Regulation .03 Covered Services.
Regulation .03 Covered Services.LinkCopy Citation
A.
The Program covers the services listed in this chapter when the services are:
(1)
Diagnosed, identified, and prescribed by an EPSDT provider to be medically necessary;
(2)
Preauthorized by the Department or its designee; and
(3)
Delivered in accordance with the behavioral plan.
B.
The following services are covered:
(1)
Therapeutic behavioral assessment and reassessment that includes:
(a)
Development of a behavioral plan with the participant and parent, guardian, or individual who customarily provides care which specifically:
(i)
Identifies the target behaviors or symptoms that are placing the current living arrangement at risk or presenting a barrier to transition to a less restrictive living arrangement;
(ii)
Defines specific interventions to be used to resolve the behaviors or symptoms, including how a therapeutic aide will implement therapeutic behavioral services;
(iii)
Defines outcome measures that can be used to demonstrate the decreasing frequency of targeted behaviors;
(iv)
Defines alternative behaviors;
(v)
Defines the clinically accepted techniques for behavior change, including where, when, and the frequency of the techniques to be used and the risks and benefits of each;
(vi)
Details the strategies and skills for the participant and parent, guardian, or individual who customarily provides cares to provide continuity of care when therapeutic behavioral services are discontinued;
(vii)
Details emergency procedures to be implemented when the participant exhibits behaviors that pose harm to self or others;
(viii)
Contains written informed consent before implementation, of the parent or legal guardian, or if the participant is 18 years old or older, written informed consent of the participant; and
(ix)
Identifies the level or type of licensed healthcare professional responsible for monitoring the behavioral plan; and
(b)
Determination if therapeutic behavioral services are needed;
(2)
Therapeutic behavioral services that:
(a)
Provide one-to-one intervention for a specified period of time at the appropriate site in accordance with the behavioral plan; and
(b)
May include, but are not limited to:
(i)
Assisting the participant to engage in or remain engaged in appropriate activities;
(ii)
Minimizing the participant’s impulsive behavior;
(iii)
Providing immediate behavioral reinforcements;
(iv)
Providing time structuring activities; and
(v)
Collaboration with and support for parent, guardian, or individual who customarily provides care in the effort to provide ongoing behavioral support.