Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1155 - INTENSIVE BEHAVIORAL HEALTH SERVICES
PAYMENT FOR INTENSIVE BEHAVIORAL HEALTH SERVICES
Section 1155.35 - Payment conditions for EBT delivered through individual services, ABA services or group services
Universal Citation: 55 PA Code ยง 1155.35
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Payment will be made to a licensed IBHS agency for EBT delivered through individual services, ABA services or group services if the following conditions are met:
(1) There is a written order for EBT
that meets the requirements of §§
1155.32(a)(1),
1155.33(a)(1) or
1155.34(a)(1)
(relating to payment conditions for individual services; payment conditions for
ABA services; and payment conditions for group services).
(2) A face-to-face assessment has been
completed by an individual with the qualifications required by the EBT within
15 days of the initiation of the services and prior to completing the ITP in
accordance with §
5240.102 (relating to assessment
and individual treatment plan) 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 of the initiation
of services in accordance with §
5240.102 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
EBT, a child, youth or young adult shall have an order written within 12 months
of the initiation of the continued services that complies with §§
1155.32(a)(1)(ii)-(iv), 1155.33(a)(1)(ii)-(iv) or
1155.34(a)(1)(ii)-(iv).
(7) The
IBHS agency or the individual providing the EBT has certification or licensure
from the National certification organization or entity that developed or owns
the EBT.
(8) Services are delivered
in accordance with the specific EBT.
(b) Payment will be made to a licensed IBHS agency for EBT delivered through individual services, ABA services or group 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 EBT provided.
This section cited in 55 Pa. Code § 5240.101 (relating to EBT initiation requirements).
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