Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 36 No. 43, October 29, 2010 issue of the Florida Administrative Weekly.
These changes are in response to comments received from the Joint Administrative Procedures Committee.
65G-4.001 Definitions for Behavioral Services: Practice and Procedure.
(1) through (4) No change.
(5) Certified Behavior Analyst – A behavior analyst certified by a certification body, including a Board Certified Behavior Analyst – Doctoral level, a Board Certified Behavior Analyst, a Board Certified Assistant Behavior Analyst and a Florida Certified Behavior Analyst.
(6) through (7) No change.
(8) Desensitization – A method for teaching an individual to exhibit calm or incompatible behavior during the gradual and systematic presentation of increasing levels of an aversive or feared stimulus resulting in the ability to tolerate the formerly feared stimulus the gradual and systematic presentation of increasing levels of an aversive or feared stimulus or event and removal of it contingent upon calm behavior to teach a person to tolerate the stimulus or event.
(9) through (11) No change.
(12) Functional Communication Training (FCT) – a procedure in which a functional form of communication is taught and reinforcement is provided contingent upon communication, while withholding reinforcement and withheld for other behavior.
(13) Positive practice overcorrection – Activities that involve repeated performance of a desirable alternative behavior related to an targeted inappropriate behavior.
(14) through (16) No change.
(17) Response cost – A procedure in which a specified amount of available reinforcers are removed from the individual’s client’s reserve upon occurrence of a specified behavior.
(18) Restitutional overcorrection – Activities that involve correcting the effects of a specified behavior to a better condition than present prior to the occurrence of the specified behavior.
(19) through (20) No change.
Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.023, 65B-4.023, Amended________.
65G-4.0011 No change.
65G-4.002 Service Delivery.
(1) through (3) No change.
(4) Medicaid providers should be reminded that all contracts for programs and services provided to the Agency shall include any terms and requirements established in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook as required by (incorporated by reference in Rule 59G-13.083, F.A.C.) and Rules 65G-4.008, 65G-4.009, 65G-4.010, F.A.C.
Rulemaking Authority 393.13(4)(g)3., 393.501(1) FS. Law Implemented 393.13(4)(g)3. 393.17 FS. History–New 1-1-77, Formerly 10F-4.08, 10F-4.008, 65B-4.008.-.654, Amended________.
65G-4.003 Certification as a Behavior Analyst.
Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.024, 65B-4.024, Repealed________.
65G-4.004 Certification as an Associate Behavior Analyst.
Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.025, 65B-4.025, Repealed________.
65G-4.005 Renewal of Behavior Analysis Certification.
Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.026, 65B-4.026, Repealed________.
65G-4.006 Approved Continuing Education.
Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.027, 65B-4.028, Repealed________.
65G-4.007 Behavior Analysis Certification Fees.
Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.17 FS. History–New 9-23-96, Formerly 10F-4.028, 65B-4.027, Repealed________.
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) No change.
(b) Committees.
1. through 2. No change.
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-4.010, F.A.C., are implemented consistently statewide, including the to address 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) through (b) No change.
(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. through 6. No change.
7.2. 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) No change.
(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., if warranted, and as necessary, to ensure that behavioral programs are implemented as required and with the intended improvement in target behaviors.
1. No change.
2. Any person The LRC chairperson can request that a behavior analysis services plan be brought before the committee for its review to ensure compliance with Chapter 393, Florida Statutes, and Chapter 65G-4 or 65G-8, F.A.C., Providers should, and the also be aware of the requirements in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook (incorporated by reference in Rule 59G-13.083, F.A.C.
(b) No change.
(c) If reactive strategies (as that term is defined in Rule 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 the provider deems appropriate to demonstrate that the provider is in compliance with Chapter 393, Florida Statutes, Chapter 65G-4 or 65G-8, F.A.C., and Providers should also be aware of the requirements of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook in (incorporated by reference 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 in 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, Florida Statutes, or Chapter 65G-4 or Chapter 65G-8, F.A.C., or the Developmental Disabilities Waiver Services Coverage and Limitations Handbook (incorporated by reference in Rule 59G-13.083, 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. No change.
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. through j. No change
k. Repeated use of restricted measures for problem behavior as itemized in subsection 65G-8.006(9) 65G-4.010(1), 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. through v. No change.
w. Billing under behavior analysis for other activities that do not meet this service definition as described in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook (incorporated by reference in Rule 59G-13.083, F.A.C).
w.x. Failure to comply with the Developmental Disabilities Waiver Services Coverage and Limitations Handbook (incorporated by reference in Rule 59G-13.083, F.A.C.), Rules 65G-4.008, 65G-4.009, 65G-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. No change.
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 provided by the provider;
c. through d. No change.
(5) No change.
Rulemaking Authority 393.125, 393.13(4)(g)3., 393.17 FS. Law Implemented 393.066, 393.125, 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.029, 65B-4.029, Amended_________.
65G-4.009 Design, Implementation and Monitoring of Behavior Analysis Services.
(1) through (8) No change.
(9) The provider shall take reasonable steps to ensure data collection for behaviors targeted for increase and decrease during the entire period services are in effect. Graphic displays of weekly data for on behaviors targeted for change shall be maintained and updated by the provider at least weekly, unless the local review committee determines that a less stringent requirement is acceptable for individual cases.
(10) The LRC shall approve the provider’s behavior analysis services plan and specify the requirements for reporting of findings and data to the committee for behavior analysis services approved by the committee.
(a) No change.
(b) The behavior analysis services plan shall include, either in text or by reference to appropriate documents:
1. through 11. No change.
12. Techniques for maintaining and generalizing behavioral improvements, as well as criteria for which could include the reduction and fading of behavioral services. These plans may be general initially, acquiring more specificity in revisions as the individual makes progress.
13. through 15. No change.
(c) No change.
Rulemaking Authority 393.13(4) FS. Law Implemented 393.13(4)(g)3., 393.17 FS. History–New 9-23-96, Formerly 10F-4.030, 65B-4.030, Amended________.
65G-4.010 Behavior Analysis Services Approval.
(1) through (2) No change.
(3) Written plans describing behavior analysis services must be submitted to the LRC chairperson when:
(a) Behavior analysis services include restricted procedures such as:
1. The contingent delivery or removal of events to reduce the probability of occurrence of a problem behavior, including but not limited to: extinction or withholding of reinforcement for those behaviors referenced in paragraph 65G-4.010(3)(b), F.A.C., response blocking for more than 15 seconds, contingent exercise, restitutional overcorrection, positive practice overcorrection, time-out and response cost.
2. The removal of an aversive event contingent upon the display of a behavior targeted for increase, including but not limited to, Functional Communication Training using removal of demands or noise as a reinforcer, and desensitization programs.
3. Access to abundant amounts of an event or stimulus so that it loses potency as a reinforcer, and severely restricted access to an event or stimulus to increase its potency as a reinforcer,
4. Behavioral protective devices, as defined in subsection 65G-8.001(4), F.A.C., and electronic devices for monitoring and signaling.
5. Dietary manipulations.
(b) Behavior analysis services address behaviors that:
1. Have resulted in self-inflicted, detectable damage, or resulted in external or internal damage requiring medical attention or are expected to increase in frequency, duration, or intensity resulting in self-inflicted, external or internal damage requiring medical attention.
2. Have occurred or are expected to occur with sufficient frequency, duration or magnitude that a life-threatening situation might result, including excessive eating or drinking, vomiting, ruminating, eating non-nutritive substances, refusing to eat, holding one’s breath, or swallowing excessive amounts of air.
3. Have resulted in detectable damage, or external or internal damage to other persons that requires medical attention or are expected to increase in frequency, duration or intensity resulting in external or internal damage to other persons that requires medical attention.
4. Have resulted or are expected to result in major property damage or destruction.
5. Have resulted or are expected to result in arrest and confinement by law enforcement personnel.
6. Have resulted in the need or meet the characteristics for behavioral services in a Behavior Focused or Intensive Behavioral Residential Habilitation program.
7. Have resulted in the need for additional staffing or Behavior Assistant Services in one or more settings.
8. Have resulted in the repeated use of reactive strategies without a formal approved behavior plan.
(c) Behavioral programs or manuals implemented as group contingencies or behavior change systems, including behavioral program manuals, level systems and token economies, are implemented.
Rulemaking Authority 393.13(4)(g)3. FS. Law Implemented 393.13(4)(g)3., 393.17 FS. History–New 9-23-96, Formerly 10F-4.031, 65B-4.030, Amended_________.