Behaviorist Current business Certified by DSPD as Under state contract with DSPD as an license an authorized provider authorized provider of services and of services and supports to people with disabilities in supports to people accordance with 62A-5-103, UCA with disabilities in accordance with Training and experience in the field of UCA. acquired brain injuries of at least one completion of a training year’s length; course in positive behavioral supports prescribed by DSPD and approved by the SMA and the successful completion of a learning assessment at the conclusion of the course. Enrolled as a Medicaid provider Agency-based Current business Certified by DSPD as Under state contract with DSPD as an Behavior license an authorized provider authorized provider of services and Consultation of services and supports to people with disabilities in Service I supports to people accordance with 62A-5-103, UCA with disabilities in Training and experience in the field of accordance with acquired brain injuries of at least one UCA. completion of a training year’s length; course in positive behavioral supports prescribed by DSPD and approved by the SMA and the successful completion of a learning assessment at the conclusion of the course. Enrolled as a Medicaid provider Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Behaviorist Division of Services for People with Disabilities Annually Agency-based Division of Services for People with Disabilities Annually Behavior Consultation Service I Behavior Consultation II HCBS Taxonomy Category 1: Sub-Category 1: Category 2: Sub-Category 2:
Behaviorist Current business license Certified by DSPD as an authorized provider of services and supports to people with disabilities in accordance with UCA. Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA Training and experience in the field of acquired brain injuries of at least one year’s length; completion of a training course in positive behavioral supports prescribed by DSPD and approved by the SMA and the successful completion of a learning assessment at the conclusion of the course. Enrolled as a Medicaid provider Agency-based Behavior Consultation Service I Current business license Certified by DSPD as an authorized provider of services and supports to people with disabilities in accordance with UCA. Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA Training and experience in the field of acquired brain injuries of at least one year’s length; completion of a training course in positive behavioral supports prescribed by DSPD and approved by the SMA and the successful completion of a learning assessment at the conclusion of the course. Enrolled as a Medicaid provider Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Behaviorist Division of Services for People with Disabilities Annually Agency-based Behavior Consultation Service I Division of Services for People with Disabilities Annually Behavior Consultation II HCBS Taxonomy Category 1: Sub-Category 1: Category 2: Sub-Category 2:
ABI_Amendment_11.3.17.docx