Sec. 10.09.54.14. Covered Services — Behavior Consultation Services

A. A provider may bill for the length of a home visit to a participant, upon completion of the services specified in §C of this regulation.

B. Behavior consultation services may be preauthorized by a participant's plan of service when:

(1) A participant or the participant’s representative request the service due to an identified behavioral issue; or

(2) The participant’s behavior is:

(a) Potentially dangerous to the participant's or another person's health and functioning; or

(b) Placing the participant at risk of institutionalization due to health and safety concerns.

C. Behavior consultation services include a:

(1) Home visit by an individual qualified to render services to:

(a) Evaluate a participant's behavior;

(b) Assess the situation;

(c) Determine the contributing factors; and

(d) Recommend interventions and treatments;

(2) Written report with the results of the provider’s assessment and recommendations to be reviewed by the participant, the participant’s representative and family when applicable, and the participant’s case manager and caregivers, which may include an assisted living provider; and

(3) Verbal review of the report with the participant, the participant’s representative and family when applicable, and the participant’s case manager and caregivers, which may include an assisted living provider, to discuss:

(a) The report's findings and recommendations; and

(b) A course of action, including any related needed medical interventions.

D. Behavior consultation services do not include:

(1) The time spent on related activities before or after the home visit; or

(2) The provider’s time spent on any supervisory or consultative services provided to the renderer of services.