OAR 410-172-0695: Intensive In-Home Behavioral Health Treatment Services for Youth (IIHBT)

(1) IIBHT services as described in OAR 309-019-0167 are intended as an outcome-based, transitional, and episodic period of care to provide service and supports in a natural environment that allows the individual and their family or caregivers to successfully remain or reintegrate into their home, in school and community. (2) Participation in IIBHT services shall not be contingent upon successful completion of, or participation in, any other behavioral health treatment services. (3) A Youth and Family shall not be required to participate in other services or supports, including Wraparound, to receive IIBHT. (4) Youth may be eligible for IIBHT services in congregate care settings such as Behavioral Rehabilitation Services or Developmental Disability Group Homes. (5) Youth are considered for IIBHT services without regard to race, ethnicity, gender, gender identity, gender presentation, sexual orientation, religion, creed, national origin, age, intellectual and/or developmental disability, IQ score, or physical disability. (6) Prior to delivering any IIBHT service, IIBHT providers shall meet all qualifications, credentialing, or licensing standards and competencies described in OAR 309-019-0125, and OARs 950-060-0000 through 0160, and supervision requirements described in OAR 309-019-0130, OAR 309-019-0167, or as required by a licensing or certification board. (7) To be eligible for IIBHT services, Youth ages zero through 20 years of age shall be determined by the Department of Human Services (Department) to meet Title XIX Medicaid eligibility criteria. The Department shall complete Title XIX Medicaid eligibility determinations according to OAR chapter 461, division 135, division 140, and division 155 rules, and OAR chapter 410 division 200 and division 120 rules. (8) IIBHT services providers shall document services as described in OAR 410-120-1360 and OAR 410-0620. The Division may consider incomplete or insufficient documentation as required by OAR 410-172-0620 as non-existent records and recoup payments. (9) IIBHT services providers shall retain clinical records for seven years and financial and other records for at least five years as described in 410-120-1360 Requirements for Financial, Clinical and Other Records. The Division may consider incomplete or insufficient documentation above as non-existent records and recoup payments. (10) Qualified IIBHT services providers shall work with all providers and the youth and their family to provide transition planning as described in OAR 309-019-0167. (11) The Division shall reimburse authorized IIBHT services that are medically appropriate as described in OAR 410-172-0630 and identified on the behavioral health fee schedule described in OAR 410-172-0640. Providers shall: (a) Comply with Medicaid billing and payment rules described in OAR 410-120-1280 through 1340; (b) Comply with prior authorization described in OAR 410-172-0650; and (c) Comply with behavioral health program rules described in OAR chapter 309 division 019.