Clinical Behavioral Support Services: Definitions and Guidelines
Clinical Behavioral Support Services are therapeutic interventions aimed at enhancing individuals' independence and community inclusion. These services involve creating positive behavioral support plans, assessing behavioral needs, providing appropriate training, evaluating plan effectiveness, and ensuring modifications as needed. Services can be delivered in the individual's home or community, excluding school or facility settings. Limitations and exclusions apply, and only qualified providers can deliver these services as per specified qualifications.
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Clinical Behavioral Support Services- Service Definitions and Billing Documentation Dawne Recinos, PsyD DDS South Region Clinical Director January 21, 2021
Definition of Clinical Behavioral Services Clinical Behavioral Support Services are therapeutic services that are not covered by the Medicare or Medicaid State Plan and are necessary to improve an individual s independence and inclusion in their community. Clinical Behavioral Services may be purchased from a qualified individual practitioner or purchased from a qualified provider agency. This Photo by Unknown Author is licensed under CC BY
What is included in Clinical Behavioral Services? Development of a Positive Behavioral Support Plan that includes techniques for increasing adaptive positive behaviors and decreasing maladaptive behaviors. Assessment and evaluation of the person s behavioral need(s). The intensity of supports provided will vary depending on the complexity of an individual s needs. Training for the individual s family and other support providers to appropriately implement the behavioral support plan. Evaluation of the effectiveness of the behavioral support plan by monitoring the plan on at least a monthly basis or as noted in the individual plan. The service will also include needed modifications to the plan. The provider shall be available and responsive to the team for questions and consultation.
Where can services be delivered? Clinical Behavioral Services may be delivered in the individual s home or community, as described in the treatment/support plan in the person s Individual Plan. This service is available only to people who live in their own or family homes and receive less than 24 hour supports from DDS. This service cannot be provided in a school or a facility. This Photo by Unknown Author is licensed under CC BY-NC
Are there any limitations and exclusions? Clinical Behavioral Services may be delivered at the same time as Individualized Home Supports, Personal Support, Adult Companion and Individualized Day Supports, Life Skills coaching and community mentoring. These services, the requirements, and the rates do not apply to Residential Habilitation (CLA and CTH), Group Day Services, or Supported Employment. This Photo by Unknown Author is licensed under CC BY-SA
Who may deliver Clinical Behavioral Services? Doctoral level providers with current licensure. Master s level providers with a degree in psychology, special education, social work, or a related field (LPC, LMFT, LCSW). BCBA level providers with current licensure (L-BCBA). All prospective providers must meet the described qualifications: https://portal.ct.gov/-/media/DDS/qpap/Clinical_Behavioral_Consultant_Checklist.pdf *Note Although we are not accepting Bachelor s level providers at this time, we acknowledge that providers do hire and allow employees with BA/BS degrees to write BSPs in order for them to gain experience. In these instances, a DDS qualified doctoral or master s level clinician must review and sign off on the BSP to obtain reimbursement for this service.
What is the process to become a qualified Clinical Behavioral Provider? Qualified Providers of Clinical Behavioral Supports are required to submit documents for each clinician who will provide this service for the agency. If your agency has clinicians on staff that are currently providing supports, but have not been qualified by DDS, please notify Debra Lynch (Debra.Lynch@ct.gov) immediately. Please visit the DDS website for a list of required documents: https://portal.ct.gov/DDS/OperationsCenter/Qualified- Provider-Information/Existing-Qualified-Providers- Requesting-to-Add-a-Clinician Once the clinician is approved by the Operations Center, the provider may bill for the clinician s services through an established authorization.
What documentation is required for reimbursement? The date of service. The start time and end time of the service for each date. Using quarter hour (15-minute) unit(s). The basis of payment for services is an hourly unit of direct service time. Billing should be rounded to the nearest 15-minute interval. The location of service (community, individual s home, family home). The signature of the person providing the service. Documentation including the reason for the service, the outcome, and follow up activities. Service documentation must clearly delineate whether the time was face to face (this includes in-person, video conference, teleconference) with the service recipient. The required services should be identified in the Individual s Plan. Note: An audit may be done by the DDS Audit Unit to ensure service documentation is in compliance with the Waiver requirements.
Reviewing records, preparing reports, consultation over the phone these activities must be clearly discussed and agreed upon with the team. What services Time spent with the person. are reimbursable? Consulting and training with Direct Support staff and family members - these should account for the majority of billed time. Other activities are allowed but they cannot make up more than one third (1/3) of the time in a month without written approval from the region.
What services are NOT reimbursable? Time spent on activities related to: Billing Payment Scheduling of appointments Collateral calls Travel time Service documentation *Please note that the services above are built into the existing provider rate.* Any Clinical Behavioral Supports provided by a clinician not approved by DDS will not be reimbursed at the Clinical Behavioral Support rate.
