Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Section 144.125 - Specialized Care - Behavior Development Programs

Current through Register Vol. 48, No. 28, July 12, 2024
a) Adaptive behaviors are actions and
			 responses which are productive and appropriate. Maladaptive behaviors are
			 actions and responses which are nonproductive and/or inappropriate. Although
			 maladaptive behaviors are generally described as nonproductive and
			 inappropriate, in some cases, an individual's inappropriate behavior may be
			 productive, given the social or environmental context of a particular activity.
			 Behavior development refers to both the reduction in maladaptive behaviors and
			 the increase in adaptive behaviors. A behavior program instituted because of
			 maladaptive behaviors must also include the development of adaptive behaviors.
			 Additional reimbursement is paid for an individual who needs and receives
			 specialized care for a behavioral disability (Section
			 144.275(c)(1)
			 ), when the individual's behavior development program meets the criteria in
			 subsection (b)(1) of this Section.
b) Behavior Development Program Levels
1) Behavior development programs under
			 Specialized Care are related to maladapative behaviors which occur with high
			 frequency and/or great severity. A behavior development program, including the
			 use of psychotropics, which is developed for Specialized Care, must meet all
			 federal and State requirements including, but not limited to, development by
			 the IDT, review and approval by a Behavior Management Committee (or Human
			 Rights Committee) as required by
			 42 CFR
			 483.440(f)(3), 1993 and
			 approval by the individual or guardian, if the individual is not capable of
			 providing informed consent. The behavior development program developed by the
			 IDT must demonstrate the need for a use of a more intensive staffing pattern
			 (direct care staff) than that pattern which is reimbursed for under Section
			 144.275(a)(1).
			 Additional staff time provided under Specialized Care is a response to a
			 necessary increase in staff intensity identified in the behavior development
			 plan when other attempted interventions have failed, such as environmental
			 changes or changes in the pattern of activities throughout the day. Specialized
			 Care is not provided based solely on the frequency or severity of the
			 individual's maladaptive behavior.
2) Behavior development program services
			 under Specialized Care do not preclude the individual's participation in
			 regular training services, activities and therapies as part of a comprehensive
			 active treatment program.
3) The
			 IDT provides highly specific guidelines for the individual's behavior
			 development program relative to treatment methodology, services needed, and
			 staff needed to deliver interventions.
A)
			 Level I - Behavior development program services are delivered by staff
			 specifically trained in the delivery of the prescribed interventions. Behaviors
			 occur with high frequency but moderate severity, i.e., verbal abuse one or more
			 times per 4 hours which is hostile in tone or content including threats or
			 screaming, or pica occurring once per 4 hours in volumes small enough to be
			 non-life threatening. Examples of staffing pattern changes: The staffing
			 pattern for persons with mild mental retardation increases from the regular
			 pattern of 1:6.8 to 1:4.8,
			 and for persons with severe-profound mental retardation from 1:4.8
			 to 1:3.7.
B) Level II - Behavior
			 development programs are delivered by staff trained in the delivery of each
			 individual's intervention plan. Individuals receive personalized intervention,
			 such as individual counseling or some one-to-one intervention. Behaviors occur
			 with high frequency, and are aggressive or destructive, such as purposeful
			 attacks of others resulting in minimal injuries one or more times per day.
			 Examples of staffing pattern changes: The staffing pattern for persons with
			 mild mental retardation increases from the regular pattern of 1:6.8 to 1:3.7,
			 and for persons with severe-profound mental retardation from 1:4.8
			 to 1:3.
C) Level III - Behavior
			 development programs are delivered by staff who are specifically trained to
			 deliver the interventions. Generally, staff may be assigned to accompany the
			 individual throughout the shift. One-to-one intervention is common. Behaviors
			 occur with very high frequency, such as hyperactivity one or more times per
			 minute, or occur with high frequency and are aggressive, assaultive or
			 destructive, such as pica (daily consumption of life threatening materials), or
			 daily physical assault resulting in injuries requiring medical attention.
			 Examples of staffing pattern changes: The staffing pattern for persons with
			 mild mental retardation increases from the regular pattern of 1:6.8 to 1:2.5,
			 and for persons with severe-profound mental retardation from 1:4.8
			 to 1:2.