Ohio Admin. Code 5123-9-41 - Home and community-based services waivers - clinical/therapeutic intervention under the level one and self-empowered life funding waivers
(A) Purpose
This rule defines clinical/therapeutic intervention and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
For the purposes of this rule, the following definitions apply:
(1) "Agency provider"
has the same meaning as in
means an entity that directly employs at least one
person in addition to a director of operations for the purpose of providing
services for which the entity is certified in accordance with rule
5123-2-08 of the Administrative
Code.
(2) "Clinical/therapeutic
intervention" means services that are necessary to reduce an individual's
intensive behaviors and to improve the individual's independence and inclusion
in the community and that are not otherwise available under the medicaid state
plan. Clinical/therapeutic intervention includes consultation activities that
are provided by professionals in psychology, counseling, special education, and
behavior management. The service includes the development of a
treatment/support plan, training and technical assistance to assist unpaid
caregivers and/or paid support staff in carrying out the plan, delivery of the
services described in the plan, and monitoring of the individual and the
provider in the implementation of the plan. Clinical/therapeutic intervention
may be delivered in the individual's home or in the community as described in
the individual service plan. Clinical/therapeutic intervention
must
may be
determined necessary to reduce an individual's intensive behaviors
only by a functional behavioral assessment
conducted by a licensed psychologist, licensed professional clinical counselor,
licensed professional counselor, licensed independent social worker, licensed
social worker working under the supervision of a licensed independent social
worker, or certified Ohio behavior analyst. Experimental treatments are
prohibited.
(3) "County board"
means a county board of developmental disabilities.
(4) "Department" means the Ohio department of
developmental disabilities.
(5)
"Family member" means a person who is related to the individual by blood,
marriage, or adoption.
(6)
"Functional behavioral assessment" means an assessment, not otherwise available under the medicaid state
plan, to determine why an individual engages in
intensive behaviors and how the individual's behaviors relate to the
environment. A functional behavioral assessment describes the relationship
between a skill or performance problem and the variables that contribute to its
occurrence. A functional behavioral assessment may provide information to
develop a hypothesis as to why an individual engages in a behavior, when the
individual is most likely to demonstrate the behavior, and situations in which
the behavior is least likely to occur.
(7) "Independent provider"
has the same meaning as in
means a self-employed person who provides services for
which the person is certified in accordance with rule
5123-2-09 of the Administrative
Code and does not employ, either directly or through
contract, anyone else to provide the services.
(8) "Individual" means a person with a
developmental disability or for purposes of giving, refusing to give, or
withdrawing consent for services, the person's guardian in accordance with
section 5126.043 of the Revised Code or
other person authorized to give consent. An individual may designate another
person to assist with development of the individual service plan and budget,
selection of residence and providers, and negotiation of payment rates for
services; the individual's designee shall not be employed by a county board or
a provider, or a contractor of either.
(9) "Individual service plan" means the
written description of services, supports, and activities to be provided to an
individual.
(10) "Service
documentation" means all records and information on one or more documents,
including documents that may be created or maintained in electronic software
programs, created and maintained contemporaneously with the delivery of
services, and kept in a manner as to fully disclose the nature and extent of
services delivered that shall include
includes the items delineated in paragraph (E) of
this rule to validate payment for medicaid services.
(11) "Waiver eligibility span" means
the twelve-month period following either an individual's initial waiver
enrollment date or a subsequent eligibility redetermination
date.
(C) Provider qualifications
(4)(3)
Clinical/therapeutic intervention shall not be provided to an individual by the
individual's family member.
(1) Clinical/therapeutic intervention
shall
will be
provided by an independent provider or an agency provider that:
(a) Meets the requirements of this
rule;
(b) Has a medicaid provider
agreement with the Ohio department of medicaid; and
(2)
Clinical/therapeutic intervention shall
will be provided by senior level specialized
clinical/therapeutic interventionists, specialized clinical/therapeutic
interventionists, and clinical/therapeutic interventionists.
(a) A senior level specialized
clinical/therapeutic interventionist shall
will have a doctoral degree in psychology,
special education, medicine, or a related discipline; be licensed or certified
under the laws of the state to practice in that field; and have at least three
months of experience and/or training in the implementation and oversight of
comprehensive interventions for individuals with developmental disabilities who
need significant behaviorally-focused interventions.
(b) A specialized clinical/therapeutic
interventionist shall
will:
(i) Have a
master's degree in psychology, special education, or a related discipline and
be licensed or certified under the laws of the state to practice in that field
or be registered with the state board of psychology as an aide or a psychology
aide working under psychological work supervision in accordance with rule
4732-13-03 of the Administrative
Code; and
(ii) Have at least three
months of experience and/or training in the implementation and oversight of
comprehensive interventions for individuals with developmental disabilities who
need significant behaviorally-focused interventions.
(c) A clinical/therapeutic interventionist
shall
will
work under the supervision of a senior level specialized clinical/therapeutic
interventionist or a specialized clinical/therapeutic interventionist and
shall:
(i)
Have experience providing one-to-one care for an individual with developmental
disabilities who needs significant behaviorally-focused
interventions;
(ii) Have undergone
two monitored sessions with an individual with developmental disabilities who
needs significant behaviorally-focused interventions;
(iii) Hold a "Registered Behavior Technician"
credential issued by the behavior analyst certification board; or
(iv) Hold a "Board Certified Assistant
Behavior Analyst" credential issued by the behavior analyst certification
board.
(3) A county board or a regional
council of governments formed under section 5126.13 of the Revised Code by two
or more county boards may provide clinical/therapeutic intervention by senior
level specialized clinical/therapeutic interventionists only when no other
certified provider is willing and able. Neither a county board nor a regional
council of governments formed under section 5126.13 of the Revised Code by two
or more county boards shall provide clinical/therapeutic intervention by
specialized clinical/therapeutic interventionists or clinical/therapeutic
interventionists.
(D)
Requirements for service delivery
Clinical/therapeutic intervention shall
will be
provided pursuant to an individual service plan that conforms to the
requirements of rule
5123-4-02 of the Administrative
Code.
(E) Documentation of
services
Service documentation for clinical/therapeutic intervention
shall
will
include each of the following to validate payment for medicaid services:
(1) Type of service.
(2) Date of service.
(3) Place of service.
(4) Name of individual receiving
service.
(5) Medicaid
identification number of individual receiving service.
(6) Name of provider.
(7) Provider identifier/contract
number.
(8) Written or electronic
signature of the person delivering the service, or initials of the person
delivering the service if a signature and corresponding initials are on file
with the provider.
(9) Description
and details of the services delivered that directly relate to the services
specified in the approved individual service plan as the services to be
provided and details of the individual's response to the services, including
progress toward achieving outcomes specified in the individual service
plan.
(10) Number of units of the
delivered service or continuous amount of uninterrupted time during which the
service was provided.
(11) Times
the delivered service started and stopped.
(F) Payment standards
(1) The billing unit, service codes, and
payment rates for clinical/therapeutic intervention are contained in the
appendix to this rule.
(2) The
payment rate for clinical/therapeutic intervention provided by an independent
provider shall
will be negotiated by the individual and the
independent provider subject to the minimum and maximum payment rates contained
in the appendix to this rule and shall be
identified in the individual service plan.
(3) The payment rate for clinical/therapeutic
intervention provided by an agency provider shall
will be the
lesser of the agency provider's usual and customary charge or the statewide
payment rate contained in the appendix to this rule.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Prior Effective Dates: 07/01/2012, 09/23/2018, 07/01/2022
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