Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-41 - Home and community-based services waivers - clinical/therapeutic intervention under the level one and self-empowered life funding waivers

Current through all regulations passed and filed through July 1, 2024
(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 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 be determined necessary to reduce an individual's intensive
			 behaviors 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 rule
			 5123-2-09
			 of the Administrative Code.
(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 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.