Description
Behavior analysis services are provided to assist a person or persons to learn new be-havior that are directly related to existing challenging bebe-haviors or functionally equiva-lent replacement behaviors for identified challenging behaviors. Services may also be provided to increase existing behavior, to reduce existing behavior, and to emit behav-ior under precise environmental conditions. The term “behavbehav-ior analysis services” in-cludes the terms “behavior programming” and “behavioral programs.” Behavior analy-sis includes the design, implementation and evaluation of systematic environmental modifications for the purposes of producing socially significant improvements in and understanding of human behavior based on the principles of behavior identified through the experimental analysis of behavior. It includes the identification of functional rela-tionships between behavior and environment. It uses direct observation and measure-ment of behavior and environmeasure-ment. Contextual factors, establishing operations, ante-cedent stimuli, positive reinforcement and other consequences are used based on iden-tified functional relationships between behavior and environment, in order to produce practical behavior change.
Behavioral services must include procedures to insure generalization and maintenance of behaviors. The services are designed to engineer environmental modifications includ-ing ongoinclud-ing styles of interactions, and continclud-ingencies maintained by significant others in the recipient’s life. Training for parents, caregivers and staff is also part of the services when these persons are integral to the implementation or monitoring of a behavior analysis services plan. Services should be provided for a limited time and discontinued as the significant others gain skills and abilities to assist the recipient to function in more independent and less challenging ways.
Delivery of behavioral services is a complex process that includes provision of services directly to the recipient, at times, or others supporting the recipient in his or her pres-ence, as well as services required to assess, plan and train others without the recipient present. Examples of services provided to the recipient to caregivers, staff or other pro-viders while the recipient is present include: analog functional analysis, observation of the recipient for descriptive functional assessment, observations of and feedback re-garding interactions of caregivers, staff or other providers with the recipient, modeling procedures with the recipient for caregiver, staff, or other providers, probing new pro-cedures with the recipient, and direct training to the recipient (typically with caregivers, staff, or other providers present). In addition, services required to support behavior analysis services, may include: behavior plan development, graphing and analysis of da-ta, behavior plan revision, training staff, caregivers or other providers (recipient not pre-sent), consultation to other professionals, Local Review Committee presentation, and treatment team meeting (with or without recipient present). The latter support services may not be reimbursed in excess of 25 percent of the total units for the cost plan year.
Behavior analysis does not rely on cognitive therapies and expressly excludes psycholog-ical testing, neuropsychology, psychotherapy, sex therapy, psychoanalysis, hypnothera-py and long-term counseling as treatment modalities. Provision of behavioral services must comply with rule 65G-4.009, F.A.C. Services provided by behavior analysts with limited experience in the problem area or by behavior analysts who are not Board Certi-fied Behavior Analysts with three years of experience or licensure under Chapter 490 or 491, F.S., should receive oversight and approval of services with a more experienced be-havior analyst or with the above described highest level of certification.
Limitations
A recipient shall receive no more than 16 units of this service per day. A unit is defined as a 15-minute time period or portion thereof. This service may be provided concur-rently (at the same time and date) with another service.
Documentation Requirements
Documentation of services must comply with rule 65G-4.009, F.A.C. Reimbursement*
and monitoring documentation to be maintained by the provider includes:
1. *Copy of claim(s) submitted for payment;
2. *Copy of service log;
3. *Copy of assessment report, when an assessment has been requested;
*Quarterly summary of monitoring including the who, what, when and where of the monitoring events;
• A quarterly summary for each quarter of the support plan year;
• A quarterly summary for the third quarter of the support plan year also serves as the annual report and must include:
• a summary of the fourth quarter of the previous support plan year, and a summary of the first three quarters of the current support plan year.
4. *Behavior analysis service plan and services provided including graphic display of acquisition and reduction behaviors related to implementation of the service plan; and
5. *Dated evidence of LRC reviews and recommendations specific to target behaviors and the behavior plan, when the procedures and behaviors meet criteria for review and approval in accordance with rule 65G-4.010, F.A.C.
Documentation to be submitted to the waiver support coordinator by the provider:
1. *Copy of service log, monthly;
2. *Copy of assessment report within 30 days of initially providing services, when an assessment has been requested;
3. *A copy of the provider’s behavior analysis service plan within 90 days of initially providing services;
4. *Updates of the intervention plan as it is modified;
5. *Graphic displays of acquisition and reduction behaviors related to implementa-tion of the service updated monthly, with baseline data to allow evaluaimplementa-tion of progress; and
6. Annual report prior to the annual support plan update.
*Indicates reimbursement documentation.
Note: Refer to the definitions section for additional information.
Place of Service
These services may be provided in the provider's office, the recipient’s place of resi-dence or anywhere in the community. However, in all cases, behavior analysis services must also be provided in the setting(s) relevant to the behavior problems being ad-dressed.
Special Considerations
Behavior analysis and assessment services are described more fully in Chapter 65G, F.A.C., which is available through the APD Area Office. As stated in rule 65G-4.010, F.A.C., approval for behavior analysis services for behaviors meeting the characteristics described in the rule must be obtained from certified behavior analysts meeting educa-tional and experience requirements or persons licensed pursuant to Chapter 490 or 491, F.S., prior to implementation of the services.
Note: The F.A.C. is available online at flrules.org.