Current through Register Vol. 56, No. 18, September 16, 2024
(a) Behavioral assistance shall be delivered
in accordance with a plan of care approved by the Department of Human Services,
Children and Families, or a designated agent of either Department, which has
been prepared by the responsible case management function, including, but not
limited to, the care management organization, the contracted system
administrator, and mobile response agencies.
(b) Behavioral assistance is a dynamic
process of intervention and ongoing evaluation resulting in effective
modification of the identified behavior(s). Behavioral assistance shall be
delivered in accordance with an individualized behavioral intervention plan
that is based upon an evaluation of the identified behavior(s), which includes
recommendations for specific interventions with definable outcomes and
strategies and, developed in accordance with 10:77-4.7 and any applicable rules
of the Department of Children and Families.
(c) Behavioral assistance services shall
include applying positive behavioral principles within community and culturally
based norms to reduce undesirable behaviors and build appropriate behaviors
that are rehabilitative and restorative in nature, resulting in durable and
sustainable positive behavioral changes and improvement in functionality and
quality of life. Behavioral assistance focuses on creating and sustaining
environments that improve lifestyle changes by making problem behavior less
effective and less relevant and the desired behavior more effective and
relevant.
(d) Behavioral assistance
services shall also include interaction and instruction, provided individually
or in a group setting, with the child/youth or young adult's family and
caregiver(s) to enable them to provide the necessary support to the child/youth
or young adult to attain the goals of the service plan and sustain the positive
behavioral changes and improvement in functionality and quality of life.
1. Behavioral assistance services provided in
a group setting may be provided to the family member(s) and/or caregiver(s) of
up to three children/youth or young adults in one session.
(e) Behavioral assistance services shall be
clinically supervised, face-to-face behavioral healthcare interventions for
children, youth, young adults and/or their families/caregivers in support of
the child/youth or young adult that are designed to be rehabilitative and
restorative in nature, with the goal of strengthening skills in a variety of
life domains, including, but not limited to:
1. Physical and mental well being;
2. Interpersonal communications and
relationships;
3. Social
interactions;
4. Behavioral
conduct;
5. Adaptive coping
strategies and behaviors; and
6.
Recreational/leisure activities.
(f) Behavioral assistance shall not include
mentoring, tutoring, companionship, or other similar services which do not
require clinical supervision, a plan of care, or behavioral assistance services
in order to achieve the goals and objectives established in the child/youth or
young adult's behavioral assistance service plan.
(g) Behavioral assistance services shall be
provided either individually or in a group of up to three children/youth or
young adults, as appropriate to the needs of the child.
(h) Behavioral assistance services shall be
delivered in community-based, clinically appropriate settings that are
convenient to the child or youth and his or her family. These services shall
not be provided in an office setting, hospital, or Joint Commission-accredited
residential treatment center.
1. For the
purposes of this requirement, "providing services in an office setting"
describes a concept whereby the provider is requiring the beneficiary to come
to the provider for services rather than the provider rendering services to the
child, youth or young adult in their natural environment. Examples are listed
below:
i. The family, child, youth, or young
adult is not comfortable meeting in their home and asks the provider to meet
them at a local community center or church recreation hall. The community
center or church agrees to provide a room for such a meeting. This is not
considered an office setting, since the provider is meeting the
family/beneficiary at the local community center or church recreation hall at
the family's/beneficiary's request.
ii. Services provided to a child while the
child is in a run away shelter and the staff of the run away shelter center
offers the use of an empty office so that the child and the professional
providing the behavioral assistance services can have a private conversation.
As in the example above, this is not considered "providing services in an
office setting," even though the staff and the child were physically in an
"office" located in the building. The provider is rendering services to the
child in the place where the child is currently residing, that is, the current
home of the child.
iii. The
provider has access to office space in a community setting, such as a YMCA or a
church's community youth center, and children are scheduled to receive services
and are required to come to that site to receive the intensive in-community
services. This is considered "providing services in an office
setting."
2. Services
provided in any office of the provider shall not be reimbursed as behavioral
health rehabilitation services. These services shall be reimbursed under the
applicable Medicaid/NJ FamilyCare provider rules which describe reimbursement
for services rendered in the provider's office.
3. Behavioral assistance services shall not
be provided to a child, youth, or young adult who is in a Joint
Commission-accredited residential treatment center (see N.J.A.C. 10:75).
i. Behavioral assistance services shall only
be rendered to a child, youth, or young adult who resides in a Joint
Commission-accredited residential treatment center while the child is on an
approved therapeutic leave from the facility. Behavioral assistance services
shall not be provided on-site in a Joint Commission-accredited residential
treatment center.
4.
Behavioral assistance services should not, and are not normally, provided to
children, youth, or young adults in other residential mental health
rehabilitation facilities, including, but not limited to, group homes,
psychiatric community residences for youth, and residential child care centers
(see N.J.A.C. 10:77-3) if the
residential reimbursement includes these services. However, there may be
exceptional circumstances in which these services are clinically required to
help support the facility to admit the child into their program. These services
are intended to be short-term and shall be clinically justified by the provider
or the care management entity and prior authorized by the contracted system
administrator.
i. Behavioral assistance
services can be rendered to a child, youth or young adult who resides in other
types of residential mental health rehabilitation facilities while the child is
on an approved therapeutic leave from the
facility.
