Ohio Administrative Code|Rule 5160-27-06 | Therapeutic behavioral group service-hourly and per diem.

                                                
(A) For the purpose of medicaid reimbursement, therapeutic
		  behavioral (day treatment), group service-hourly and per diem, is defined as an
		  intensive, structured, goal-oriented, distinct and identifiable group treatment
		  service that addresses the individualized mental health needs of the client.
		  The therapeutic behavioral group service-hourly and per diem is clinically
		  indicated by assessment. The environment at this level of treatment is highly
		  structured, and has an appropriate staff-to-client ratio to guarantee
		  sufficient therapeutic services and professional monitoring, control, and
		  protection. The purpose and intent of therapeutic behavioral group
		  service-hourly and per diem is to stabilize, increase or sustain the highest
		  level of functioning.
(1) Therapeutic behavioral group service-hourly
			 and per diem must be a group treatment service that includes but is not limited
			 to the following:
(a) Skills development of
				interpersonal and social competency, problem solving, conflict resolution, and
				emotions/behavior management,
(b) Developing of positive
				coping mechanisms,
(c) Managing mental health
				and behavioral symptoms to enhance independent living, and
(d) Psychoeducational
				services including instruction and training of persons served in order to
				increase their knowledge and understanding of their psychiatric diagnosis(es),
				prognosis(es), treatment, and rehabilitation in order to enhance their
				acceptance, increase their cooperation and collaboration with treatment and
				rehabilitation, and favorably affect their outcomes. 
(B) Service requirements.
(1) When the service is provided for less than
			 2.5 hours per day, the therapeutic behavioral group service hourly billing code
			 must be used.
(2) When the service is provided for 2.5 or more
			 hours per day, the therapeutic behavioral group service per diem must be used
			 and the service must:
(a) Be delivered at a
				nationally-accredited program and must be provided by a licensed practitioner,
				or an unlicensed mental health practitioner as described in paragraph (A)(2) of
				rule 5160-27-08 of the Administrative Code.
(b) The staff to client
				ratio cannot exceed 1:12.
(C) Limitations.
(1) Reimbursement for therapeutic behavioral
			 group service-hourly and per diem will not be made while the patient is
			 enrolled in assertive community treatment (ACT), intensive home based treatment
			 (IHBT) or a substance use disorder (SUD) residential treatment
			 facility.
(2) For adults, reimbursement for the following
			 medically necessary behavioral health group services will be limited to no more
			 than four fifteen-minute units, or one hour per day on the same day as the
			 therapeutic behavioral group service (hourly, or per diem).
(a) Mental health group
				psychotherapy.
(b) SUD group
				psychotherapy.
(c) Mental health
				counseling.
(d) SUD group
				counseling.
(e) Group community
				psychiatric supportive treatment.
(3) A therapeutic behavioral group service per diem and
			 therapeutic behavioral group service hourly reimbursement will not be made on
			 the same day with the same provider for the same individual.
(4) Other behavioral health individual services may be reimbursed
			 on the same day as therapeutic behavioral group service-hourly and therapeutic
			 behavioral group service per diem.
(5) A medicaid recipient can receive one therapeutic behavioral
			 group service per diem service per day. Prior authorization may be approved for
			 a different billing provider furnishing an additional therapeutic behavioral
			 group service per diem on the same day.
(D)  Providers must adhere to documentation requirements set
		  forth in rules 5160-1-27 and 5160-8-05 of the Administrative Code.


Last updated November 30, 2021 at 3:23 PM