SERVICE POLICY GUIDELINES
BEHAVIOR INTERVENTION SERVICES
Tri-Counties Regional Center enhances the quality of life for persons with developmental disabilities by working with individuals and their families to secure assessment and treatment supports and services that maximize their opportunities and choices for living, learning, working, and pursuing recreational activities in their community.
Tri-Counties Regional Center will coordinate, support, and advocate for individuals to obtain appropriate behavior intervention services in their community. Tri-Counties Regional Center works with and advocates within the communities it serves to develop and identify appropriate behavior intervention services provided by professionals experienced with and sensitive to the needs of individuals with developmental disabilities. Such services maximize the potential for individuals to develop, and/or prevent deterioration, in areas of their development.
Behavior intervention services are prescribed assessments or treatments provided directly by, or under the supervision of, a qualified licensed or certified professional or a professional trained in behavior management. This service is intended to assist persons served and parents or care givers when the individual exhibits maladaptive, harmful, socially unacceptable, or developmentally unacceptable behaviors. Behavior intervention services use specialized methods of teaching important social and adaptive skills and of training family members, or primary care givers, in the effective use of positive behavior management skills. All parents or care givers will be expected to attend a brief orientation to behavior intervention services by Tri- Counties Regional Center staff before services commence. Tri-Counties Regional Center endorses only the use of non-aversive behavior intervention techniques which are evidence-based.
Access to specialized behavior intervention services directly related to the developmental disability of the individual may be necessary for the functional ability of some individuals. Tri-Counties Regional Center may authorize funding for behavior intervention services when an individual exhibits maladaptive, harmful, socially unacceptable, or developmentally unacceptable behaviors that constitute a danger or have a significant adverse effect on their participation in school or work, on family functioning, or on residential options.
The period, frequency, and total amount of behavior intervention services is determined by the Planning Team, including a Tri-Counties Regional Center service coordinator, manager, psychologist or physician, the parents, and service provider. The provision of behavior intervention services is based on the needs of the individual or family as determined by an initial or follow up behavioral assessment. Typically, the behavior intervention service is time limited to achieve both behavioral goals for the individual and training goals for the family or care givers. In addition, the Planning Team may determine that periodic support is needed on a consultative basis to ensure the continued success of past intervention services. The intent for provision of such consultative services is to offer guidance and preventive intervention.
In some situations, intensive family support provided in the form of behavior intervention services may be required to address persistent aberrant behaviors of their children. These behavior intervention services may be offered when the parent or care giver participates as the primary agent of change. The intent for provision of such behavior intervention services is for the parent or care giver to be provided withtechnical supervision and support. Before intensive behavior intervention services begin, the parent or care giver is expected to attend a group parent training program that explains intensive behavior intervention, expectations of service provision, and the parent participation necessary for the intensive services to be successful. Review of the intensive behavior intervention services is expected to take place at least every six months through the planning team process involving the parent, Tri-Counties Regional Center service coordinator, manager, and clinician, and the service provider. The purpose of the review is to assure the satisfaction of the parent, the quality assurance of the service provision, and the effectiveness of the behavior program.
For persons in public school programs and individuals who reside in Level 4 behavior facilities or in health care facilities, behavior intervention services are expected to be provided as part of the individual’s program, rather than as a separately funded service. Tri-Counties Regional Center service coordinators will actively advocate with local education agencies and health care facility providers to ensure the delivery of required and mandated services.
Services for children that the Tri-Counties Regional Center clinical team suspects of having autism should begin as soon as eligibility for regional center services has been determined and the IFSP or IPP has been developed. The IFSP or IPP may include the need for intensive services. Tri-Counties Regional Center will coordinate services and supports with other public agencies, including the schools, which have a legal responsibility to serve children with autism or other developmental disabilities. Services for children with autism should be systematically planned and involve developmentally appropriate activities that target specific objectives. They should also have a strong and continuous parent training component.
Children up to three years of age suspected of having autism, served under the California Early Intervention Services Act’s Early Start program, should receive a total of up to 25 hours per week of intervention. Included in this total are services from all agencies, including Tri-Counties Regional Center as necessary, that address the core deficits associated with autism. It does not include services that address other needs which are not specific to autism, such as physical therapy and California Children Services (CCS) services.
Starting at three years of age, preschool children eligible for regional center services with a diagnosis of autism under the Lanterman Act should have the school as their primary program of educational intervention. Up to 15 hours per week of Tri-counties Regional Center funded services that address the core deficits associated with autism may be used to supplement the school program. This does not include services that address other needs which are not specific to autism, such as physical therapy and CCS services.
By seven years of age, children with autism should be enrolled in a school program with approximately 30 hours per week of educational instruction. Up to 10 hours per week of Tri-Counties Regional Center funded services that address the core deficits associated with autism may be used to supplement the school program. This does not include services that address other needs which are not specific to autism, such as physical therapy and CCS services.
Tri-Counties Regional Center will advocate for and work with individuals and their family members to ensure that generic and private service providers discharge their obligations to meet the needs of persons with developmental disabilities. In accordance with Lanterman Act section 4659.1, it is the financial responsibility of individuals or their families to pay premiums and, for non-IPP/IFSP services, meet anyrequired deductible amount of their health care service plan or health insurance policy, as determined by generic resources and/or private insurance carriers.
For children under the age of three (3), in accordance with Government Code section 95004, Tri-Counties Regional Center shall require families to first pursue using private insurance as a generic service for behavioral services identified in the IFSP. If behavioral services are included in the IFSP and paid for by a health care plan or health insurance, Tri-Counties Regional Center will pay any applicable copayment, coinsurance or deductible associated with the service or support. And as long as there is no other third party having liability for the cost of the service and the cost of the copayment, coinsurance or deductible does not exceed the cost of funding the services entirely.
For individuals three years of age and older, Tri-Counties Regional Center shall also require families to first pursue using private insurance as a generic service for behavioral services identified in the IPP. If behavioral services are included in the IPP and paid for by a health care plan or health insurance, Tri-Counties Regional Center may pay any applicable copayment, coinsurance, or deductible when the individual’s or family’s annual gross income does not exceed 400 percent of the federal poverty level. When the annual gross income exceeds 400 percent of the federal poverty level, Tri-Counties Regional Center may, by exception, pay a copayment, coinsurance, or deductible for an IPP service if the person or family can demonstrate either the existence of an extraordinary event, a temporary catastrophic loss, or significant unreimbursed medical costs associated with the person served by Tri-counties Regional Center that impacts the ability to pay copayments, coinsurance, or deductibles.
Except as legally prohibited by the terms of a Special Needs Trust instrument, trust funds established for the care or benefit of a person served are considered a private resource and it is expected that this source of funds be used prior to regional center authorized use of public funds. When at all possible, TCRC shall be provided the opportunity to review a proposed Special Needs Trust and present timely input to the court. Once established by the court, the Special Needs Trust documents shall be provided to TCRC for the case record.
If a generic or private resource initially denies a required behavior intervention service that Tri-Counties Regional Center has determined to be their responsibility, that denial will be considered for appeal and/or referral to the Department of Managed Health Care for an independent medical review. Tri-Counties Regional Center may authorize funding for a behavior intervention service while the individual or family member pursues coverage or appeals a denial of service by a generic or private resource, including private health insurance, under the following circumstances:
Tri-Counties Regional Center will not authorize funding of any behavior intervention service that is considered experimental, optional, or elective in nature. The expected result from the provision of a behavior intervention service must meet measurable outcomes as stated on the person’s Individual Program Plan. The provision of behavior intervention services must be both clinically and fiscally an effective use of public funds.
Exceptions:
Tri-Counties Regional Center recognizes that some individual needs are so unique that they may not be addressed in this Service Policy and may require an exception. Such requests for an exception to a Service Policy will be made through the Planning Team process.
Approvals:
