10 Colo. Code Regs. § 2505-10-8.7509

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.7509 - Behavioral Therapies

8.7509.ABehavioral Therapies Eligibility

1. Behavioral Therapies are a covered benefit available to Members enrolled in one of the following HCBS waivers:

a. Developmental Disabilities Waiver

b. Supported Living Services Waiver

c. Brain Injury Waiver

8.7509.BBehavioral Therapies Definition

1. Behavioral Therapies mean services related to the Member's intellectual or Developmental Disability that assist a Member to acquire or maintain appropriate interactions with others.

8.7509.CBehavioral Therapies Inclusions

1. Behavioral Therapies shall address specific challenging behaviors of the Member and identify specific criteria for remediation of the behaviors.

2. A Member with a co-occurring diagnosis of an intellectual or Developmental Disability and mental health diagnosis covered in the Medicaid state plan shall have identified needs met by each of the applicable systems without duplication but with coordination by the behavioral services professional to obtain the best outcome for the Member.

3. Behavioral Therapies include:

a. Behavioral consultations and recommendations for behavioral interventions and development of behavioral support care plans that are related to the Member's Developmental Disability and are necessary for the Member to acquire or maintain appropriate adaptive behaviors, interactions with others and behavioral self-management.

b. Intervention strategies related to an identified challenging behavioral need of the Member. Specific goals and procedures for the behavioral service shall be established.

c. Behavioral plan assessment services include observations, interviews of direct care staff, functional behavioral analysis and assessment, evaluations, and completion of a written assessment document.

d. Individual or group counseling services include psycho therapeutic or psycho educational intervention that:

i. Is related to the Developmental Disability in order for the Member to acquire or maintain appropriate adaptive behaviors, interactions with others and behavioral self-management, and

ii. Positively impacts the Member's behavior or functioning, and

iii. May include cognitive behavior therapy, systematic desensitization, anger management, biofeedback, and relaxation therapy.

e. Behavioral line services include direct one on one (1:1) implementation of the behavioral support care plan and are:

i. Delivered under the supervision and oversight of a behavioral consultant.

ii. Inclusive of acute, short-term interventions at the time of enrollment from an institutional setting, or

1) To address an identified challenging behavior of a Member at risk of institutional placement, and that places the Member's health and safety or the safety of others at risk.

8.7509.DBehavioral Therapies Exclusions and Limitations

1. Services covered as Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) or a covered mental health diagnosis in the Medicaid State Plan, covered by a third-party source or available from a natural support are excluded and shall not be reimbursed.

2. Behavioral consultation services are limited to 80 units per support plan year. One unit is equal to 15 minutes of service.

3. Behavioral plan Assessment services are limited to 40 units and one assessment per support plan year. One unit is equal to 15 minutes of service.

4. Behavioral line services are limited to 960 units per support plan year. One unit is equal to 15 minutes of service.

5. Counseling services are limited to 208 units per support plan year. One unit is equal to 15 minutes of service.

6. Services for the sole purpose of training basic life skills, such as Activities of Daily Living, social skills and adaptive responding are excluded and not reimbursed under behavioral services.

8.7509.EBehavioral Therapies Provider Agency Requirements

1. Behavioral Therapies consultants shall meet one of the following minimum requirements:

a. Shall have a Master's degree or higher in behavioral, social, or health sciences or education and be nationally certified as a "Board Certified Behavior Analyst" (BCBA), or certified by a similar, nationally-recognized organization. Shall have at least 2 years of directly-supervised experience developing and implementing behavioral support plan sutilizing established approaches including Behavioral Analysis or Positive Behavioral Supports that are consistent with best practices for and research on effectiveness for people with intellectual and developmental disabilities; or

b. Shall have a Baccalaureate degree or higher in behavioral, social, or health sciences or education and

i. Be certified as a "Board Certified Assistant Behavior Analyst" (BCABA) or

ii. Be enrolled in a BCABA or BCBA certification program or have completed a Positive Behavior Supports training program and be working under the supervision of a certified or licensed Behavioral Services Provider.

2. Counselors shall meet one of the following minimum requirements:

a. Shall hold the appropriate license or certification for the provider's discipline according to state or federal law as a Licensed Clinical Social Worker, Certified Rehabilitation Counselor, Licensed Professional Counselor, Licensed Clinical Psychologist, or BCBA, and must demonstrate or document a minimum of two years' experience in providing counseling to individuals with intellectual and developmental disabilities; or

b. Have a Baccalaureate degree or higher in behavioral, social, or health science or education and work under the supervision of a licensed or certified professional as set forth in Section 8.7509.E.1.

3. Behavioral Plan Assessor shall meet one of the following minimum qualifications:

a. Shall have a Master's degree or higher in behavioral, social, or health science or education and be nationally certified as a BCBA or certified by a similar, nationally-recognized organization. Shall have at least 2 years of directly-supervised experience developing and implementing behavioral support plans utilizing established approaches including Behavioral Analysis or Positive Behavioral Supports that are consistent with best practices for and research on effectiveness for people with intellectual and developmental disabilities; or

b. Shall have a Baccalaureate degree or higher in behavioral, social, or health science or education and be

i. certified as a "Board Certified Associate Behavior Analyst" (BCABA), or

ii. be enrolled in a BCABA or BCBA certification program or completed a Positive Behavior Supports training program and working under the supervision of a certified or licensed Behavioral Services provider.

4. Behavioral Line Staff shall meet the following minimum requirements:

a. Must be at least 18 years of age, have graduated from high school or earned a high school equivalency degree, and have a minimum of 24 hours training inclusive of practical experience in the implementation of positive behavioral supports and/or applied behavioral analysis and that is consistent with best practices for and research on effectiveness for people with intellectual and developmental disabilities.

b. Must work under the direction of a Behavioral Consultant.

10 CCR 2505-10-8.7509

47 CR 03, February 10, 2024, effective 3/16/2024

47 CR 21, November 10, 2024, effective 11/30/2024