Terms and Conditions

Last Updated: 10/13/2023

The following Terms and Conditions apply to services provided at Michael Humphries, M.S. CCC-SLP, BCBA & Associates, PLLC doing business as (DBA) Not Your Everyday Therapy Services (NETS). NETS therapy services include speech language and behavior analyst services which may include but are not limited to programming and/or services rendered necessary to support client services.

NETS is committed to providing every child with medically necessary Speech-Language and Behavior Analyst services. Prior to beginning services all Clients/Legal Guardians will review the following:

Both are located on our website and require a signed acknowledgement to be kept on file. Both are periodically updated on our website and electronic communications will advise changes. Please direct any questions regarding this information to info@notyoureverydaytherapy.com.

Legal Notice

These are the terms and conditions for receiving services at Not Your Everyday Therapy Services (NETS). This document is known as the “Terms and Conditions”. In addition to these Terms and Conditions all members participating in therapy services must agree to and follow the Policies and Procedures.

To receive services at NETS, you agree to be bound by the Terms and Conditions which include:

Insurance Agreement
Confidentiality Agreement
Early Intervention vs. Developmental Acquisition
Collaboration with Other Service Providers
Access to Records Policy
Type and Frequency of Documentation Statement
Appointment Cancellation Policy
Medical Necessity Statement
Termination and Dismissal Statement
Policies and Procedures Statement

NETS Terms and Conditions are posted and periodically updated on our website. It is the responsibility of all Client(s)/Legal Guardian(s) to review and understand these informational documents. Please direct any questions regarding these documents to info@notyoureverydaytherapy.com.

Insurance Agreement

This Insurance Agreement (the “Agreement”) is made and entered into between (“Legal Guardian”) and NETS:

I Legal Guardian must make sure the office is aware of any name, address, phone and/or insurance information changes before the appointment.
I Legal Guardian am responsible for contacting my insurance company and understanding speech-language and/or behavior analyst coverage terms before evaluation or therapy begins at NETS.
I Legal Guardian agree to pay for any and all medical/therapy services I receive from NETS including those that my insurance company refuses to pay, for whatever reason. NETS will file a claim on my behalf (if contracted with my insurance company), however, if my insurance company denies payments for any reason (e.g. non-covered services, services not medically necessary, my failure to obtain a referral, etc.), I will pay these charges promptly upon written/verbal notification of this refusal. If the insurance company requests additional information for processing a claim, NETS will resubmit one time. After the second submission, the Legal Guardian will be responsible for payment of claim to NETS and working directly with the insurance company to resolve the claim. No appeals will be filed by NETS on my behalf.
I Legal Guardian understand that failure of my insurance company to pay within 60 days of claim filing date will be considered a refusal to pay and I will be responsible for payment in full due upon receipt of notification.
If your account is delinquent, your balance will be turned over to a collection agency and a collection fee of $125.00 or double your balance will be added.

Confidentiality Agreement

This Confidentiality Agreement (the “Agreement”) is made and entered into between (“Legal Guardian”) and Michael Humphries, M.S. CCC-SLP, BCBA & Associates, PLLC doing business as (DBA) Not Your Everyday Therapy Services (NETS). (“Covered Entity”).

The parties acknowledge that Legal Guardian may incidentally or inadvertently encounter, view or access certain Confidential Information maintained by Covered Entity which may qualify as Protected Health Information (“PHI”) or electronic PHI within the meaning of the Health Insurance Portability and Accountability Act of 1996, as amended, and the privacy and security standards promulgated pursuant thereto (“HIPAA”).

NOW, THEREFORE, in consideration of the mutual promises contained herein, as well as other good and valuable consideration, the parties hereto agree as follows:

“Confidential Information” means any and all non-public, medical, financial and personal information in whatever form (written, oral, visual or electronic) possessed or obtained by either party. Confidential Information shall include all information which (i) either party has labeled in writing as confidential, (ii) is identified at the time of disclosure as confidential, (iii) is commonly regarded as confidential in the healthcare industry, or (iv) is Protected Health Information as defined by HIPAA.
Legal Guardian agrees to maintain the confidentiality of any Confidential Information, including Protected Health Information that it may incidentally or inadvertent encounter, view or have access to while providing the services under the terms and conditions set forth in this Agreement.
Legal Guardian agrees not to further use or disclose any Confidential Information, including Protected Health Information that it incidentally or inadvertently views or obtains access to and further agrees to implement appropriate safeguards to prevent any further use or disclosure of any Confidential Information that is incidentally or inadvertently accessed.
Legal Guardian agrees to report to the Covered Entity any use or disclosure of Confidential Information in violation of this Agreement, HIPAA or any other federal, state or local law or regulation.
Legal Guardian agrees to comply with all applicable laws and regulations, including HIPAA and the HITECH Act, to the extent applicable, in meeting obligations under this Agreement.
The obligations of confidentiality and non-use and non-disclosure under this Agreement will continue indefinitely from the effective date of this Agreement.
This Agreement may be modified or amended only with the written consent of both parties.
No waiver of any provision of this Agreement, including this paragraph, shall be effective unless the waiver is in writing and signed by the party making the waiver.

NETS understands the sensitivity of the information shared with our staff and strives to keep all information shared private and confidential. To maintain confidentiality, only general information will be shared by NETS concerning the type of services provided. Clinicians are available to discuss sessions in greater detail either in private during the beginning or end of the session(s). Prior to participating in services provided by NETS, all families must acknowledge and sign for the terms of conditions which includes the confidentiality agreement stated above.

Type and Frequency of Documentation/Communication of Services

Assessment of speech and language disorders is a complex and dynamic process. Each practice setting has its own considerations that influence the assessment process. Speech-language pathologists (SLPs) in private practice use screening and assessment tools. Most screenings are pass/fail with recommendation for further evaluation. Clinicians balance the clinical needs of their clients with test choice, state regulations, and payer requirements.

Clinicians select the most appropriate method(s) and measure(s) to use for a particular individual, based on his or her age, cultural background, and values; language profile; severity of suspected communication disorder; and factors related to language functioning (e.g., hearing loss and cognitive functioning).

Behavior analysts are knowledgeable about and comply with all applicable requirements (e.g., BACB rules, laws, regulations, contracts, funder and organization requirements) for storing, transporting, retaining, and destroying physical and electronic documentation related to their professional activities. They destroy physical documentation after making electronic copies or summaries of data (e.g., reports and graphs) only when allowed by applicable requirements. When a behavior analyst leaves an organization, these responsibilities remain with the organization.

Behavior analysts use understandable language in, and ensure comprehension of, all communications with clients, stakeholders, supervisees, trainees, and research participants. Before providing services, they clearly describe the scope of services and specify the conditions under which services will end. They explain all assessment and behavior-change intervention procedures before implementing them and explain assessment and intervention results when they are available. They provide an accurate and current set of their credentials and a description of their area of competence upon request.

References:

American Speech-Language-Hearing Association. ASHA Website (2023). Assessment tools, techniques, and data sources. https://www.asha.org/practice-portal/clinical-topics/late-language-emergence/assessment-tools-techniques-and-data-sources/

American Speech-Language-Hearing Association. ASHA Website (2023). Assessment considerations in speech-language pathology private practice. https://www.asha.org/slp/clinical/assessment-in-private-practice/

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Medical Necessity for Services

Audiology and speech-language pathology services are medically necessary to treat speech-language, swallowing, cognitive communication, hearing, and balance disorders. Many of these disorders—such as head injury, Parkinson’s disease, stroke, autism, and cerebral palsy—have a neurological basis. Determining medical necessity takes into consideration whether a service is essential and appropriate to the diagnosis and/or treatment of an illness, injury, or disease. The U.S. National Library of Medicine defines disease as “an impairment of the normal state.” Loss of hearing, impaired speech and language, and swallowing difficulties all reflect an impairment of the normal state, and services to treat such impairment must be regarded as meeting medical necessity.

Habilitation services, referenced in the ACA definition of medical necessity, treat illness, injury, condition, and diseases (or symptoms) and, thus, should be included in definitions of medical necessity. Developmental deficits requiring habilitation services meet medical necessity. A diagnosis of developmental deficit in a child indicates an abnormal state of function, and speech, language, and hearing services are as medically necessary for this patient as they are for an adult who has suffered a stroke and has lost speech and language function.

Behavior analysts ensure, to the best of their ability, that medical needs are assessed and addressed if there is any reasonable likelihood that a referred behavior is influenced by medical or biological variables. They document referrals made to a medical professional and follow up with the client after making the referral.

References:

American Speech-Language-Hearing Association. ASHA Website (2023). Medical necessity for audiology and speech-language pathology services. Retrieved from https://www.asha.org/practice/reimbursement/medical-necessity-for-audiology-and-slp-services/

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Access to Records

In accordance with the Health Insurance Portability and Accountability Act 45 CFR § 164.524, Upon request, Legal Guardians have the right to inspect or obtain a copy, or both, of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity of the individual’s choice. Individuals have a right to access this PHI for as long as the information is maintained by a covered entity, or by a business associate on behalf of a covered entity, regardless of the date the information was created; whether the information is maintained in paper or electronic systems onsite, remotely, or is archived; or where the PHI originated (e.g., whether the covered entity, another provider, the patient, etc.).

Early Intervention vs. Developmental Acquisition Statement

NETS follows the Roles and Responsibilities of Speech-Language Pathologists in Early Intervention as set forth by the American Speech Language Hearing Association (ASHA).

Early intervention is the process of providing services, education, and support to young children who are deemed to have an established condition, those who are evaluated and deemed to have a diagnosed physical or mental condition (with a high probability of resulting in a developmental/behavioral delay), an existing delay or a child who is at-risk of developing a delay or special need that may affect their development or impede their education. The purpose of early intervention is to lessen the effects of the disability, behavior, or delay. Services are designed to identify and meet a child’s needs in five developmental areas, including: physical development, cognitive development, communication, social or emotional development, and adaptive development.

Developmental Acquisition in Child development refers to how a child becomes able to do more complex things as they get older. Development is different than growth. Growth only refers to the child getting bigger in size. Normal development involves the following skills:

Gross motor skills use large groups of muscles to sit, stand, walk, run, etc., keeping balance and changing positions;
Fine motor skills use hands and fingers to be able to eat, draw, dress, play, write, and do many other things;
Language skills include speaking, using body language and gestures, communicating, and understanding what others say;
Cognitive skills relate to thinking skills including learning, understanding, problem-solving, reasoning, and remembering; and,
Social skills include interacting with others, having relationships with family, friends, teachers by displaying social/emotion regulation skills to include cooperating and responding to the feelings of others.

Reference:

American Speech-Language-Hearing Association. Practice Portal (2023). Early intervention. https://www.asha.org/practice-portal/professional-issues/early-intervention/

Behavior Analyst Role and Responsibility

NETS follows the Roles and Responsibilities of Behavior Analysts based on the Code of Ethics when providing treatment to prioritize clients’ rights and needs in service delivery. They provide services that are conceptually consistent with behavioral principles, based on scientific evidence, and designed to maximize desired outcomes for and protect all clients, stakeholders, supervisees, trainees, and research participants from harm. Behavior analysts implement nonbehavioral services with clients only if they have the required education, formal training, and professional credentials to deliver such services.

Reference:

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Collaboration with Other Service Providers

In accordance with the American Speech-Language Hearing Association’s Code of Ethics and expectations set forth by Behavior Analyst Certification Board, NETS shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided.

Behavior analysts collaborate with colleagues from their own and other professions in the best interest of clients and stakeholders. Behavior analysts address conflicts by compromising when possible and always prioritizing the best interest of the client. Behavior analysts document all actions taken in these circumstances and their eventual outcomes.

References:

American Speech-Language-Hearing Association. (2023). Code of ethics. https://www.asha.org/siteassets/publications/code-of-ethics-2023.pdf

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Dismissal & Termination of Services

When receiving speech-language services, the ideal circumstance for discharge would be when the team—consisting of the individual with the communication disorder, the family, and the speech-language pathologist–comes to a mutual decision. The main reasons for discharge are:

the communication disorder has been remediated or compensatory strategies have been successfully established;
the individual or family chooses not to participate in treatment, relocates, or seeks another provider;
treatment no longer results in measurable benefits after multiple modifications have been attempted.

Each program should have established policies and procedures for following the individual after discharge. Follow-up is necessary because an individual’s circumstances may change, new treatments may become available, or the individual may respond differently due to maturational changes or new life transitions (ASHA, 2004).

Termination Due to Lack of Progress/Speech-Language Services

An apparent “lack of progress” is based on the assumption that the prescribed treatment goals, methods, data collection, and use are all appropriate for the individual with disabilities and their family. However, it is possible that the perceived lack of progress is actually an indication that the procedures being implemented are not well-suited to the individual with disabilities. In other words, lack of progress might indicate that the intervention is a poor fit. It is important to examine whether the intervention itself is optimal for the individual, their family, and their other caregivers and educators.

Assuming treatment directions and methods are appropriate, it may be necessary to attempt some training and direct support for family members. The objectives of this training would likely be to make family members aware of the potential benefits of treatment participation and to clarify any confusion related to the methods used and the role of families as agents of change.

Schepis and Reid (2003) provided a possible resource to assist with training families and other stakeholders. These authors discussed competency- and performance-based training built on adult learning principles and derived from applied research. Adopting this training approach could be an initial step in promoting the comprehensive application of communication-based treatment across settings and could lead to a dramatic change in support.

Termination of Service Based on Parent Preferences/Speech-Language Services

One issue concerns dismissal of a student when the family no longer desires treatment. If this is the case, ASHA suggests that discharge is appropriate. According to ASHA (2004), discharge is defensible when “the individual, family, and/or guardian requests to be discharged or requests continuation with another provider” (p. 5). If the discharge is motivated by a lack of progress, questions such as the following should be carefully considered before a final decision is made:

How appropriate have the intervention goals been?
Has treatment occurred with appropriate intensity and over a sufficient amount of time?
Have appropriate methods been implemented?
Has intervention been guided by careful data collection and analysis?
Have sufficient supports been provided to optimize opportunities for successful outcomes?
(ASHA, 2004)

Termination of Service/Behavior Analyst Services

Behavior analysts include the circumstances for discontinuing services in their service agreement. They consider discontinuing services when: (1) the client has met all behavior-change goals, (2) the client is not benefiting from the service, (3) the behavior analyst and/or their supervisees or trainees are exposed to potentially harmful conditions that cannot be reasonably resolved, (4) the client and/or relevant stakeholder requests discontinuation, (5) the relevant stakeholders are not complying with the behavior-change intervention despite appropriate efforts to address barriers, or (6) services are no longer funded. Behavior analysts provide the client and/or relevant stakeholders with a written plan for discontinuing services, document acknowledgment of the plan, review the plan throughout the discharge process, and document all steps taken.

References:

American Speech-Language-Hearing Association. ASHA website (2023). Decision-making in termination of services. https://www.asha.org/njc/decision-making-in-termination-of-services/

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Schepis, M. M., & Reid, D. H. (2003). Issues affecting staff enhancement of speech generating device use among people with severe disabilities. Augmentative and Alternative Communication, 19, 59–65.