Fla. Admin. Code Ann. R. 65G-4.008 - Behavior Analysis Services Oversight System Organization
(1) The Agency will
establish and maintain a behavioral services program including a senior
clinician, the Agency Senior Behavior Analyst (ASBA), to assume direction for
standards of behavioral practice as provided in this chapter, develop and
manage systems of quality, utilization and cost containment for statewide
behavioral practice. The ASBA holds a doctorate from an accredited university
program with behavior analysis as a primary focus, is a board certified
behavior analyst, has completed a dissertation that had behavior analysis as
its central focus and has at least one year of experience in the provision of
behavior analysis services for persons with developmental disabilities.
However, if no one with these qualifications is available, then the ASBA must
be a certified behavior analyst with at least the education and experience
established by the designated certification board. The behavioral services
program will also include the support of at least one master's level board
certified behavior analyst. The ASBA will direct:
(a) Area Behavior Analysts, who will be
recruited, appointed, given clinical supervision and annually evaluated in
conjunction with their functional supervisor in the area to which they are
assigned.
(b) Committees.
1. The Local Review Committees (LRC) working
in conjunction with the ASBA shall adopt the model LRC bylaws to establish
guidelines for committee function, including the establishment of time frames
for scheduling, reviewing, and approving, as well as tracking for efficient
program review and approval, charter content, committee membership, meeting
participants, confidentiality requirements and development of a process to
resolve provider and LRC disputes.
2. The Peer Review Committee (PRC) working in
conjunction with the ASBA shall adopt the model PRC bylaws to establish
membership, as well as annual projects including, at minimum, review of
behavioral practices in at least one Developmental Disability Center, at least
one state operated forensic facility, at least one area community residential
behavioral provider, at least one Local Review Committee, and other services as
identified by the Agency.
3.
Behavior Analysis Practices Committee (BAPC) shall be established to meet at
least annually with membership from Area and Developmental Disabilities Centers
Behavior Analysts, the PRC, providers of behavior analysis and behavior
assistant solo service providers and agency providers, as well as behavioral
residential services providers to assure that common operational requirements
established in Rules 65G-4.008,
65G-4.009, and 65G-4.10, F.A.C.,
are implemented consistently statewide, including the qualifications and
processes for establishing individuals and agencies as behavior analysis
providers, behavior analysis agencies and residential behavioral providers,
establishing consensus standards for LRC operation, standards for behavioral
assessment content and behavior analysis support plan program content,
standards for graphic display of data, documentation, billing, as well as
behavioral services practice and service sanctions to ensure service quality to
meet the changing needs of service recipients and provider
requirements.
(2) A statewide peer review committee (PRC)
and local review committees (LRCs) shall be appointed by the Agency to provide
oversight of behavior analysis services.
(a)
The Agency will establish the composition, function and procedures to be
followed by the committees in the form of Model bylaws incorporated by
reference in subsection (5), of this rule.
(b) Each committee shall be chaired by a
person who holds a doctorate from an accredited university program with
behavior analysis as a primary focus, is a board certified behavior analyst,
has completed a dissertation that had behavior analysis as its central focus
and has at least one year of experience in the provision of behavior analysis
services for persons with developmental disabilities. However, if no one with
these qualifications is available, then the chairperson must be a certified
behavior analyst with at least the education and experience requirements for
taking the board's behavior analyst examination.
(c) Local review committees may establish
subcommittees within varied locations outside the area office or within large
facilities, upon mutual agreement between an area office and a provider, or
between a primary facility campus and remote locations, and operate under the
rules governing local review committees. Subcommittees shall ensure that at
least two participating members are certified behavior analysts who are not
employed or contracted by the facility, and who have no interest in the
behavior programs produced by it. Members whose programs are reviewed in the
course of the LRC meeting must abstain from decisions regarding their programs.
The LRC shall remain responsible for the decisions of the subcommittees.
1. A sufficient number of LRCs shall be
established to allow for the timely and thorough review of behavior analysis
services.
2. Programs developed,
implemented and submitted by a BCBA to the LRC chairperson following
implementation may proceed forward until a decision is rendered by the LRC
chairperson.
3. A provider
submitting a behavior analysis services plan will be notified by the LRC
chairperson within 21 days that the plan has been received with preliminary
review completed.
4. Within 30 days
of receipt of a behavior analysis services plan the LRC chairperson will notify
the provider of the date the plan will be reviewed by the committee, if
needed.
5. Behavior analysis
services plans must be reviewed and a decision rendered within 90 days of
receipt by the LRC chairperson.
6.
At the time of review by the LRC, a decision will be rendered:
a. To "approve, " and a review date
established, or
b. To "approve with
modifications" and a review date established. Behavior analysis services plans
developed, implemented and submitted by a BCBA may proceed forward and
modifications submitted by the provider to the LRC chairperson within 30 days
without further LRC review, until the next established review date,
or
c. To "not approve" Behavior
analysis services plans that are not approved must be revised by the provider,
and resubmitted within 14 working days. Based upon the modifications the LRC
chairperson must render a decision orally and in writing within seven working
days of receipt, in the language of the provider, and in
English.
7. Each LRC will
be chaired by an individual meeting the qualifications set forth in paragraph
(2)(b), above, who is either an employee of the Agency or under contract to
provide this service. Under no circumstances may the chair participate in the
LRC review of his or her own services, services provided by or to a family
member, or related services.
(3) The PRC shall conduct onsite reviews of
behavior analysis services including the operations of local review committees;
provide training and technical assistance related to client and systemic
behavior analysis services issues; and provide recommendations regarding laws
and regulations that affect behavior analysis services.
(4) Each area office, and each developmental
disabilities center, hereafter referred to as "facility, " shall have a local
review committee that shall oversee behavior analysis services provided to
clients in their area or facility as specified in paragraphs (a)-(c), below:
(a) The committee shall review behavior
analysis services programs as required in Rule
65G-4.010, F.A.C., to ensure
that behavioral programs are implemented as required and with the intended
improvement in target behaviors.
1. The
person who designed the services or a certified or licensed designee, who has
sufficient knowledge of the plan and its implementation, shall be present
during the initial committee review. A person with primary responsibility for
the ongoing implementation and monitoring of the services shall be present at
all future meetings at which the services are reviewed by the
committee.
2. Any person can
request that a behavior analysis services plan be brought before the committee
for its review to ensure compliance with Chapter 393, F.S., and Chapter 65G-4
or 65G-8, F.A.C. Providers should also be aware of the requirements in the
Developmental Disabilities Waiver Services Coverage and Limitations Handbook
(in Rule 59G-13.083,
F.A.C.)
(b) The committee
shall monitor behavior analysis services in accordance with a monitoring
schedule approved by the committee. Approval of services includes the
determination by the LRC chairperson that the individual designing and
implementing the behavior analysis services is in compliance with subsection
65G-4.001(14),
F.A.C., above, or is appropriately supervised.
(c) If reactive strategies (as that term is
defined in subsection
65G-8.001(15),
F.A.C., continue without the implementation of required behavioral programs or
behavior analysis services requiring review are not presented to the LRC or are
not found to be in accordance with Florida law, the committee chairperson shall
request that the Agency notify the behavior analyst, and when appropriate, the
residential provider and behavior analyst's supervisor, of the services, orally
at the time of review and in writing within ten days of review in the language
of the provider or supervisor, and in English, of each area of non-compliance.
1. Absent emergency circumstances that
threaten public health, safety or welfare, the provider shall have twenty (20)
days within which to demonstrate compliance or present to the committee
chairperson in writing evidence showing that the services being provided are in
compliance with Florida Statutes and the Agency rules. The provider may present
whatever evidence appropriate to demonstrate that the provider is in compliance
with Chapter 393, F.S., Chapter 65G-4 or 65G-8, F.A.C. Providers should also be
aware of the requirements of the Developmental Disabilities Waiver Services
Coverage and Limitations Handbook in Rule
59G-13.083, F.A.C.
2. If emergency circumstances exist for the
recipient of behavioral services the committee chairperson may give instruction
to the provider on how to proceed with services or to cease and desist from
continued behavior analysis services, with other recommendations for necessary
safeguards and supports.
3. If,
however, the committee determines that the behavior analyst, and when
appropriate, the residential provider, is not in compliance with Chapter 393,
F.S., or Chapter 65G-4 or 65G-8, F.A.C. the committee chairperson shall report
all facts and circumstances to the Agency in writing within five (5) days of
the provider's response and request a final decision be made by the Agency.
Providers should also be aware of the requirements of the Developmental
Disabilities Waiver Services and Limitations Handbook in Rule
59G-13.083, F.A.C.
4. Within twenty (20) days of such report,
the Agency shall notify the committee, in writing, and the provider, in writing
and orally in the language of the provider and in English, of its decision. In
the event the Agency finds the provider is not in compliance with Florida
Statutes or the Agency rules, the Agency shall allow the provider an additional
ten (10) days to modify services to meet requirements. If modifications are not
made within the time allotted, the Agency shall consider whether a recoupment
action should be initiated, provider status should be revoked, supervision be
required, complaint be submitted to the designated certification or licensing
board, or the requirement that the services being provided be
discontinued.
5. If modifications
are not made within the time allotted in subparagraph 4., and the agency must
take one of the actions in subparagraph 4., the agency shall consider whether
any of the following occurred:
a.
Falsification of Documentation.
b.
Absence of documentation, such as graphs, behavioral assessments, behavior
plans and required summaries.
c.
Lack of program monitoring as approved by the LRC.
d. Failing to maintain a current behavior
plan for an individual served.
e.
Failure to present behavior plan/s requiring LRC review.
f. Failure to revise behavior plans based
upon LRC recommendations or upon analysis of data and consistent with Chapter
65G-4, F.A.C.
g. Failure to address
behaviors related to health and safety.
h. Failure to provide adequate supervision to
behavior analysts and behavior assistants working under such service delivery
arrangement.
i. Failure to resubmit
behavior plan revisions within time constraints established by the
LRC.
j. Repeated deficiencies that
display lack of competence.
k.
Repeated use of restricted measures for problem behavior as itemized in
subsection 65G-8.006(9),
F.A.C., or use of reactive strategies without an LRC approved behavior analysis
services plan as set forth in Rule
65G-8.006, F.A.C.
l. Consistent pattern of failure to return
phone calls or email, reply to any correspondence or show up for scheduled
service visits and cannot be located.
m. Failure to report abuse of a minor, or
adult with disabilities as mandated by Florida Law.
n. Failure to report immediately to law
enforcement of potentially life threatening situations such as possession of
explosives, fire arms, weapons, toxic material or illegal substances by
individuals with impaired judgment and behavioral issues.
o. Felony or misdemeanor related to the
practice of behavior analysis or the health and safety of an
individual.
p. Failure to abide by
ethical guidelines of their professional certification or licensing
body.
q. Assessment Report past due
30 day limit.
r. Behavior plan past
due 90 day limit.
s. Documentation
not submitted to the waiver support coordinator.
t. Non-Compliance with standards of Behavior
Focused and Intensive Behavior homes, including a current behavior plan
developed or revised within the year and reporting of reactive
strategies.
u. Falsifying billing
or billing at a higher rate than the analyst's qualifications
warrant.
v. Billing for services in
school settings.
w. Failure to
comply with Rules 65G-4.008, 4.009, 4.010, F.A.C.,
or Chapter 393, F.S.
x. Providers
should also be aware of the requirements of the Developmental Disabilities
Waiver Services and Limitations Handbook in Rule
59G-13.083,
F.A.C.
6. Following a
committee report set forth above, the Agency, after consideration of the
factors set forth in subparagraph 5., above, may require additional supervision
of the provider's services. The requirement for additional supervision may be a
prerequisite for allowing the provider to continue to serve as an authorized
behavior analysis services provider. Such required supervision shall include
the following conditions:
a. Supervision must
be provided by a Board Certified Behavior Analyst - Doctoral level, or a Board
Certified Behavior Analyst, or a person licensed under Chapter 490 or 491,
F.S., (Psychologist, School Psychologist, Clinical Social Worker, Marriage and
Family Therapist or Mental Health Counselor), with evidence (e.g. work samples)
of at least three years of experience in the application of Applied Behavior
Analysis procedures approved by a local review committee, to persons with
exceptional needs post certification or licensure,
b. Face-to-face meetings for up to two hours
every two weeks or two hours per 40 hours of the provider's contact with
clients. These meetings shall be between the provider and a board certified
behavior analyst or a person licensed under Chapter 490 or 491, F.S., during
which the supervisor directs and evaluates the behavior analysis
services,
c. The supervisor shall
not be, at the time supervision is provided, the provider's subordinate or
employee, spouse or family member. The supervisor shall not be considered an
employee of the provider if the only compensation received by the supervising
behavior analyst consists of payment for supervision; and,
d. The provider's presentation of behavior
analysis services designed and implemented by the provider, with a focus on
graphic displays of data, at local review committee meetings, established in
Rule 65G-4.008, F.A.C., may be
substituted for up to 25 percent of the total supervision time
required.
(5) Forms incorporated by Reference.
(a) Model LRC Bylaws are hereby incorporated
by reference as Form APD-CBA - 1 (10/10).
(b) Model PRC Bylaws are hereby incorporated
by reference as Form APD-CBA - 2 (10/10).
Anyone may acquire a copy of the model bylaws by contacting the ASBA at the APD Central Office, 4030 Esplanade Way, Tallahassee, Florida 32399, email: apd_info@apd.state.fl.us, phone: (850)488-4257.
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