Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-43 - Home and community-based services waivers - functional behavioral assessment 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 functional behavioral assessment 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) "County board" means a county board of
			 developmental disabilities.
(3)
			 "Department" means the Ohio department of developmental disabilities.
(4) "Family member" means a person who is
			 related to the individual by blood, marriage, or adoption.
(5) "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.
(6) "Independent
			 provider" 
									has the same meaning as in rule
			 5123-2-09
			 of the Administrative Code.
(7) "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.
(8) "Individual service plan" means the
			 written description of services, supports, and activities to be provided to an
			 individual.
(9) "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.
(10) "Usual and
			 customary charge" means the amount charged to other persons for the same
			 service.
(11) "Waiver
			 eligibility span" means the twelve-month period following either an
			 individual's initial waiver enrollment date or a subsequent eligibility
			 redetermination date.