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 on-site 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, Florida Statutes, 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 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 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 Chapter 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: [e-mail]. Phone: [phone].

Rulemaking Authority 393.125, 393.13(4)(g)3., 393.17 FS. Law Implemented 393.066, 393.13(4)(g)3. FS. History–New 9-23-96, Formerly 10F-4.029, 65B-4.029, Amended 4-4-12.