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Behavioral support

Page posted: 10/1/03

Page reviewed: 2/19/13

Page updated: 5/26/17

Legal authority

Federally approved BI, CAC and CADI waiver plans, Minn. Stat. §245D.03

Definition

Behavioral support: Service to increase positive behavior and decrease or eliminate severe, challenging behavior.

Covered services

Behavioral support covered the following services:

  • • Completion of an individualized functional assessment of target behaviors
  • • Development of a positive behavior support plan that may also include specific reactive or emergency strategies
  • • Implementation of the plan
  • • Training and supervision of caregivers and behavior staff, as needed, to implement the plan
  • • Reassessment and modification of the plan periodically.
  • Behavioral support services may be provided in the home or community.

    Non-covered services

    Behavioral support services cannot supplant or duplicate services available through other funding sources such as Medicare, Medicaid and private insurance. See the additional resources section for services that should be maximized before this waiver service.

    Assessment guidelines

    Prior to initial authorization of behavioral support services, the lead agency must:
    1. Obtain documentation of a mental health diagnostic, cognitive, neuropsychological or neurological assessment
    2. Document recommendations from the diagnostic assessment.\
    3. Assist the person to access recommended services available through other funding sources
    4. Update the support plan to ensure state plan mental health and behavioral support services are integrated and coordinated.

    Choice of providers

    When the person resides in a setting where the residential provider also provides behavioral support services, the lead agency must ensure there is documentation of the person's choice of behavioral support providers.

    Roles and responsibilities

    Behavioral support service consists of three progressive staffing levels: waiver behavior professionals, waiver behavior analysts and waiver behavior specialists. More than one staffing level can be authorized. The following determine the level(s) of behavioral support to be authorized:

  • • Person’s assessed needs
  • • Environmental factors
  • • Personal choice that includes an analysis of risk and benefit
  • • Informed consent
  • • Person’s history (history of behavior, services, how the person has responded to treatments, etc.)
  • Each staffing level has associated functions. Most of these functions are billable indirect support activities.

    Waiver behavior professionals

    Waiver behavior professionals may do the following:

    1. Complete individualized functional assessments
    2. Develop person-centered, positive practice, individualized behavior support plans that identify specific, proactive and, if necessary, reactive intervention strategies
    3. Distribute plans to those with a need to know
    4. Evaluate effectiveness of the service
    5. Modify plans as necessary
    6. Provide onsite instructional learning regarding the use of behavioral
    interventions
    7. Train and supervise waiver behavior analysts and specialists.

    Waiver behavior professional consultative activities may be delivered face-to-face or via remote communication (e.g., phone, web).

    Waiver behavior analysts

    Waiver behavior analysts may do the following:

    1. Oversee implementation of the person-centered, positive-practice, individualized behavior support plan; this includes assessing the adequacy of the plan
    2. Train and direct waiver behavior specialists or caregivers who implement the behavior support plan
    3. Provide feedback to and coordinate with the waiver behavior professional
    4. Design data collection methodology
    5. Train and oversee data collection.

    Waiver behavior specialists

    Waiver behavior specialists may do the following:

    1. Collect and record behavioral data
    2. Communicate questions or concerns to the waiver behavior professional or analyst
    3. Implement the person-centered, positive practice, individualized behavior support plan.

    Billable indirect support activities

    Some components of behavioral support services do not involve direct support to the person. The providers may bill the following services and support activities as indirect time to support people:

  • Behavioral support professional: Assessment, development and modification of behavior support plans.
  • Behavioral support analyst: Overseeing implementation of plan, designing data collection and training staff on data collection.
  • Behavioral support specialist: Implementing the plan, collecting and recording behavioral data
  • For more information on billable indirect services, see Rates Management System User Manual — Quick reference guide on billable indirect time page.

    Provider standards and qualifications

    Behavioral support is a DHS enrollment-required service. For more information, see CBSM – Waiver/AC provider enrollment standards.

    License requirements

    A behavioral support provider must have a license under Minnesota Statutes, Chapter 245D as an intensive support service provider. A provider licensed under 245D must report all uses of controlled procedures, emergency use of manual restraint and prohibited procedures according to Minn. Stat. 245D.06, subd. 5 to DHS via the Behavioral Intervention Report Form DHS-5148 (PDF).

    Requirements for each staffing level

    The following sections include specific requirements for the three staffing levels.

    Waiver behavior professional

    A waiver behavior professional must have competencies in areas related to:

  • • Behavior reduction/elimination strategies that promote least restrictive approved alternatives
  • • Co-occurring mental health or neurocognitive disorders
  • • Data collection, tracking and reporting
  • • Demonstrated expertise with populations being served
  • • Ethical considerations related to behavioral services
  • • Functional analysis
  • • Functional assessment
  • • Measurement of behavior and interpretation of data
  • • Identifying desired outcomes
  • • Selecting intervention strategies to achieve desired outcomes
  • • Staff/caregiver training
  • • Support plan monitoring and revisions.
  • The waiver behavior professional must also meet one of the following six sets of criteria:

    1. Psychologist licensed under Minn. Stat. §148.88 to 148.98 with competencies as identified above actively listed with the Minnesota Board of Psychology

    2. Clinical social worker licensed as an independent clinical social worker under Minn. Statutes, Chapter 148D, or a person with a master's degree in social work from an accredited college or university with at least 4,000 hours of post-master's, supervised experience in the delivery of clinical services in the above competency areas

    3. Physician licensed under Minnesota Statutes, Chapter 147 and certified by the American Board of Psychiatry and Neurology, or eligible for board certification in psychiatry

    4. A licensed professional clinical counselor licensed under Minn. Stat. §148B.29 to 148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services who has demonstrated competencies in the above areas

    5. A person with a master's degree from an accredited college or university in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services

    6. A registered nurse who is licensed under Minn. Stat. §148.171 to 148.285 and who either:

  • • Is certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization
  • • Has a master's degree in nursing or one of the behavioral sciences or related fields from an accredited college or university or its equivalent, with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services.
  • Waiver behavior analyst

    A waiver behavior analyst must either:

  • • Have obtained a baccalaureate degree, master’s degree or a PhD in a social services discipline
  • • Meet the qualifications of a mental health practitioner, as defined in Minn. Stat. §245.462, subd. 17.
  • Additionally, a waiver behavior analyst must have all of the following:

  • • Four years of supervised experience working with individuals who exhibit challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder
  • • 10 hours of instruction in functional assessment and functional analysis
  • • 20 hours of instruction in the understanding of the function of behavior
  • • 10 hours of instruction on design of positive practice, behavior support strategies
  • • 20 hours of instruction on the use of behavior reduction approved strategies used only in combination with behavior positive practices strategies
  • • A determination by a waiver behavior professional to have the training and prerequisite skills required to provided positive practice strategies as well as behavior reduction approved/permitted intervention to the person who receives behavioral support
  • • Direct supervision by a waiver behavior professional.
  • Waiver behavior specialist

    A waiver behavior specialist must have either:

  • • An associate’s degree in a social services discipline
  • • Two years of supervised experience working with individuals who exhibit challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder.
  • Additionally, the waiver behavior specialist must have all of the following:

  • • Minimum of four hours of training in functional assessment
  • • 20 hours of instruction in the understanding of the function of behavior
  • • 10 hours of instruction on design of positive practices behavioral support strategies
  • • Determination by a waiver behavior professional to have the training and prerequisite skills required to provide positive practices strategies as well as behavior reduction approved intervention to the person who receives behavioral support
  • • Direct supervision by a waiver behavior professional.
  • Authorization, rates and billing

    Behavioral support is a framework service. The lead agency uses the Rate Management System (RMS) to determine rates. For more information, see CBSM – Rate Management System and Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945 (PDF).

    Additional resources

    Adult Rehabilitative Mental Health Services (ARMHS)
    Children’s Therapeutic Services and Supports
    (CTSS)
    MHCP Provider Manual – Diagnostic Assessment

    MHCP Provider Manual – Mental health services

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