Ohio Admin. Code 5160-27-08 - Mental health therapeutic behavioral services and psychosocial rehabilitation
(A) For the
purposes of medicaid reimbursement, therapeutic behavioral services (TBS) are
goal-directed supports and solution-focused interventions.
(1) Activities included must be intended to
achieve the identified goals or objectives as set forth in the individual's
treatment plan. Activities include but are not limited to the following:
(a) Treatment planning. Participating in and
utilizing strengths based treatments/planning which may include assisting the
individual and family members or other collaterals with identifying strengths
and needs.
(b) Identification of
strategies or treatment options. Assisting the individual and family members or
other collaterals to identify strategies or treatment options associated with
the individual's mental illness.
(c) Developing and providing solution focused
interventions and emotional and behavioral management drawn from evidence-based
psychotherapeutic treatments.
(d)
Restoration of social skills. Rehabilitation and support with the restoration
of social and interpersonal skills to increase community tenure, enhance
personal relationships, establish support networks, increase community
awareness, develop coping strategies, and promote effective functioning in the
individual's social environment including home, work and school.
(e) Restoration of daily functioning.
Assisting the individual to restore daily functioning specific to managing
their own home including managing their money, medications, and using community
resources and other selfcare requirements; and
(f) Crisis prevention and amelioration.
Assisting the individual with effectively responding to or avoiding identified
precursors or triggers that would risk their remaining in a community setting
or that result in functional impairments.
,
Activities may
include,
including
but not be limited to, assisting the individual
and family members or other collaterals with identifying a potential
psychiatric or personal crisis, developing a crisis management plan, and/or, as
appropriate, seeking other supports to restore stability and
functioning.
(2) Eligible
providers must be a licensed or an unlicensed mental health practitioner in
accordance with rule
5160-27-01
of the Administrative Code who have at a minimum:
(a) A bachelor's or a master's degree in
social work, psychology, nursing, or in related human services, or
(b) A high school diploma with a minimum of
three years of relevant experience as determined by the employing agency and
documented in the employee's record.
(B) For the purposes of this rule,
collateral/collateral supports contact occurs when
with the
practitioner contacts individuals who play a significant role in a medicaid
recipient's life. The information gained from the collateral contact can
provide insight into the individual's
treatment.
or
basic
Basic psychoeducation provided to
a medicaid recipient's
that collateral contacts
contact
can assist with their
the treatment.
of the medicaid recipient.
(C) For the purposes of medicaid
reimbursement, psychosocial rehabilitation (PSR) assists individuals with
implementing interventions outlined on a treatment plan to compensate for or
eliminate functional deficits and interpersonal and/or mental health barriers
associated with an individual's mental health diagnosis.
(1) Activities include:
(a) Restoration, rehabilitation and support
of daily functioning to improve self-management of the negative effects of
psychiatric or emotional symptoms that interfere with a person's daily
functioning.
(b) Supporting the
individual with restoration and implementation of daily functioning and daily
routines critical to remaining successful in home, school, work, and
community.
(c) Rehabilitation and
support to restore skills to function in a natural community
environment.
(2) Eligible
providers are unlicensed mental health practitioners in accordance with rule
5160-27-01
of the Administrative Code, are at least eighteen years of age and who have, at
a minimum, a high school diploma with appropriate mental health training as
determined by the employing agency and documented in the employee's
record.
(D) Limitations.
(1) TBS and PSR will not be reimbursed when a
patient is enrolled in assertive community treatment (ACT), intensive home based treatment (IHBT), or
receiving residential substance use disorder treatment services.
A separate payment will not be made for TBS and PSR
while a youth is enrolled in intensive home based treatment (IHBT) unless the
service is prior authorized.
(2) TBS must be delivered as an individual or
group intervention with the individual, family/caregiver and/or other
collateral supports.
(3) PSR must
be delivered as an intervention with the individual, not in a group
setting.
(E) Providers
shall adhere to documentation requirements set forth in rules 5160-01-27 and
5160-8-05
of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 5162.02, 5164.02
Rule Amplifies: 5164.02, 5164.03
Prior Effective Dates: 01/01/2018, 08/01/2019 (Emer.), 11/29/2019, 06/12/2020 (Emer.), 01/01/2021
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