Ohio Administrative Code › Title 5123:2 - Community Services › Chapter 5123:2-9 - Home and Community-Based Services Waivers › Section 5123:2-9-41 - Home and community-based services waivers - clinical/therapeutic intervention under the self-empowered life funding waiver

Current through all regulations passed and filed through July 1, 2024
(A)
								 Purpose
The purpose of this rule is to define
				clinical/therapeutic intervention and set forth provider qualifications,
				requirements for service delivery and documentation of services, and payment
				standards for the service.
(B)
								
			 Definitions
(1)
									 "Agency provider" means an entity that employs persons for
			 the purpose of providing services.
(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 his or her community and that are not otherwise
			 available under the state medicaid program. 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 be determined necessary to reduce an
			 individual's intensive behaviors by a functional behavioral assessment
			 conducted by one of the following: licensed psychologist, licensed professional
			 clinical counselor, licensed professional counselor, licensed independent
			 social worker, or licensed social worker working under the supervision of a
			 licensed independent social worker. 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 state medicaid program to determine why an
			 individual engages in intensive behaviors and how the individual's behaviors
			 relate to the environment. Functional behavioral assessments describe the
			 relationship between a skill or performance problem and the variables that
			 contribute to its occurrence. Functional behavioral assessments can provide
			 information to develop a hypothesis as to why the individual engages in the
			 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" means a person who provides services 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, his or her
			 guardian in accordance with section
			 5126.043 of the Revised Code or
			 other person authorized to give consent. An individual who is his or her own
			 guardian may designate another person to assist the individual 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)
									 "Medicaid program" has the same meaning as in section
			 5111.01 of the Revised
			 Code.
(11)
									 "Service and support administrator" means a person,
			 regardless of title, employed by or under contract with a county board to
			 perform the functions of service and support administration and who holds the
			 appropriate certification in accordance with rule
			 5123:2-5-02
			 of the Administrative Code.
(12)
									 "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 the items delineated in paragraph (E) of
			 this rule to validate payment for medicaid services.
(13)
									 "Support
			 broker" means a person who is responsible, on a continuing basis, for providing
			 an individual with representation, advocacy, advice, and assistance related to
			 the day-to-day coordination of services (particularly those associated with
			 participant direction) in accordance with the individual service plan. The
			 support broker assists the individual with the individual's responsibilities
			 regarding participant direction, including understanding employer authority and
			 budget authority, locating and selecting providers, negotiating payment rates,
			 and keeping the focus of the services and support delivery on the individual
			 and his or her desired outcomes. The support broker, working in conjunction
			 with the service and support administrator, assists the individual with
			 creating the individual service plan, developing the waiver budget, and doing
			 day-to-day monitoring of the provision of services as specified in the
			 individual service plan.
(14)
									 "Waiver
			 eligibility span" means the twelve-month period following either an
			 individual's initial enrollment date or a subsequent eligibility
			 re-determination date.