... (;~~-:;~;.."!':.·:;-411·~ ~ !·' •; \·"\ \ ~·· · .. ...._ ·~ .. -~ ....·.:J' · ISF Phone: (954) 960-7091 Fax: (954) 5334053 (877) .25-SOBER ••,.. ...,,. h~lc••• •r •••U f'l"r••• February 5, 2015 ;~-:~'!::~· ··;;:; · i:~;- ...):,-\'.' ;.• ~ ~ ..... ._... J~ • i . ,__- -- t .. :r.j~j.• Ms. Maritza Lopez Substance Abuse Services Coordinator Florida Department of Children & Families (DCF) Circuit 17 (Broward County) Substance Abuse Mental Health (SAMH) Program Office 201 W. Broward Boulevard - Suite 511 Ft. Lauderdale, Florida 33301 Re: ·1~1 '-~ .. . V" . FEB 0 6 • .. I .,_~~5 l..; I t i Recovery Institute of South Florida- License# 1706AD352501, License# 1706AD352502 Christian Recovery Solutions - License # 1706AD70280 1 Dear Ms. Lopez: In accordance with your office •s correspondence dated December 17, 2014 we are providing the required corrective action plan. We have addressed each of the specific issues of concern raised in the site visit summary. If there are any questions or further clarification of our corrective action plan please do not hesitate to contact me at (954) 960-7091. Thank you for your assistance and attention to this matter. John Lichtenberg Executive Director Enclosures (2) JUbr Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 ~ '- .·· ' . I I 1. l. 3. 4. s. 6. 7. 8. 9. 10. 11. 12. • RULE: Plll'SU3llt to 650-30.004 (12) (c) l.r., F.AC., Copies of service-related correspondence, generated or received by the provider, when available... No effort was made to solicit client's Drior MH tx historv. • RULE: Pursuant to 650-30.004 (13) (a), F.A.C., The person conducting the screening shall document the rationale for any action taken.... No rationale provided. • RULE: Pursuant to 65D-30.004 (14) (b) l. e., F.A.C., Financial status...Not{u/ly explored • RULE: Pursuant to 650-30.004 (14) (b) 1. e., F.AC., Current living conditions...Not fully explored. • RULE: Pursuant to 650-30.004 (14) (b) 1. g., P.A.C., Past or current sexual abuse or trauma. ..Notfolly explored • RULE: Pursuant to 650-30.004 (14) (b) 3., F.AC., Ifthe psychosocial assessment was not completed initially by a qualified professional, the psychosocial assessment shall be reviewed. countersigned, and dated by a qualified professional within 10 calendar davs of conroletion.... No OP evident- comDleted by BHT. • RULE: Pursuant to 650-30.004 (14) (c), F.A.C., Such clients shall be accommodated directly or through referral...Client appeared to have a strong hx ofMH issues that were not addressed. • RULE: Pursuant to 650-30.004 (14) (c), F.A.C., A record of all services provided directly or through referral shall be maintained in the client record. .. Since provider does not have ACHA licensure, client could have been referred out for MH issues. • RULE: Pursuant to 650-30.004 (15), F.A.C., Client file contains admission justification according to criteria.... Completed late on 5128. • RULE: Pursuant to 6SD-30.004 (15), F.A.C., Client file contains transfer/discharge justification according to criteria ....ComDieted /ate-client le./t 5130. completed 6/26. • RULE: Pursuant to 650-30.004 (16) (b) 2., F.A.C., Applicable fees ... Not detailedfor this client. • RULE: Pursuant to 650-30.004 (16) (b) 6., F.A.C., General information about the provider's infection control policies and Drocedures; .. .Not made known to client upon placement. Admissions staff will make every effort to ensure that client's prior mental health treatment history and documentation is obtained. Linden New Intake Assessment form was implemented and intake staff was retrained to provide the rationale for actions taken. Dontrell Staff retrained to ensure correct infunnation is placed in the "pre-admission assessment" and fully explored. Intake staff retrained to ensure that current living conditions are fully explored and documented. Additional train~ will be done, as needed. Staff was retrained and received instructions on how to explore fully the "past or current sexual abuse or trauma" section. Intemal chart review tool was created by clinical director to ensure compliance. Further training to take place in Februarv. Staff was retrained and received instructions on timeliness of services as well as signature and review requirements by qualified professionals in regards to the psychosocial assessments... Further training to take place in February. Wayne Barbara Nikki Staff received training and instructions on referral requirements to ensure MH needs are addressed properly. This training included documentation requirements. Beatriz Staff received training and instructions on referral requirements to ensure MH needs are addressed properly. This training included documentation requirements. Beatriz Staff was retrained and received inslructions on timeliness of service requirements. Internal chart review tool was created by clinical director to ensure compliance. Further training to take place in February. Beatriz Staff was retrained and received instructions on timeliness of service requirements. Internal chart review tool was created by clinical director to ensure compliance. Further training to take place in February. Beatriz The admissions staffwill detail any financial responsibility of the client, which will be a part of the Business file. Infection control Policies and Procedures will be added to Patient Orientation Handbook. Program Director is currently in the process of updating the handbook. Page 1 of 13 Beatriz Beatriz Wayne Barbara Nikki Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 14. Staff received training on treatment planning twice in the past two months. Treatment plan reviews were addressed and forms were modified in the EMR. Medical records will prompt counselors of the need to one and clinical director will monitor with Staff received training on treatment planning twice in the past two months. Counselors will be monitored to ensure compliance and were given a sheet with timefratnes for the prompt completion of every document as standards Staff received training on treatment planning twice in the past two months. Training included signature requirements for all documentation. Counselors will be monitored by ongoing chart reviews. 15. 16. 17. 18. was current to populate goals and objectives into the DAP notes. Treatment plan training was offered twice during the past two months. Counselors will be monitored to ensure compliance. 19. 20. 21. • RULE: Pursuant to 65I)..30.004 (22) (a), F.AC., The provision of other services needed by the client following discharge, including aftercare ... .No clinical provisions were made to help client remain ~sober" • RULE: Pursuant to 65D-30.004 (29) (b), F.A.C., Providers shall provide a copy of the telephone numbers to reach client placed in services.... Update client docs/posters to have co"ect SAMH contact Clinical staff received training and instructions on how to properly address and document provision of services needed by clients following discharge. Counselors will be monitored to ensure compliance. Beatriz Program Director updated and posted the phone numbers of the Abuse Hotline, Florida Advocacy Council, and the District's Substance Abuse and Mental Health Program Office. Phone numbers will also be provided to clients at intake and in the patient orientation handbook. Barbara Beatriz 1. • RULE: Pursuant to 6SD-30.004(12)(a), F.A.C., Client/participant records shall be kept secure from unauthorized access and maintained in accordance with 42 Code of Federal Regulations, Part 2 and ss. 397.50(7), F.S.... Update EMR to include scanned KIPU EMR PHI records are kept on a secure database platform, data is encrypted, and database is backed up every night. LeoBorraza z. • RULE: Pursuant to 6SD-30.004(29)(b), F.A.C., district Alcohol, Drug Abuse, and Mental Health Program Office... Update. Program Director updated and posted the phone numbers of the Abuse Hotline, Florida Advocacy Barbara Beatriz Council, and the District's Substance Abuse and Mental Health Program Office. Phone numbers will also be to clients at intake and in the orientation handbook. Page 2of13 Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. o RULE: Pursuant to 65!)..30.004{17) (b)l., F.A.C. , For intensive outpatient treatment, treatment, treatment plan reviews shall be Staff received training on treatment planning twice in the past two months. Treatment plan reviews were addressed and fonns were modified in the EMR. Medical records will prompt counselors of the need to 11. RULE: Pursuant to 65D-30.004(17) (a), F.A.C., The treatment plan reviews shall be signed and dated by the person providing the service.. .Not completed. Staff received training on treatment plaruring twice in the past two months. Treatment plan reviews were addressed and fonns we# modified in the EM.R. Medical records will prompt counselors of the need to complete one immediately and clinical director will monitor required signatures and dates through u. 13. o Staff received training on treatment planning twice in the past two months. Treatment plan were addressed and fonns were modified in the EMR. Medical records will prompt counselors of the need to complete one immediately and clinical director will monitor required signattm:s and dates through chart reviews. Staff was retrained, clinical director current forms to populate goals and objectives into the DAP notes. Treatment plan training was offered twice during the past two months. Counselors will be monitored to ensure compliance. Page 3of13 Beatriz Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 I ·' '' ' ,, I' 14. • RULE: Pumlantto 65JJ-30.004{22) (b),l''.A.C., A transfer summary shall be completed immediately fur clients who transfer from one component to another within the same provider, and. .. Completed late for entry to lOP. '' New transfer summary form was developed and clinical staff received training on timely COlll\1\et\Qn \\~\\ ?.~\riz changes in levels of care as well as transfers. Intensive Outpatient Treatll\Ult frogram ~Review 1 2. 3. • RULE: Pursuant to 65D-30.004(12)(a), F.AC., Client/participant records shall be kept secure from unauthorized access and maintained in accordance with 42 Code of Federal Regulations, Part 2 and ss. 397.50(7), F.S.... Update EMR to include scanned item. • RULE: Pursuant to 650-30.004( 12)(a)3., F.AC., In those instances where records are maintained electronically, a staff identifier code will be accepted in lieu of a signature... Update EMR to include scanned items. • RULE: Pursuant to 65D-30.004(29)(b), F.A.C. , district Alcohol, Drug Abuse, and Mental Health Program Office...Update. KlPU EMR PHI records are kept on a secure database platfonn, data is encrypted, database is backed up every night. Leo Signatures are already in place. Leo Program Director updated and posted the phone numbers of the Abuse Hotline, Florida Advocacy Council, and the District's Substance Abuse and Mental Health Prograu Office. Phone numbers will also be provided to clients at intake and in the patient orientation handbook. Barbara Beatriz Admissions staff will make every effort to ensure that client's prior menull health treatment history and documentation is obtained. Linden New Intake Assessment furm was implemented and intake staffwas retrait!ed to provide the rationale fur actions taken. Dontrell Admissions staff will exhaust every avenue available to vet level of substance abuse impairment. Wayne Preadmission personnel will provide more detail regarding client's job dutietl, employment history, job status etc.. . Preadmission& personnel will provide infurmation about who the clients socialize with in the notes section. Wayne Day or Night Treatment Chart Review 1. 2. 3.. 4, 5. • RULE: Pursuant to 650-30.004 (12) (c) l. r., F.AC., Copies of Service-related Correspondence, generated or received by the provider, when available.... Client denied repeatedly history and problems with SA, has been in tx for MH, however. no effort was made to solicit docs from prior tx. • RULE: Pursuant to 650-30 .004 (13) {a), F.A.C., The person conducting the screening shall document the rationale for any action taken ... No rationale provided by intake staff. • RULE: Pursuant to 650-30.004 (14) (b) l. b., F.AC., Level of substance abuse impairment. .. Client repeatedly denied SA problems and impairment. • RULE: Pursuant to 650-30.004 (14) (b) I. e., F.A.C., Employment history, and...Not folly explored-what nursing Job? • RULE: Pursuant to 650-30.004 (14) (b) U:, F.AC., Peer relationships, and .. .Not fully explored. Page 4of13 Barbara Wayne ·' Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 I ; ']I I '' ; .. I ·' I I .': ': " I t'ursuant to 650-30.004 (14) (b) 1. f, F.A.C., Current oonditions ... Not fully explored. .JLE: Pursuant to 650-30 .004 (14) (b) 1. g. F.A.C., Past or ..;urrent sexual abuse or trauma. .. Not fully explored. -· 9. 10. 11. 12. 13. 14. 15. 16. l7. • RULE: Pursuant to 650-30.004(14)(c), F.A.C., Such clients shall be accommodated directly or through referral ... Client has extensive hx ofMH tx-no referral and cannot be accommodated directly. • RULE: Pursuant to 650-30.004(14) (c), F.A.C., A record of all services provided directly or through referral shall be maintained in the client record... Ifclients with MH needs only are to be accommodated, provider may require certification by the Agency for Healthcare Administration. Provider is encouraged to research need for certification with AHCA. • RULE: Pursuant to 650-30.004 (15), F.A.C., Client file contains admission justification according to criteria....Comvleted late. • RULE: Pursuant to 650-30.004 (16) (b)l., F.A.C., A description of services to be provided... Update to include more detail regarding this component and step down process, what to expect, length ofstay, etc... • RULE: Pursuant to 650-30.004(16)(b)2., F.AC., Applicable fees ... Updt;Jte to explain fees in client file-insurance breakdown/out ofpocket deductible. • RULE: Pursuant to 650-30.004 (16 )(b)6., F.AC., General information about the provider's infection control policies and procedures... Not made known to the client upon placement. • RULE: Pursuant to 650-30.004 (16) (c), F.A.C ., An initial treatment plan shall be completed on each client upon placement, unless an individual treatment plan is completed at that time... Completed 6/4 client admitted 613 to detox? • RULE: Pursuant to 650-30.004 (16) (c), F.A.C., The initial treatment plan shall be signed and dated by clinical staff....Staff signed6/9? • RULE: Pursuant to 650-30.004 (16) (c), F.A.C ., The initial treatment plan shall be signed by the client....Client sif!11ed 619? • RULE: Pursuant to 650-30.004 (17) (c), F.A.C., Progress notes shall be entered into the client record documenting a client's progress or lack of progress toward meeting treatment plan goals and oi)i ectives.... Not all notes reflect client's Intake staff retrained to ensure that current living conditions are fully explored and documented. Additional trainin2 will be done, as needed. Staff was retrained and received instructions on how to explore fully the "past or current sexual abuse or trauma" section. Internal chart review tool was created by clinical director to ensure compliance. Further training to take place in February. Staffreceived training and instructions on referral requirements to ensure MH needs are addressed properly. This training included documentation requirements. ( ,1 Wayne Wayne Beatriz Staff received training and instructions on referral requirements to ensure MH needs are addressed properly. This training included documentation requirements. Beatriz Staff received training on timeliness of services and will be monitored to ensure compliance. Beatriz Program Director will update and include details necessary to comply with standards of care. Beatriz The admissions staff will detail any financial responsibility of the client, which will be a part of the Business file. Wayne Infection control Policies and Procedures will be added to Patient Orientation Handbook. Program Director is currently in the process of updating the handbook. Nikki Staff received training on timeliness of completion of detox treatment plan and will be monitored to ensure that they are completed and signed upon placement by client and staff. Beatriz Staff received training on timeliness of completion of detox treatment plan and will be monitored to ensure that they are completed and signed upon placement by client and staff. Beatriz Staff received training on timeliness of completion of detox treatment plan and will be monitored to ensure that thev are completed and signed upon placement by client and staff. Staff was retrained, clinical director is working with medical records to modify the current forms to populate goals and objectives into the DAP notes. Treatment plan training was offered twice during the past two months. Counselors will be monitored to ensure compliance. Beatriz Page 5 of13 Beatriz '1' I • -- ~.uaava ..-u uuu J1 R.Dlllles Licensure Inspection Survey Responses from September, 2014 . ;v_ .6: Pursunnt to 6.m-.10.004(7.9)(h). F.A.C:.• Pruvicll:r,.; shall 11dc a copy oflhe telephone nnmhen; to rear.h client placerl in Pro~ Director -~~ed and the phone numbers of the Abuse Hotline, Florida Advocacy C:onncll, and the T>istrict s Substance Abuse and Mental Health Program Office. Phone numbers will also be 1o clients at intake and in the Bea1riz orientation handbook. Bea1riz KIPU EMR PHI records are kept on a secure database platform, data is encrypted, database is backed up Leo every night. leo Signatures are already in place. Bubara Bcatriz James 4. s. Housekeeping will ensure all buildings and equipment are clean and in repm. Supervisor will ensure all daily maintenance and housekeeping functions are met. 6. Safety Officer will ensure that all chemicals are properly container. Page 6of13 and stored in a locked, flammable James Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 1. and intake staff was retrained to provide the rationale for 3. & 4. As part review process, make sure that MD required. Also that aU ab results are uploaded into the EMR. Stephanie are in place Medical Records and Nursing staff will ensure that all results are reviewed/signed/time stamped prior to being scanned into the EMR. 6. Dontrell Barbara of substance abuse impairment. Nikki Wayne 7. 8. Wayne 9. Wayne 10. Nikki 11. ll. • RULE: Pursuant to 65D-30.004(14)(c), F.AC., clients shall be accommodated directly or through referral.... For AP client has extensive history ofMH. denied SA could have been referred to MHtx. are to ensure (c), F.AC., A record of all shall be maintained Page 7 of 13 needs are addressed Beatriz Nikki Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 client, which will be a part of the lS. Waynt! • RULE: Pursuant to 65D-30.004 (I 7) (c), F.AC., Progress notes shall be entered into the client record documenting a client's Beatriz progress or lack ofprogress toward meeting treatment plan goals and objectives. (Signed and dated)... not all notes reflect client's progress or lack ofprogress in meeting tx plan 16. 17. 1. up KIPUEMRPHI every night. Leo Signatures arc already in place. Barbara Beatriz 3. 4. s. Leo • RULE: Pursuant to 65D-30.004 plan shall incorporate evacuation procedures .... Please update policy to include all types of disasters and removal and storage of medications. • RULE: Pursuant to (34) (h), F.A.C., Provisions shall be made to ensure that housekeeping and maintenance services are capable of keeping the building and equipment clean and in . . Plan in Policies & Supervisor will ensure all daily maintenance and housekeeping functions arc met. Pap Bof 13 James : '. -~; - Recovery Institute of South Florida Department of Children and Families Licensure Inspection Survey Responses from September, 2014 I I '' ' '' I ' ...ad dust, ants m bathroom ursuant to 65D-30.004 (34) (j), F.A.C., Providers shall .11at hazardous materials are propt.Tiy ider•tifioo, handled, ..., used, and di,s-p(:nscd ... Laundry facility looks great, better ' ' I• ' . - ' ..... , : I I Safety Officer will ensure that all chemicals are properly labeled and stored in a locked, flammable container. James New Intake Assessment form was implemented and intake staff was retrained to provide the rationale for actions taken. Dontrell Barbara All medical services personnel will be re-educated regarding medical protocol in place. History & Physical form will indicate that MD signature is required and not initialed. Stephanie As part of the nursing assessment process, staffwill is making sure that MD signatures are in place where required. All results will be reviewed/signed/time stamped prior to being scanned into the EMR. Nikki Protocol will be put in place for medical stabilization. If detox is not needed for client, they will be placed on 3-day medical observation status and then cleared to transfer to least restrictive necessary setting. Nikki The admissions staff will detail any financial responsibility of the client, which will be a part of the Business file. Barbara Infection control Policies and Procedures will be added to Patient Orientation Handbook. Program Director is currently in the process of updating the handbook. Nikki Protocol will be put in place for medical stabilization. If detox is not needed for client, they will be placed on 3 day medical observation status and then cleared to transfer to least restrictive necessary setting. Nikki Staff received training on treatment planning twice in the past two months. The training included timeframes for documentation and signatures. Beatriz ,;anized, however, detergents/chemicals are stored in the space -lnd clients are not always supervised. ' Residential Detoxification Chart Review 1. • RULE: Pursuant to 65D-30.004 (13) (a), F.A.C., The person conducting the screening shall document the rationale for any action taken.... No rationale provided by intake stafffor files 2. • RULE: Pursuant to 65D-30.004 (14) (a) 3. a., F.A.C., Further, the examination shall be reviewed, signed, and dated by the physician in accordance with the medical protocol established in ss.65D-30.004(1) , F.A.C... .No MD siJQUJture only initialed exams. • RULE: Pursuant to 650-30.004 (14) (a) 4.a., F.A.C., Further, the results of the laboratory tests shall be reviewed, signed, and dated during the assessment process and in accordance with the medical protocol established in ss. 65D- 30.004(7) .... MD only initialed reviewed. 3. labs for files reviewed. 4. s. 6. • RULE: Pursuant to 650-30.004 (15), F.AC., Client file contains admission justification according to criteria. ... For LK -Client admitted 6110 ASAM done/signed 6125?--For AP-client according to MD did not meet criteria for detox admission. • RULE: Pursuant to 650-30.004 (16) (b) 2., F.AC., Applicable fees ... Fee breakdown not made c!earfor clients/ clients should acknowledge and sign the total ol.!t ofpocket after deductibles and sliding scale totals. • RULE: Pursuant to 65D-30.004 (16) (b) 6., F.A.C., General information about the provider's i:lfection control policies and procedures.... Client exposure to possible infections I communicable diseases not made known to client upon placement. 7. • RULE: Pursuant to 65D-30.004 (17) (a) 5 ., F.A.C., A medical plan for stabilization and detoxification .... For LK not evident-For AP-Presentingproblem states: client complains ofjob hara~;sment, anxiety, hx ofdomestic violence, no alcohol; MD clearly states that client does not meet criteria for detox. 8. • RULE: Pursuant to 650-30.004 (17) (a) 5.,F.A.C., The treatment plan shall be signed and dated by the client.... For LK signed late. Page 9of 13 8eatriz Beatriz 15. 16. Pursuant to 650-30.004 (14) (c), F.A.C., Such clients shall be accommodated directly or through referral... For AP client has extensive history ofMH. denied S.4. could have been refe"ed toMHtx. • RULE: Pursuant to 650-30.004 (c), F.AC., A record all services provided directly or through referral shall be maintained in the client record ...For AP provider does not corry ACHA Services ~Yill be provided to clients as needed, to accommodate referring out to other service providers. Staff training and instructions on properly. This training included documentation requirements. licensure and client not refe"edfor MH support which is what needed. Standards for Residential Detoxifi.cadon Services Review ,• Page 10of13 to ensure MH are Amity Clinic, LLC Clinical Services 9:00am!O:OOam I Treatment Goals I life Recovery Skills I Mindfulness Wellness and Nutrition Medication Management !O:OOam12:00pm Disease of Addiction Group Process Group 12:00pm1:00pm Lunch Lunch Lunch Lunch I Lunch 1:00pm3:00pm Feelings Group Family Dynamics Codependency Workshop Principles of Recovery I Spirituality 3:00pm4:30pm Defense Mechanisms In Recovery Relapse Dual Diagnosis Group Prevention Treatment Goals Disease of Addiction Defense Mechanisms In Recoverv Experiential Therapy I Self- Esteem Group Cognitive Behavioral Therapy Group Mindfulness Medication Relapse Prevention Coping Skills Self-Esteem Group Coping Skills Anger Management/COnflict Resolution Anger Management Conflict Resolution AMITY CLINIC, LLC COMPREHENSIVE OUTLINE OF SERVICES PROVIDED Amity Clinic's primary goal is to provide quality treatment that will foster independence, personal responsibility, and improved relationships with family members and community. Our well-integrated continuum of care addresses individuals with addiction or dual diagnosis disorders. PARTIAL HOSPITILIZATION is the primary level of care offering more support and structure than outpatient treatment can provide. This program does not offer 24hour medical supervision. Patients participate in a variety of groups according to their individual needs 7 hours daily. INTENSIVE OUTPATIENT is a step-down level of care for those who have completed the partial hospitalization program. Continued support and treatment allows the patient to develop skills to integrate into the work, family and social environment that will support their newly developed independence. The three-hour-a-day Monday through Friday program is designed to enhance this transition process. CONTINUING CARE is a valued asset to the above 1 programs. The treatment team works closely with each patient to set realistic goals for recovery and to develop a continuing care plan to solidify the goals made in treatment. AMITY CLINIC, LLC COMPREHENSIVE OUTLINE OF SERVICES PROVIDED Our extensive list of Treatment Modalities is individualized to each patient's unique needs. Included in the identified needs of the majority of our clients are the following options: Group therapy Psycho-educational groups life skills Spirituality Family therapy Family support groups Relapse prevention Medication management of affective disorders 12 Step Recovery Integration 2 12 Step Recovery Meetings Treatment is intensive and structured with an emphasis on family involvement as appropriate on and individual basis. 3 AMITY CLINIC, LLC SCHEDULE OF FEES FOR MEDICAL SERVICES PROVIDED: POLICY: Fees that will be charged for client's responsibility outlining what the client is obligated to pay. PURPOSE: To comply with the client's financial responsibility for services rendered. A reasonable fee shall be charged to the client. AMITY CLINIC sets the costs and fee schedule. RESPONSIBILITY: The Medical Director and the Billing Department. FEE-CASES: • PHP • • • • lOP OP I Ambulatory Detox Individual Counseling Group Meetings NON-FEE CASES: • To be determined on a case by case review FEES:" The following fees shall be charged for services indicated: 1. 2. 3. 4. PHP = $ 895.00 per day IOP = $ 695.00 per day OP/ Ambulatory Detox = $ 1100.00- per session Individual Counseling= $ 275.00 - per session Note: These Fees are subject to change annually.