Working Agreement

WELCOME to the YWCA Greater Austin!  Please read this information about your rights as a client and the YWCA’s policies and practices.

The YWCA provides individual, couple, family and group services from a cultural relational model and with the knowledge that it is not uncommon for individuals to experience some sort of trauma in their lives.  We value diversity and have a firm commitment to nondiscrimination with regard to race, color, ethnicity, religion, gender, sexual orientation, national origin, age, disability, relationship status, amnesty, veteran status, and other diversity. 

The YWCA’s policies, practices, and privacy and security measures are derived from federal, state, and local law, rules, and regulations.  In the United States, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and subsequent revisions, sets national standards for protecting the confidentiality, integrity, and availability of individually identifiable health information by health care providers who conduct the standard health care transactions electronically.  Compliance with the Privacy Rule has been required as of April 14, 2003 and compliance with the Security Rule was required as of April 20, 2005.

CONFIDENTIALITY:

YWCA Greater Austin makes every effort possible to protect and maintain your information confidential, however there are a few exceptions to this as it pertains to Federal, State, or local law, including HIPAA, and/or professional and ethical guidelines which mandate the following:

1.      Exceptions to confidentiality

• If we suspect you pose a threat to yourself or someone else;

• If we suspect a minor/child, a person with disabilities, and/or an elderly person (65 yr. +) has been or is now in danger of being abused, neglected, or exploited;

• If you report that the person who harmed/abused you has access to children;

• If you report that you have been abused and/or exploited by any mental health provider;

In these circumstances, we are required by law to report to the appropriate authoritative system (police/sheriff department, Mental Health Deputies, Child Protective Services, or Texas state board).  We will make every effort to inform you ahead of time prior to disclosing your information.

2.      Other exceptions to confidentiality

• If you (or your legal representative) request and give written consent for your records or case information to be released to yourself or a third party. This information can be released after consultation with the Clinical Supervisor or Clinical Director and after completing a YWCA Consent to Release of Information form.

• If the records are those of a minor child and the parent or guardian, who signed for the minor to receive services, consents for record release;

• If your records are court-ordered by a judge;

• If the therapist discusses your situation with their supervisor, another professional within the agency, and/or in group supervision for training and consultation purposes only;

• If required by auditors and evaluating, credentialing, and accrediting organizations regarding organizational quality or competency assurance (use of anonymous data); 

• If you provided informal consent by designating an emergency contact or medical personnel to whom information may be released in the case of a medical emergency or death.

3.      Special considerations and Social Media

• Friending: Counselors do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). Adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy.

• Business sites: The YWCA may be found on sites such as Yelp, Facebook, or other places which list businesses. Please know that our listing is not a request for a testimonial, rating, or endorsement, however if you want to provide a review or connect via Facebook or twitter, be aware that your confidentiality might be compromised.

Location of Services

Individual, couple, family and/or group services are provided in-person at the YWCA Greater Austin’s main office at 2015 S. IH-35, suite 110, at one of our satellite office spaces, or a local institution as designated by provider/client (ex. school, partner organization). Services may also be provided virtually.

Duration of Services

The YWCA offers ten counseling sessions per calendar year (per type of counseling) with the option to extend the number of sessions based on the mutual agreement between the client and their therapist. YWCA offers 5 sessions for care coordination with the option to extend the number of sessions.

Providers

Services are provided by licensed professionals (LCSW, LPC, LMFT, LMSW, LPC-associates, LMFT-associates), graduate and undergraduate student interns, and peer volunteers under the direct supervision of a Clinical Supervisor, Lead Therapist, and/or the Clinical Director. Clinical and Care Coordination staff is trained in evidence-based and promising practices such as Somatic Experiencing®, Trust-Based Relational Interventions, Eye Movement Desensitization and Reprocessing, Relational-Cultural Therapy, and Narrative therapy, as well as, systems navigation, community resources, etc.

FEES FOR SERVICES:

1. Counseling Fees:  The cost of services assessed during the initial intake is based on a sliding scale which takes into account household income and is then verified at the first session when documentation is provided by the client.  Unless there is a prior agreement with a third party payer or insurance providers, the client is expected to pay their fee at the time of their session. In the rare instance that you cannot pay at the time of services, full payment must be made at or before the following session to avoid accumulation of fees.  Please discuss any payment concerns with your counselor to discuss options. If your financial situation changes in any way, please notify your counselor immediately for a fee readjustment. New clients are charged an initial processing fee of $5.00. This is not covered by insurance.

2. Cancellation Fees:  You may cancel your appointment without charge if you call the day before your appointment.  If you must cancel, call our office at 512-326-1222, Monday through Thursday between the hours of 8:30 a.m. and 7:00 p.m., or Friday between the hours of 8:30 a.m. and 5:00 p.m.   Cancellations for Monday appointments are taken on Monday until 12 noon due to lack of weekend office hours.  If you do not cancel the day before your appointment, you will be charged for the session and it will be counted as one of your allotted sessions.  Please note:  messages left on voicemail, may or may not be retrieved in a timely manner therefore, please try to cancel during office hours.  If your sessions are subsidized by a third party, (Crime Victims’ Compensation, EAP, private entity, etc.) or insurance any late cancellation fees are your responsibility.  If you were unable to call and cancel due to extenuating circumstances, please speak with your counselor about options to waive the fee.

3.  No Show Fees (Not showing up and not letting us know):  If you do not show up for your appointment and do not call to cancel you will be charged for the session and it will be counted as one of your allotted sessions. If you do not show up for an appointment and do not contact our office within 48 hours, we will attempt to contact you, but your file may be closed, and your appointment time may be given to another person.  You may resume sessions once you contact us again, but will have to pay off any remaining balance. If your sessions are subsidized by a third party, (Crime Victims’ Compensation, EAP, private entity, etc.) any late cancellation fees are your responsibility.  If you were unable to call and cancel due to extenuating circumstances, please speak with your counselor about options to waive the fee.

4. Returned Check Fees:  There is a $25.00 charge for each returned check.

5 . Good Faith Estimate:

This Good Faith Estimate below shows the costs of services that are reasonably expected for your request. The estimate is based on information and documentation provided at the time of intake and does not include any unknown or unexpected costs that may arise during treatment. This estimate also includes the assessed fee for no-shows and late cancellations. This estimate may be updated based on documentation presented at a later date. If you believe you are billed incorrectly federal law allows you to dispute the bill (see client rights below).

RECORDINGS

YWCA does not record any sessions unless it is discussed with you previously.  If we do record, videos are kept confidential and would be used for training purposes only and used with internal supervisors. Please do not record audio or video of your sessions. Making recordings can quickly and easily compromise your privacy.

Sessions with minors may be recorded due to liability insurance requirements. These recordings are kept in an electronic file and destroyed after 7 years as per our records retention policy.

CHILDREN AT SESSIONS:

1.Although the YWCA of Greater Austin is sensitive to families’ needs, we do not provide child care, and it is not recommended that children be allowed in adult counseling sessions.

2. Children should not be left unattended in the Reception area.  If necessary, you may bring another adult with you to watch your children while you are in session.

3. In situations where you do not have child care, we encourage you to call to reschedule instead of bringing your children to session.  If rescheduled without day notice, fees for that session can be discussed with your counselor. 

CLIENT RIGHTS:

You have a right as a client of the YWCA of Greater Austin and its programs to:

• Be treated with dignity and respect;

• A weapons-free environment: Firearms, concealed or holstered, and other weapons are prohibited from our workspace.

• To know the name, credentials, qualifications, licensure, and education of your counselor.

• Be informed of the program policies and procedures before participation;

• Right to be informed of the risks and benefits of therapy, methods used in therapy, duration and fees.

• Accept or refuse services after being informed of services, policies, and procedures;

• Terminate services at any time or request a change in counselors.

• Have your confidentiality maintained.

• Dispute any inaccurate fees

• Make a complaint to the program’s Clinical Supervisor, Clinical Director, or the YWCA’s Executive Director, or to the Texas State Board

Concerns and/or Compliments about your counseling sessions and/or your experience at the YWCA Greater Austin can be discussed with your counselor, but you may also contact the Clinical Supervisor, the Clinical Director, or the Executive Director at 512-326-1222.  If you share a concern, please be assured that this will not jeopardize your services.

Direct complaints may also be made to the following oversight organizations:

• Texas State Board of Social Work Examiners at 1 (800) 232-3162;

• Texas State Board of Examiners of Professional Counselors at (512) 834-6658.

• Texas State Board of Marriage and Family Therapists at (512) 834-6657.

To dispute/negotiate a bill or charge:

• Contact the YWCA billing personnel or Clinical Director by phone or email.

• Provide information on fee being disputed; information will be reviewed within 5 business days of receipt.

COMPLIANCE WITH HIPAA STANDARDS AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

The major goal of the Privacy Rule standards within HIPAA is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide services.  Protected Health Information (PHI) is identifiable information relating to the client, such as past, present, or future health, mental health, treatment, and/or payment for services, and demographic information such as name, birth date, address, etc.

Federal laws require that clients are clearly informed about how medical information may be used, how it is maintained, how it may be disclosed, and how you may get access to this information, if you wish to do so.

 How PHI may be used:

• Treatment: Consists of any services provided by a health provider intended to change or ameliorate conditions or problems, including but not limited to supervision, case-consultation

• Payment: Encompasses activities of a health provider to obtain premiums, determine or fulfill responsibilities for coverage and provision of benefits, and furnish or obtain reimbursement for health care delivered

• Health Care Operations: Refers to quality assessment and improvement activities, including case management and care coordination; business planning, development, management, and administration; and business management and general administrative activities of the entity,

• Quality or competency assurance: Includes activities such as provider or health plan performance evaluation, credentialing, and accreditation; conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; specified insurance functions, such as underwriting, risk rating, and reinsuring risk;

How PHI is maintained:

• The YWCA uses a code for each client rather than full names on files and for data keeping;

• Client files are only accessible to the therapist, the therapist’s supervisor, Clinical Supervisor, and Clinical Director, for consultation/training and administrative staff, for business operations;

• Files are kept for 7 years as required by law under. Paper files are kept under three sets of locks. Electronic files are kept in a HIPAA compliant database system.

How PHI may be disclosed:

• Information disclosed is limited to the minimum amount of information necessary to accomplish the task requested.

• YWCA will only disclose information:

  • As requested by the client and with the client’s knowledge;

  • As required by auditors and evaluating, credentialing, and accreditation organizations regarding organizational quality or competency assurance (use of anonymous data); 

  • As necessary for business management and general administrative activities of the organization, improvement of services and payment transactions through third-party payers, insurance, and relevant collaborators.

  • Re. Payment:

    • If we contract with a third-party payer who is covering the client’s fees, the YWCA will release only the limited amount of information necessary for billing and as agreed upon in the contract.  The information requested by the specific third-party payer will be disclosed at intake and at the first session to the client whose fees are being covered.

    • If a client is utilizing insurance, the YWCA will release only the minimal amount of information as necessary for billing. This information will be disclosed and explained to the client at intake and at the first session.

• We may use and disclose a deceased individual’s PHI to family members and others who were involved in an individual’s care, unless doing so is inconsistent with any prior expressed wishes or preferences of the deceased individual.

• Re. Payment:  If we contract with a third-party payer who is covering the client’s fees, the YWCA will release only the limited amount of information necessary for billing.  The information requested by the specific third-party payer will be disclosed in the first session to the client whose fees are being covered.

• How you may get access to your PHI information:

  • Clients have the right to access any information kept in their files by requesting it from their current counselor, the Clinical Supervisor, and/or the Clinical Director.

  • If you need information about you disclosed to a third party, you must complete a consent to release information form before we can give out any information.

LEGAL CONCERNS AND COURT COSTS:

The counseling services of the YWCA are primarily therapeutic in nature.  Therefore, our agency does not generally expect to take part in court matters.  Our counselors will appear in court only if court-ordered by a judge.  If court-ordered, counselor testimony and advocacy will be provided at the cost of $100.00 per hour, plus travel and preparation  to be paid by the client at the time of service.  There is no sliding scale fee for court testimony and/or advocacy.

YOUR AUTHORIZATION:

(1) My signature below provides authorization to the YWCA to use and provide my private health information in the course of daily business activities, as explained in the HIPAA-related policies noted above.

(2) I understand the limits and exceptions to confidentiality as explained to me.

(3) I understand my rights and responsibilities as a client and have had the opportunity to ask questions. 

(4) I understand my assessed fee/copay and policies and procedures around cancellations and no-shows.

  With my signature, I affirm that I have read the above information, and understand and agree to this working agreement.