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Welcome  » September 30, 2022 11:52 PM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Behavioral Treatment Benefit

Covered and Noncovered Services : Covered Services and Requirements

Topic #18979

Behavior Identification Assessment and Plan of Care Development

ForwardHealth covers clinical assessment activities used to identify target behaviors and to develop a POC (i.e., treatment plan, protocol) for the member. Covered assessment activities include:

  • Administration of assessments
  • Discussion of findings and recommendations
  • Analyzing data
  • Scoring and interpreting assessments
  • Preparing the report/POC

These assessment activities must be conducted by licensed supervisors, although behavior identification supporting assessments may be designed by the licensed supervisor and implemented by a treatment therapist. Behavior identification assessment services generally do not require PA. ForwardHealth covers up to 96 units/24 hours of behavioral identification assessment services within a calendar year without PA. This service includes a combination of face-to-face and non-face-to-face activities. Providers conducting behavior identification assessments should spend at least half of the assessment time in a face-to-face setting with the member.

If more non-face-to-face time is needed, providers must document the unique clinical circumstances that justify the additional non-face-to-face time relative to the face-to-face assessment services. Providers are required to submit a Prior Authorization Amendment Request for additional units beyond 96 units/24hours.

Behavior identification supporting assessments may be conducted by licensed supervisor to finalize or fine-tune the baseline results or POC. Supporting assessment may be provided for up to two hours may be billed per DOS and do not count towards the 24-hour limit for behavior identification assessments.

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