR RESPONSIBILITIES REGARDING YOUR/YOUR CHILD’S
PROTECTED HEALTH INFORMATION
Transformations is required by law to:
*maintain the privacy of your/your child’s health information
*provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about your child
*abide by the terms of this notice
*notify you if we are unable to agree to a requested restriction
*accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We reserve the right to make changes to this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. Any changes made will affect the protected health information we maintain at that time. We will post a copy of the current Notice at our office site. We will provide a revised copy of the Notice to parents/legal guardians upon request on or after the effective date of revision.
WE WILL NOT USE OR DISCLOSE YOUR/YOUR CHILD’S PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION, EXCEPT AS DESCRIBED IN THIS NOTICE.
If you have questions, would like additional information, or feel your rights have been violated, you may contact the Privacy Officer: Teresa Lloyd, 4010 Dupont Circle, Suite 582, Louisville, KY 40207. firstname.lastname@example.org.
If you have any other complaints or concerns, you may also call the privacy officer and clinical director at 502-899-5411.
If you are still dissatisfied, you may file a complaint by sending a written statement to the above address
4010 Dupont Circle Suite 582
Louisville KY 40207
Office of Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Transformations will not retaliate against you if you choose to file a privacy complaint or exercise your privacy rights.
COVID-19 Preparedness Plan
In accordance with federal mandates Transformations requires all staff and providers to receive vaccinations and boosters for COVID-19 or to perform a weekly COVID-19 test.
When we provide face-to-face services, we encourage each provider to adhere to the following protocol to reduce the risk of infection. These practices are in place to help protect the provider, the client, and any household members.
- The CDC encourages visits to occur outdoors when possible.
- When outdoor visits are impossible, the CDC emphasizes the importance of maintaining a minimum of 6-ft social distance, and optimally for the visit to occur within a well ventilated space (for example, an open window or screen-door with a fan circulating fresh air in the room would be helpful).
- All staff are expected to complete a self Covid-19 screening assessment daily, and prior to any contact with clients, family, co-workers, or community networks.
- Providers are expected to complete a Covid-19 screening assessment of their clients and other persons present in the household prior to each session and any direct contact.
- The Covid-19 screening tool for providers’ use is on the Transformations website: https://www.transformationsllc.net/wp-content/uploads/2020/05/COVID19Screener5-2020.docx
- A copy of the Covid-19 screening tool is also attached for reference.
- All providers, clients and household members are expected to wash their hands before and after sessions, or to use an alcohol-based hand sanitizer (minimum 60% alcohol) if soap and water are not available.
- Housekeeping staff will be cleaning the office regularly and sanitizing commonly touched surfaces. Providers and staff who do work in the office should disinfect (Lysol wipes or other cleaning solutions) surfaces they have used, before and after work sessions.
- We ask that our clients and others present who have not been vaccinated against COVID-19 wear face masks when our providers are present unless this is contra-indicated due to health or other limitation
- Transformations has masks available for client and providers’ use.
- Transformations has hand-sanitizer available for providers to refill small bottles for themselves or their clients’ needs.
- If a provider or client tests positive for Covid-19, follow the guidance of your health provider or the local or Kentucky state health department.
- Other basic guidance from the CDC may be found here: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
Quality Assurance Program
Transformations is committed to supporting its providers in learning new and better ways to help you. So your feedback on our services is important to help us know what we need to change. Transformations will be emailing you a few brief questionnaires. Please answer each survey as you receive it. The surveys will be sent through a secure website and email system. You may also contact us at any time at email@example.com or call me personally at 502-905-9494.
Thank you for choosing Transformations as your service provider.
Teri Lloyd, LMFT
4010 Dupont Circle Suite 582
Louisville KY 40207