Current through Register Vol. 54, No. 44, November 2, 2024
(a) Payment will be made to a licensed IBHS
agency for individual services if the following conditions are met:
(1) There is a written order for services
based on a face-to-face interaction with the child, youth or young adult that
meets the following:
(i) Written within 12
months prior to the initiation of IBHS.
(ii) Written by a licensed physician,
licensed psychologist, certified registered nurse practitioner or other
licensed professional whose scope of practice includes the diagnosis and
treatment of behavioral health disorders and the prescribing of behavioral
health services, including IBHS.
(iii) Includes a behavioral health disorder
diagnosis listed in the most recent edition of the DSM or ICD.
(iv) Orders one or more IBHS for the child,
youth or young adult and includes the following:
(A) The clinical information to support the
medical necessity of the service ordered.
(B) The maximum number of hours of each
service per month.
(C) The settings
where services may be provided.
(D)
The measurable improvements in the identified therapeutic needs that indicate
when services may be reduced, changed or terminated.
(2) A face-to-face assessment has
been completed by an individual qualified to provide behavior consultation
services or mobile therapy services within 15 days of the initiation of
individual services and prior to completing the ITP in accordance with §
5240.21 (relating to assessment)
or a face-to-face assessment has been reviewed and updated within 12 months of
the previous face-to-face assessment.
(3) The assessment and all updates have been
signed by the staff person who completed the assessment.
(4) An ITP based upon the assessment and the
written order for services has been completed within 30 days after the
initiation of services in accordance with §
5240.22 (relating to individual
treatment plan) or an ITP has been reviewed and updated within 6 months of the
previous ITP.
(5) The ITP and all
updates have been reviewed and signed by the youth, young adult, or parent or
legal guardian of the child or youth, the staff person who completed the ITP
and an individual who meets the qualifications of a clinical director in §
5240.12 (relating to staff
qualifications).
(6) For continued
individual services, a child, youth or young adult shall have an order written
within 12 months of the initiation of the continued services that complies with
subsection (a)(1)(ii)-(iv).
(b) Payment will be made to a licensed IBHS
agency for individual services for up to 45 days after initiation of services,
if an ITP has not yet been completed but there is a written order for services
that complies with subsection (a)(1) and there is a treatment plan for the
individual services provided.
This section cited in 55 Pa. Code §
1155.34 (relating to payment
conditions for group services); 55 Pa. Code §
1155.35 (relating to payment
conditions for EBT delivered through individual services, ABA services or group
services); 55 Pa. Code §
1155.37 (relating to limitations);
55 Pa. Code §
5240.22 (relating to individual
treatment plan); 55 Pa. Code §
5240.41 (relating to individual
records); 55 Pa. Code §
5240.74 (relating to individual
services initiation requirements); and 55 Pa. Code §
5240.96 (relating to individual
treatment plan).
