Regulation .34 Covered Services — Behavior Consultation Services.
Regulation .34 Covered Services — Behavior Consultation Services.LinkCopy Citation
A.
Definition. “Unit of service” means an hour of service rendered by a qualified individual during a home visit to a participant, not including:
(1)
The time spent on related activities before or after the home visit; or
(2)
The time spent on supervisory or consultative services to the provider.
B.
A provider may bill for the length of a home visit to a participant, upon completion of the services specified in §D of this regulation.
C.
Behavior consultation services may be preauthorized by a participant's plan of care as necessary and appropriate when:
(1)
A participant's behavior is:
(a)
Disruptive;
(b)
Potentially dangerous to the participant's or another person's health and functioning; or
(c)
Placing the participant at risk of institutionalization due to health and safety concerns; and
(2)
Advice is needed as to how to manage the disruptive behavior of a participant.
D.
Behavior consultation services include a:
(1)
Home visit by an individual qualified to render services to:
(a)
Evaluate a participant's acute behavior change;
(b)
Assess the situation;
(c)
Determine the contributing factors; and
(d)
Recommend interventions and treatments;
(2)
Written report prepared for review by the case manager and the assisted living services provider or the participant's family, which assesses the situation and makes recommendations; and
(3)
Verbal review of the report with the case manager and the assisted living services provider or the participant's family to discuss:
(a)
The report's findings and recommendations; and
(b)
A course of action, including any related needed medical interventions.