Transitional living programs shall meet all standards established to operate as an Assisted Living Residence according to C.R.S. 25-27-104.
All people receiving HCBS-BI transitional living services have the following rights:
Providers of Transitional Living shall agree to accept the acuity-based per diem reimbursement rate established by the Department.
Providers shall not charge a Medicaid participant more than the Department's annually established room and board rate.
All transitional living services shall be prior authorized through submission to the Department. A Medicaid Prior Authorization Request must be submitted with tentative goals and rationale of the need for intensive transitional living services.
Transitional living services which extend beyond a duration of 180 days must be reauthorized with treatment plan justification and shall be submitted through the reconsideration process established by the Department.
Behavioral programming and education is an individually developed intervention designed to decrease/control the Client's severe maladaptive behaviors which, if not modified, will interfere with the individuals ability to remain integrated in the community.
Behavioral programming must be documented on the Client's care plan and prior authorized through the State Brain Injury Program Coordinator. Behavioral programming services will be paid on an hourly basis as established by the Department
Counseling services mean individualized services designed to assist the participants and their support systems to more effectively manage and overcome the difficulties and stresses confronted by people with brain injuries.
Reimbursement will be on an hourly basis per modality as established by the Department. There are three separate modalities allowable under HCBS-BI counseling services including Family Counseling, Individual Counseling, and Group Counseling.
Substance abuse programs are individually designed interventions to reduce or eliminate the use of alcohol and/or drugs by the water participant which, if not effectively dealt with, may interfere with the individual's ability to remain integrated in the community.
Inpatient treatment is not a covered benefit.
Reimbursement will be on an hourly basis per modality as established by the Department. There are three separate modalities allowable under HCBS-BI counseling services including Family Counseling (if the individual is present). Individual Counseling, and Group Counseling.
Family members providing respite services shall meet the same competency standards as all other providers and be employed by the certified provider agency.
10 CCR 2505-10-8.516