Adults and/or Children with the following:
- Diagnosis of a serious mental illnes, such as Autism, Schizopheria or Bipolar Disorder, ADHD, ODD, Depression, ADD and others.
- Significant difficulty independently managing responsabilities at home, at work or in the community.
- Recent psychiatric hospitilizations or frequent contacts with Crisis Services.
- Children Under 21 with Autism Spectrum Disorder
The following critical elements MUST be satisfied to qualify for BA services:
- Eligibility – The recipient must meet all criteria for BA services as outlined in the Behavior Analysis Services Coverage Policy, Rule 59G-4.125, F.A.C.
- Medical necessity - The recipient must meet medical necessity criteria as outlined in in Rule 59G-1.010, F.A.C.
- The recipient currently engages in maladaptive behaviors
- These maladaptive behaviors interfere with the recipient’s daily functioning
1. Criteria for Initial Behavior Analysis Assessment – BOTH of the following MUST be satisfied:
- ALL critical elements are met
- Provider submits a valid written physician’s order as stipulated in the Behavior Analysis Services Coverage Policy, Rule 59G-4.125, F.A.C.
2. Criteria for Behavior Analysis Services and Reassessments - ALL of the following MUST be satisfied:
- ALL critical elements are met
- An assessment or, if applicable, a reassessment, authored by a lead analyst, is provided. An assessment of the maladaptive behavior(s) is a necessary element of the process of identifying the frequency and magnitude of the behaviors as well as the variables associated with the occurrence of the maladaptive behavior(s). This helps in defining what are the functional consequences of the problem behavior(s) so that an adequate behavior plan can be implemented. This (re)assessment MUST include, at a minimum, ALL of the following:
a. A clear operational description of the maladaptive behavior(s)
b. Baseline and/or updated treatment data (if reassessment)
c. Progress toward identified goals (if a reassessment)
d. Identification of the events, times, and situations that appear to be associated to the occurrence of the maladaptive behavior(s)
e. Identification of the functional consequences of the maladaptive behavior(s)
f. Development of hypotheses and summary statements that describe the maladaptive behavior(s) and its(their) functions
g. Summary and recommendations
3. A behavior plan authored or updated by a lead analyst. The behavior plan is the cornerstone of the delivery of Behavior Analysis services and it is based on the information obtained in the assessment. It proposes specific interventions to reduce or eliminate the maladaptive behavior. These interventions take into consideration the variables, both present before the behavior, as well as after the behavior, that influence the occurrence of the maladaptive behavior(s). This plan also includes replacement appropriate behaviors for the recipient to engage in instead of the maladaptive behaviors in order to obtain the same function. The plan must be detailed enough to warrant the requested services and include mechanisms to monitor its effectiveness. This MUST include, at a minimum, ALL of the following:
- Observable and measurable descriptions of the maladaptive behavior(s)
- Identified function of the maladaptive behavior(s) behavior as a result of the assessment or reassessment conducted
- Goals and strategies for changing the maladaptive behavior(s)
- Written detailed description of when, where, and how often these goals will be addressed and proposed strategies will be implemented
- System for monitoring and evaluating the effectiveness of the plan
- Safety and crisis plan, if applicable
- Summary and recommendations
- Discharge criteria
- Transition Plan (if applicable)
NOTE: Although the assessment and behavior plan were addressed separately, both of them can be submitted as a single document.