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Behavior Analysis

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Behavior Analysis- Requirements To Receive

Description

Behavior analysis services are provided to assist a person or persons to learn
new behavior that are directly related to existing challenging behaviors or
functionally equivalent replacement behaviors for identified challenging behaviors.
Services may also be provided to increase existing behavior, to reduce existing
behavior, and to emit behavior under precise environmental conditions. The term
“behavior analysis services” includes the terms “behavior programming” and
“behavioral programs.” Behavior analysis 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 relationships
between behavior and environment. It uses direct observation and measurement
of behavior and environment. Contextual factors, establishing operations,
antecedent stimuli, positive reinforcement and other consequences are used
based on identified 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 including ongoing styles of interactions, and contingencies
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.

Behavior analysis does not rely on cognitive therapies and expressly excludes
psychological testing, neuropsychology, psychotherapy, sex therapy,
psychoanalysis, hypnotherapy 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 Certified 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 behavior
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 concurrently (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;
4. *Monthly summary of monitoring including the who, what, when and where of
the monitoring events;
5. *Behavior analysis service plan and services provided including graphic
display of acquisition and reduction behaviors related to implementation of the
service plan;
6. *Annual report; and
7. *If the targeted reduction behaviors meet the requirements identified in rule
65G-4.009, F.A.C., the LRC review date and recommendations made specific
to the plan, a review schedule for the plan must be included.

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;
3. *A copy of the provider’s behavior analysis service plan within 90 days of
initially providing services;
4. *Monthly updates of the intervention plan as it is modified;
5. *Graphic displays of acquisition and reduction behaviors related to
implementation of the service updated monthly, with baseline data to allow
evaluation 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
residence 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 addressed.

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 educational 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 https://www.flrules.org.

Behavior Analysis Provider Requirements


Behavior Analysis Provider Requirements
Provider Qualifications Providers of behavior analysis must have licensure or certification on active
status at the time services are provided. Providers of this service must have
one or more of the following credentials:
Level 1 Board Certified Behavior Analyst; Florida Certified Behavior Analyst
with expanded privileges; 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 more than three years of experience in behavior
analysis post certification or licensure.
Level 2 Board Certified Behavior Analyst; Florida Certified Behavior Analyst
with expanded privileges; 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 less than three years of experience in behavior
analysis post certification or licensure; or a Florida Certified
Behavior Analyst with a Masters or Doctorate, regardless of
experience.
Level 3 Board or Florida Certified Associate Behavior Analyst or a Florida
Certified Behavior Analyst with bachelors or high school diploma,
regardless of experience.

Training Requirements The provider is responsible for all training requirements outlined in the Core
Assurances.
Note: Refer to the Core Assurances in Appendix A for the provider training
requirements.