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Behavior Services

Behavior Services shall mean:

a.   Services to assess and ameliorate waiver participant behavior that jeopardizes the health and safety of the waiver participant, that endangers others, or that prevents the waiver participant from being able to successfully participate in community activities; and

b.   Development, monitoring, and revision of behavior intervention strategies, including development of a Behavior Support Plan and staff instructions for caregivers who are responsible for implementation of prevention and intervention strategies; and

c.   The initial training of caregivers on the appropriate implementation of behavior intervention strategies, including the Behavior Support Plan (BSP) and staff instructions.

Therapeutic goals and objectives shall be required for waiver participants receiving Behavior Services.

Behavior Services shall not be billed when provided during the same time period as Physical Therapy, Occupational Therapy, Nutrition Services, Orientation and Mobility Services for Impaired Vision, or Speech, Language, and Hearing Services unless there is documentation in the waiver participant’s record of medical justification for the two services to be provided concurrently.

Behavior Services shall be provided face to face with the waiver participant except for:

    • Waiver participant-specific training of staff; and

 

    • Behavior assessment and plan development; and
    • Presentation of waiver participant behavior information at human rights committee meetings, behavior support committee meetings, and waiver participant planning meetings.  Reimbursement for presentation of waiver participant behavior information at meetings shall be limited to a maximum of 5 hours per waiver participant per year per provider.

 

Behavior assessments, behavior plan development, and presentations at meetings shall not be performed by Behavior Specialists.  Reimbursement for behavior assessments shall be limited to a maximum of 8 hours per assessment (32 qtr. hour units per year) with a maximum of 2 assessments per year. 

Reimbursement for behavior plan development resulting from such a behavior assessment and the training of staff on the plan during the first 30 days following its approval for use shall be limited to a maximum of 6 hours (24 qtr. hour units per year). 

Reimbursement shall not be made for travel time to meetings and for telephone consultations, but may be made for consultations with the waiver participant’s treating physician or psychiatrist during an office visit when the waiver participant is present.

Reimbursement for presentation of person behavior information at human rights committee meetings, behavior support committee meetings, and person planning meetings shall be limited to 5 hours per provider (20 qtr. hour units per year).

Behavior Services are not intended to replace services that would normally be provided by direct care staff or to replace services available through the Medicaid State Plan/TennCare Program, including psychological evaluations and psychiatric diagnostic interview examinations.

Behavior Services shall not be covered for children under age 21 years (since it would duplicate TennCare/EPSDT benefits).

Applicable limits, if any, on the amount, frequency, or duration of this service:

  • 8 hours per assessment for completion of the behavior assessment; 2 assessments per year.
  • 6 hours per assessment for behavior  plan development and staff training during the first 30 days following its approval; 2 assessments per year.
  • 5 hours for presentations at meetings per year

 

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