About Behavior Support Services
Behavior Support Services are part of the Medicaid-funded Community First Choice State Plan Option. Behavior Support Services are provided by certified Behavior Consultants using Positive Behavior Support.
Services are designed to support eligible individuals and their care providers by reducing frustration, injuries, stress, placement failures and other concerns that can result from persistent and difficult behaviors.
Who is eligible?
People who are Medicaid-eligible and receiving Home and Community-Based Care Community First Choice State Plan Option services are eligible for Behavior Support Services if they have one or more of the following needs:
- Has or will receive a move-out notice due to challenging behaviors
- Assisted living facility, residential care facility, adult foster home or in-home agency provider requests assistance with client behaviors that disrupt other residents or challenge caregivers
- Current behavior plan for client is inadequate, not used or ineffective
- Is in a new placement and has had a recent placement failure due to challenging behaviors
- Has been assigned a special rate to support caregivers who are implementing a behavior plan
- Is receiving as-needed (PRN) psychotropic medications for specific behavior
What can Behavior Consultants do?
Behavior Consultants identify changes that can be made by the caregiver or within the person's environment. Services focus on support to address:
- challenging behaviors
- cognition processing
- communication skills
- self-help activities
- impulse control
- adaptive skills
How to make a referral
Behavior Support Services are authorized by Aging and People with Disabilities case managers. Anyone involved with the person's care can contact the case manager to make a request for these services.
After services are authorized, the Behavior Consultant will contact the person's primary caregiver, foster home provider or facility administrator to begin the process.
Frequently asked questions
Aging and People with Disabilities (APD) has permission from the federal government to provide Behavior Support Services as part of the Home and Community-Based Care (HCBC) "K" Plan. Services are provided by Behavior Consultants who work for agencies that have a contract with APD. APD case managers refer clients to this contracted service. Services can't be provided without prior case manager authorization.
The goal of Behavior Support Services is to reduce frustration, injuries, stress, placement failures and crisis situations that result when people who have persistent and difficult behaviors are not provided with the support they and their caregivers need. Activities provided by the Behavior Consultants focus on helping caregivers change their behaviors and learn to use the client's daily activities, schedules and interests to promote positive interactions, experiences and behaviors.
Each local office has a priority system for identifying referrals with the contracting agency in their area. Individuals must be Medicaid-eligible and receiving services in their home or a community-based care setting.
The service can't be provided to individuals who live in nursing homes, hospitals or a Program for All-Inclusive Care for Elders (PACE).
The goal of the Behavior Consultant service is to focus on changes that can be made by the caregiver or within the person's environment. Unlike traditional methods of behavior "management," this approach changes routines rather than expecting the person to change.
Using observation, interviews and environmental evaluations, the Behavior Consultant will develop a Behavior Plan. The plan includes ideas, strategies and practical approaches to help caregivers create or maintain a positive relationship with the person they support.
The Behavior Consultant is expected to complete the assessment, develop a Behavior Plan, and provide onsite teaching/coaching and revisions within 120 days of accepting the referral.
The service can be repeated one time within 12 months or more often with central office authorization.
Contracted agencies that provide Behavior Support Services can only deliver the service with Behavior Consultants who have passed a Competency Evaluation.
Contractors are selected based on experience with individuals who use our services, familiarity with the APD delivery system including local office functions and their plans to hire and support individuals who meet Behavior Consultant qualifications.
Behavior consultants must provide case managers with timely email and completed documentation of the work they are doing for the client.
Concerns about placement, healthcare, medications or a caregiver's skill sets need to be communicated by the Behavior Consultant to the case manager and the lead caregiver or licensed provider.
It is important for case managers to retain their leadership in managing these issues so that the Behavior Consultant can spend their limited service hours on creating an effective behavior plan, teaching all critical caregivers how to use the plan and how to change it if necessary.
The services provided by the consultant are intended to complement but not substitute for mental health, medical or nursing evaluations.
While the Behavior Consultant might alert a licensed provider or case manager to a health issue that may be impacting behavior, they should not be the person who coordinates with the nurse or primary care provider.
The Behavior Consultant might work alongside a mental health professional but the service is not an alternative for mental health assessment or therapy. Participation in the formal care planning process is not a function for the Behavior Consultant; however, if authorized by the case manager they may participate as a resource in a care planning team.
This service is designed to be proactive. It is not to be used in a protective service or crisis management situation. However, it can be provided to support a post crisis plan.
Consultants create a written recommendation called a Behavior Plan within 30 days of accepting a referral. Copies of the plan are provided to the case managers and caregivers.
The plan is intended to be used by one or several caregivers while interacting with a specific client. The caregivers and their employers are responsible for deciding how to incorporate the plan into the care planning process required in their setting.
The Behavior Consultant is expected to provide both group teaching and individual coaching to caregivers on how to implement and revise the plan. The consultant must provide the case manager with progress notes on a mandatory form documenting all contacts with the client and their caregiver(s).
This is an evidence-based set of practices developed within fields of special education and behavioral psychology. The practices are based on philosophies of person-centered care, self-empowerment and autonomous decision-making.
The APD Behavior Support Services program was piloted for three years in Jackson and Josephine counties and is based on a curriculum developed especially for caregivers who work in APD settings.
An evaluation of these pilots indicated that caregivers and case managers found the service to be valuable and save time, and that placement changes decreased for clients receiving the service. Learn more about this approach at The Arc Oregon.
Local offices have developed a referral process with the contractor in their area. The referral process will include an internal system to prioritize clients, track referrals and ensure supervisor participation in referral decisions.
Yes, Behavior Support Services do not duplicate services provided under a person's Medicaid Rehabilitation benefit.
In the rare instance when a person has a mental health provider who is delivering services at the person's home and those services include the development of a behavior plan, the case manager is advised to contact Matthew Baldwin who will facilitate a review of the case to ensure that the services are not duplicative.
The training curriculum is based on a model of Positive Behavior Supports that is widely used in the field of Special Education and Developmental Disabilities.
All services for Medicaid clients must be prior authorized by the case manager. Contracted BSS agencies have a Medicaid provider number. Local offices have a process using case managers to authorize client-specific vouchers.
Hourly rates for the service are established in contracts with each agency. Services are designed to be provided for up to four months at a time with a maximum of 40 hours per client. The four month/40 hour service can be repeated in a 12 month period.
Consultants provide documentation to the case manager using the Progress Notes form at the time the agency submits their claim. Remittance or payment is provided to the contracted agency on a monthly basis.
Behavior Support Contractors