Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 146 - SPECIALIZED HEALTH CARE DELIVERY SYSTEMS › Subpart H - MEDICALLY COMPLEX FOR THE DEVELOPMENTALLY DISABLED FACILITIES › Section 146.1020 - 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 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
				146.1035(c)(1)),
				when the individual's behavior development program meets the criteria in
				subsection (b)(1).
b) Behavior
				Development Program Levels
1) Behavior
				development programs under Specialized Care are related to maladaptive
				behaviors which occur with high frequency, great severity, or both high
				frequency and 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 Interdisciplinary Team (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
				146.1035(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 intellectual disability increases from the
				regular pattern of 1:6.8 to 1:4.8, and for persons with
				severe-profound intellectual disability 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
				intellectual disability increases from the regular pattern of 1:6.8 to 1:3.7, and for persons
				with severe-profound intellectual disability 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 intellectual disability increases from the regular pattern of
				1:6.8 to 1:2.5, and for persons with
				severe-profound intellectual disability from 1:4.8 to
				1:2.