A Functional Behavioral Assessment can help a person understand why they do the things they do. It is meant to help someone who hurts themselves, hurts other people, or damages property, because they feel upset or stressed, or sometimes without knowing why they do it.
A Functional Behavioral Assessment looks at all kinds of things that may influence how someone acts, such as where they live, who they live with, how often they go out, and what medications they take. Then, the assessment is used to make a plan to help someone change behaviors that might be harmful to themselves or others.
When to Apply this Service
The person’s service and support administrator, or SSA, will assess them for a need for a Functional Behavioral Assessment. If there is a need, the SSA will include it in the person’s individual service plan.
A person may receive only one Functional Behavioral Assessment in a waiver eligibility span, the cost of which must not exceed $1,500.
Providing this Service
Agency and independent providers that have a Medicaid provider agreement and are DODD-certified can provide this service.
A Functional Behavioral Assessment is provided as a one-on-one service.
A county board or a regional council of governments may provide a Functional Behavioral Assessment only when no other certified provider is willing and able.
A Functional Behavioral Assessment must not be provided to a person by his or her family member.
Training Requirements for this Service
After initial provider certification and completing annual training requirements, the following is required to provide this service.
A Functional Behavioral Assessment must be provided by a person who has the experience necessary to perform psychometric tests that assess a person's functional behavioral level and who is a
- state-licensed psychologist;
- state-licensed professional clinical counselor;
- state-licensed professional counselor;
- state-licensed independent social worker;
- state-licensed social worker working under the supervision of a licensed independent social worker;
- or certified Ohio behavior analyst.
Billing and Payment Information
All services must be delivered as specified in the individual service plan and authorized in Payment Authorization for Waiver Services, known as PAWS, to be successfully submitted for payment through eMBS.
Rates and limits for the Functional Behavioral Assessment are contained in the service rule's appendix.
Providers of a Functional Behavioral Assessment are prohibited from submitting claims under both the Level One or SELF Waiver and the Medicaid State Plan for the same Functional Behavioral Assessment.