[48 Pa.B. 4762]
[Saturday, August 4, 2018]
[Continued from previous Web Page]
PART VII. MENTAL HEALTH MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 5240. INTENSIVE BEHAVIORAL HEALTH SERVICES
GENERAL PROVISIONS Sec.
5240.1. Scope. 5240.2. Definitions. 5240.3. Provider eligibility. 5240.4. Organizational structure. 5240.5. Service description. 5240.6. Restrictive procedures. 5240.7. Coordination of services.
STAFFING 5240.11.
Staff requirements. 5240.12. Staff qualifications. 5240.13. Staff training plan. 5240.14. Criminal history checks and child abuse certification.
SERVICE PLANNING AND DELIVERY 5240.21.
Assessment. 5240.22. Individual treatment plan. 5240.23. Service provision.
DISCHARGE 5240.31.
Discharge. 5240.32. Discharge summary.
RECORDS 5240.41.
Individual records. 5240.42. Agency records. 5240.43. Record retention and disposal.
NONDISCRIMINATION 5240.51.
Nondiscrimination.
QUALITY IMPROVEMENT 5240.61.
Quality improvement requirements.
INDIVIDUAL SERVICES 5240.71.
Staff qualifications. 5240.72. Supervision. 5240.73. Staff training requirements. 5240.74. Individual services initiation requirements. 5240.75. Individual services provision.
APPLIED BEHAVIORAL ANALYSIS 5240.81.
Staff qualifications. 5240.82. Supervision. 5240.83. Staff training requirements. 5240.84. ABA initiation requirements. 5240.85. Assessment. 5240.86. Individual treatment plan. 5240.87. ABA services provision.
EVIDENCE-BASED THERAPY 5240.91.
EBT initiation requirements. 5240.92. Assessment and individual treatment plan. 5240.93. EBT requirements.
GROUP SERVICES 5240.101.
Staff requirements and qualifications. 5240.102. Supervision. 5240.103. Staff training requirements. 5240.104. Group services initiation requirements. 5240.105. Assessment. 5240.106. Individual treatment plan. 5240.107. Group services provision. 5240.108. Requirements for group services in school settings.
WAIVERS 5240.111.
Waivers.
GENERAL PROVISIONS § 5240.1. Scope.
(a) This chapter applies to all entities that provide IBHS, as defined in this chapter, to children, youth or young adults under 21 years of age and provides the minimum requirements that shall be met for an agency to obtain a license to provide one or more IBHS.
(b) This chapter does not apply to individual licensed practitioners or group arrangements in which only licensed practitioners provide IBHS.
§ 5240.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise:
ABA—Applied behavioral analysis—The design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior or to prevent loss of attained skill or function, which includes all of the following:
(i) The use of direct observation, measurement and functional analysis of the relations between environment and behavior.
(ii) The attempt to address one or more behavior challenges or skill deficits using evidence-based principles and practices of learning and behavior.
(iii) The analysis of the relationship between a stimulus, consequence or other variable. The changes of stimuli, consequences or other variables may occur individually, as a combination or in relationship with each other. The change of stimuli, consequences or other variables may be external or internal to the person whose behavior is being analyzed.
ABSA—Assistant behavior specialist analyst.
ASD—Autism spectrum disorder—A pervasive neurodevelopmental disorder present from early childhood which involves maladaptive or restrictive behaviors, impairments in communication, and impairments in social interactions and relationships as described in the diagnostic criteria in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
BCaBA—Board-certified assistant behavior analyst—An undergraduate-level professional certified by the Behavior Analyst Certification Board to provide ABA services.
BCAT—Board-certified autism technician—A paraprofessional certified by the Behavioral Intervention Certification Council to provide ABA services.
BCBA—Board-certified behavior analyst—A graduate-level professional certified by the Behavior Analyst Certification Board to design and provide ABA services. BCBA refers to both master's (BCBA) and doctoral level credentials (BCBA-D).
BHT—Behavioral health technician.
BHT-ABA—Behavioral health technician-applied behavioral analysis.
Caregiver—An individual with responsibility for the care and supervision of a minor.
Child—A person under 14 years of age.
Consequence—A resulting directly measurable change of a child's, youth's or young adult's behavior produced by a change in a stimulus or stimuli.
Department—The Department of Human Services of the Commonwealth.
EBT—Evidence-based therapy—Behavioral health therapy that uses scientifically established behavioral health interventions and meets one of the following:
(i) Categorized as effective in the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-based Programs and Practices.
(ii) Categorized as Model or Model Plus in the Blueprints for Healthy Youth Development registry.
(iii) Categorized as well-established by the American Psychological Association's Society of Clinical Child and Adolescent Psychology.
(iv) Rated as having positive effects by the Institute of Education Sciences What Works Clearinghouse.
(v) Designated as a model intervention by the Department.
Formal support—An agency, organization or person that provides assistance or resources to a child, youth or young adult within the context of an official role.
Full-time equivalent—37.5 hours per week of staff time.
Group services—Therapeutic interventions provided primarily in a group format through psychotherapy, structured activities and community integration activities that address a child's, youth's or young adult's identified treatment needs. When included in a child's, youth's or young adult's ITP, group services may include individual interventions.
IBHS—Intensive behavioral health services—An array of therapeutic interventions and supports provided to a child, youth or young adult in the home, school or other community setting.
IBHS agency—An entity that provides one or more IBHS.
ITP—Individual treatment plan—A detailed written plan of treatment services specifically tailored to address each child's, youth's or young adult's therapeutic needs that contains the type, amount, frequency, setting and duration of services to be provided and the specific goals, objectives and interventions for each service.
Individual services—Intensive one-to-one therapeutic interventions and supports that are used to reduce and manage identified therapeutic needs, increase coping strategies and support skill development to promote positive behaviors with the goal of stabilizing, maintaining or maximizing functioning of a child, youth or young adult in the home, school or other community setting.
Manual restraint—A physical hands-on technique that restricts the movement or function of a child, youth or young adult, or a portion of a child's, youth's or young adult's body. A manual restraint does not include the use of hands-on assistance when needed to enable a child, youth or young adult achieve a goal or objective identified in the ITP.
Mental health direct service—Working directly with a child, youth or young adult to provide a mental health service.
Natural support—An agency, organization or person that provides support to a child, youth or young adult in a personal or nonprofessional role.
RBT—Registered behavior technician—A paraprofessional certified by the Behavior Analyst Certification Board to implement an ITP that includes ABA services.
Restrictive procedure—A practice that limits or restricts a child's, youth's or young adult's freedom of movement, activity or function.
Stimulus—An event, circumstance or condition that can be changed or does change based upon the behavior specialist analyst's manipulation.
Systems of care principles—Guiding philosophies that form the essential elements of a coordinated network of community-based services and supports that is organized to meet the challenges of children, youth and young adults with serious mental health needs and their families that is family-driven and youth-guided and includes interagency collaboration, individualized strengths-based care, cultural and linguistic competence, community-based services and accountability.
Trauma—The result of an event, series of events or set of circumstances that is experienced by a child, youth or young adult as physically or emotionally harmful or threatening and that has lasting effects on the child's, youth's or young adult's functioning and physical, social, emotional or spiritual well-being.
Trauma-informed approach—Recognizes the widespread impact of trauma including the signs and symptoms of trauma and potential paths for recovery by integrating knowledge about trauma into policies, procedures and practices that avoids retraumatization.
Variables—An observed or manipulable condition that can be changed or does change and a directly measurable change of a child's, youth's or young adult's behavior produced by the change.
Young adult—A person 18 years of age or older but under 21 years of age.
Youth—A person 14 years of age or older but under 18 years of age.
§ 5240.3. Provider eligibility.
(a) An IBHS agency shall obtain a license from the Department prior to beginning operations.
(b) An IBHS agency that holds an outpatient psychiatric clinic, a psychiatric partial hospitalization program or a family based mental health license issued by the Department as of ______ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), is required to comply with this chapter as of that date.
(c) An IBHS agency that holds an outpatient psychiatric clinic, a psychiatric partial hospitalization program or a family based mental health license issued by the Department as of ______ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), is required to obtain a license under this chapter when that license expires.
(d) An IBHS agency that is approved to provide ABA services shall be required to obtain a license under this chapter within 180 days of ______ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.).
§ 5240.4. Organizational structure.
(a) An IBHS agency shall have an administrative director, clinical director and staff.
(b) The organizational structure of the IBHS agency must be specified in an organizational chart and the IBHS agency shall notify the Department within 10 days of a change in the organizational structure of the IBHS agency.
§ 5240.5. Service description.
(a) As part of the initial licensing application, the IBHS agency shall submit to the Department for review and approval a written description of services to be provided that must include all of the following:
(1) Identification and description of each service offered by the IBHS agency.
(2) Purpose of the service being offered by the IBHS agency, expected duration of the service and expected outcomes for children, youth or young adults.
(3) Identification of the target population served by each service, including age range and presenting issues, which may include specific diagnoses.
(4) The days and hours each service is available.
(5) Identification of the counties where the IBHS agency provides each service.
(6) Description of admission criteria.
(7) Description of discharge criteria.
(8) Description of any exclusionary criteria.
(9) Staffing ratios for each service offered by the IBHS agency.
(10) Maximum number of children, youth or young adults that may be assigned to a BHT or BHT-ABA, if a BHT or BHT-ABA will be providing services.
(11) Treatment modalities.
(12) Locations where the service are offered.
(b) Prior to the IBHS agency changing its services or if the information in the service description is otherwise no longer accurate, the IBHS agency shall submit an updated service description to the Department for review and approval.
§ 5240.6. Restrictive procedures.
(a) A restrictive procedure shall only be used in an emergency situation to prevent self-injury or to prevent injury to others by a child, youth or young adult and after all of the following:
(1) Every attempt has been made to anticipate and de-escalate the behavior using methods of intervention that are less intrusive than a restrictive procedure.
(2) Less intrusive techniques and resources appropriate to the behavior have been tried but have failed.
(b) A manual restraint is the only restrictive procedure that may be used and may not:
(1) Apply pressure or weight on a child's, youth's or young adult's respiratory system.
(2) Use a prone position.
(c) The position of the manual restraint or the staff person applying a manual restraint shall be changed at least every 10 minutes during the application of the manual restraint.
(d) A staff person who is not applying the manual restraint procedure shall observe and document the physical and emotional condition of the child, youth or young adult at least every 10 minutes during the application of the manual restraint.
(e) A manual restraint shall be discontinued when the child, youth or young adult demonstrates the ability to regain self-control.
(f) An IBHS agency shall have policies and procedures for the use of manual restraints that include all of the following:
(1) Appropriate use of the manual restraint procedure, including all prohibitions on the use of a manual restraint.
(2) Required use of less intrusive techniques and resources appropriate to the behavior prior to the use of a manual restraint procedure.
(3) Immediate discontinuation of the manual restraint procedure when the child, youth or young adult demonstrates the ability to regain self-control.
(g) An IBHS agency shall require yearly training for each staff person who administers a manual restraint procedure that includes all of the following:
(1) De-escalation techniques and strategies.
(2) Proper use of the specific manual restraint procedure that is appropriate for the age and weight of the child, youth or young adult.
(3) Demonstrated experience in the proper use of the manual restraint procedure on other staff.
(4) A testing process to demonstrate the ability to properly apply the specific manual restraint procedure.
(h) An IBHS agency shall keep a record of each staff person's training in the use of manual restraint procedures.
(i) An IBHS agency shall document the use of any manual restraint procedure in the child's, youth's or young adult's individual record in accordance with § 5240.41(a)(11) (relating to individual records).
§ 5240.7. Coordination of services.
(a) An IBHS agency shall have written agreements to coordinate services with other service providers, including all of the following:
(1) Psychiatric inpatient facilities.
(2) Partial hospitalization programs.
(3) Psychiatric outpatient clinics.
(4) Crisis intervention programs.
(5) Mental health and intellectual or developmental disability case management programs.
(b) An IBHS agency shall update the written agreements with other service providers at least every 5 years.
(c) An IBHS agency shall have a list of community resources that provide behavioral health services that is available upon request by a parent or caregiver of a child or youth, or a youth or young adult receiving services that includes all of the following:
(1) The name of the program or organization.
(2) Description of the services provided.
(3) Address and phone number of the program or organization.
(d) An IBHS agency shall update the community resource list annually.
(e) An IBHS agency shall have a written referral process for children, youth and young adults whose therapeutic needs cannot be served by the agency. The IBHS agency shall document in the records of the IBHS agency the referrals made for a child, youth or young adult the IBHS agency could not serve.
(f) An IBHS agency that provides group services is not required to comply with subsections (a) and (b).
STAFFING § 5240.11. Staff requirements.
(a) An IBHS agency shall have an administrative director and a clinical director.
(b) The administrative director's responsibilities shall include all of the following:
(1) The overall daily management of the agency.
(2) Setting work schedules to meet the needs of the children, youth and young adults served and that accommodate their parents' or caregivers' schedules.
(3) Ensuring compliance with staff qualifications and training requirements.
(4) Monitoring the IBHS agency's compliance with this chapter.
(5) Developing and monitoring the quality improvement plan for the agency.
(c) The administrative director may also be the clinical director if the person meets the qualifications for both positions.
(d) When an entity operates more than one IBHS agency, the administrative director may be responsible for more than one IBHS agency that is licensed under this chapter.
(e) The administrative director shall dedicate a minimum of 7.5 hours each week for each IBHS agency that he directs.
(f) The clinical director's responsibilities shall include all of the following:
(1) Ensuring supervision is provided to all staff in accordance with this chapter.
(2) Providing 1 hour of supervision to all staff that supervise other staff at least two times a month.
(3) Maintaining clinical oversight of all IBHS provided.
(4) Ensuring staff that provide IBHS have access to supervisory staff during all hours that IBHS are provided, including evenings and weekends.
(5) Conducting and documenting monthly staff meetings.
(6) Completing and documenting a clinical record review for quality of the services provided and compliance with this chapter and documenting the outcomes of the review on a quarterly basis.
(7) Ensuring that training for IBHS agency staff is being provided as required by this chapter.
(g) An IBHS agency shall employ a sufficient number of qualified staff to comply with the administrative oversight, clinical supervision and monitoring requirements of this chapter.
(h) An IBHS agency shall employ a sufficient number of qualified staff to provide the maximum number of service hours identified in the written order and the ITP for each child, youth or young adult admitted to services.
§ 5240.12. Staff qualifications.
(a) An administrative director of an IBHS agency shall meet one of the following:
(1) The qualifications for a clinical director in subsection (b).
(2) Have a graduate degree in psychology, social work, counseling, education, human services, public administration, business administration or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation.
(3) Have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(b) A clinical director of an IBHS agency shall meet all of the following:
(1) Have a minimum of 1 year of full-time postgraduate experience in the provision of mental health direct service to children, youth or young adults.
(2) Be licensed in this Commonwealth as a psychiatrist, psychologist, professional counselor, marriage and family therapist, or clinical social worker, or be licensed in this Commonwealth as a certified registered nurse practitioner and have a mental health certification or be licensed in this Commonwealth as a social worker with a graduate degree that required a clinical or mental health direct service practicum.
(c) This section does not apply to ABA services.
§ 5240.13. Staff training plan.
(a) An IBHS agency shall develop and implement a written plan that ensures initial and annual training requirements are met which includes all of the following:
(1) A written individual training plan that is:
(i) Updated annually based on the date of hire for each staff person.
(ii) Based upon the staff person's educational level, experience, current job functions and performance reviews.
(iii) Appropriate to the staff person's skill level.
(2) An overall plan to ensure that staff receive training in accordance with this chapter to provide IBHS in a manner that is consistent with the policies and procedures of the IBHS agency.
(3) An annual review and update of the IBHS agency training plan based on service outcomes and staff performance evaluations.
(b) An IBHS agency shall keep documentation of the completed initial and annual training requirements in each staff person's personnel file in accordance with § 5240.42(b)(2) (relating to agency records).
(c) An IBHS agency shall accept documentation of the completion of initial or annual training requirements from a college, university, National training organization, training entity accepted by a professional licensing organization or the Department.
(d) An IBHS agency may choose to not require a staff person to complete additional training if the staff person has completed the required initial or annual training while working for another IBHS agency.
(e) An IBHS agency shall keep records of all initial and annual trainings that it provides to staff that includes documentation of all of the following:
(1) The date, time and location of the training.
(2) The name of the person who conducted the training and the person's qualifications to conduct the specific training.
(3) The names of IBHS agency staff who participated in the training.
(4) The specific topics addressed at the training.
(5) A copy of any written materials distributed to participants.
(6) A copy of any written materials that were used during the training.
(7) Department approval of the training.
§ 5240.14. Criminal history checks and child abuse certification.
(a) Criminal history checks and child abuse certification shall be completed in accordance with 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law) and Chapter 3490 (relating to protective services).
(b) An IBHS agency shall have policies and procedures to ensure that staff having contact with children or youth comply with 23 Pa.C.S. §§ 6301—6386 and Chapter 3490, including mandatory reporter and training requirements.
SERVICE PLANNING AND DELIVERY § 5240.21. Assessment.
(a) A comprehensive face-to-face assessment shall be completed by a behavior specialist or mobile therapist for each child, youth or young adult within 15 days of the initiation of IBHS and prior to developing the ITP.
(b) The assessment shall be completed in collaboration with the youth, young adult, or parent or caregiver of the child or youth, and the child as appropriate.
(c) The assessment shall be individualized and include all of the following:
(1) The strengths and needs across developmental and behavioral domains of the child, youth or young adult.
(2) The strengths and needs of the family system in relation to the child, youth or young adult.
(3) Existing and needed natural and formal supports.
(4) The specific services, skills, supports and resources the child, youth or young adult requires to address the child's, youth's or young adult's identified therapeutic needs.
(5) The specific supports and resources, if any, the parent or caregiver of the child, youth or young adult requires to assist in addressing the child's, youth's or young adult's identified therapeutic needs.
(6) Clinical information that includes all of the following:
(i) Treatment history.
(ii) Medical history.
(iii) Developmental history.
(iv) Family structure and history.
(v) Educational history.
(vi) Social history.
(vii) Trauma history.
(viii) Other relevant clinical information.
(7) The child's, youth's or young adult's level of developmental, cognitive, communicative, social and behavioral functioning across the home, school and other community settings.
(8) The cultural, language or communication needs and preferences of the child, youth or young adult and the parent or caregiver.
(d) The assessment shall include a summary of the treatment recommendations received from health care providers, school or other service providers involved with the child, youth or young adult.
(e) The assessment shall be reviewed and updated at least every 6 months and if one of the following occurs:
(1) A parent or caregiver of a child or youth requests an update.
(2) A young adult or youth requests an update.
(3) A child or youth experiences a change in living situation that results in a change of the child's or youth's primary caregivers.
(4) The child, youth or young adult completes an ITP goal.
(5) The child, youth or young adult is not progressing towards the goals identified in the ITP within 90 days from the initiation of services identified in the ITP.
(6) The child, youth, young adult or the family experiences a crisis event.
(7) An IBHS agency staff person, primary care physician, other treating clinician, case manager or other professional involved in the child's, youth's or young adult's services determines an update is needed.
(f) The assessment and all updates shall be signed and dated by the IBHS agency staff person that completed the assessment and the supervisor of the staff person that completed the assessment.
(g) This section does not apply to ABA services.
(h) Subsection (a) does not apply to EBT or group services.
§ 5240.22. Individual treatment plan.
(a) A written ITP shall be developed within 30 days after the initiation of a service and be based on the assessment completed in accordance with § 5240.21 (relating to assessment).
(b) The ITP must include the recommendations from the licensed professional who completed the written order for the IBHS in accordance with § 1155.32(1) (relating to payment conditions for individual services).
(c) The ITP shall be strength-based with individualized goals and objectives to address the identified therapeutic needs for the child, youth or young adult to function at home, school or in the community.
(d) The ITP must include all of the following:
(1) Service type and the number of hours of each service.
(2) Whether and how parent or caregiver participation is needed to achieve the identified goals and objectives.
(3) Safety plan to prevent a crisis, a crisis intervention plan and a transition plan.
(4) Specific goals, objectives and interventions to address the identified therapeutic needs with definable and measurable outcomes.
(5) Type of staff providing the services.
(6) Time frames to complete each goal.
(7) Settings where services may be provided.
(8) Number of hours of service at each setting.
(e) The ITP shall be developed in collaboration with the youth, young adult, or at least one parent or caregiver of a child.
(f) The ITP shall be reviewed and updated at least every 6 months and if:
(1) An ITP goal is completed.
(2) No significant progress is made within 90 days from the initiation of the services identified in the ITP.
(3) A youth or young adult requests a change.
(4) A parent or caregiver of a child or youth requests a change.
(5) The child, youth or young adult experiences a crisis event.
(6) The ITP is no longer clinically appropriate for the child, youth or young adult.
(7) An IBHS agency staff person, primary care physician, other treating clinician, case manager or other professional involved in the child's, youth's or young adult's services recommends a change.
(g) An ITP update must include the elements in subsection (d) and all of the following:
(1) A description of progress or lack of progress toward the goals and objectives.
(2) A description of any new goals, objectives and interventions.
(3) A description of any changes made to the goals, objectives or interventions.
(4) A description of the new interventions to be used to reach previously identified goals and objectives.
(h) The ITP and all updates shall be reviewed, signed and dated by the youth, young adult, or at least one parent or caregiver of a child or youth, and the IBHS staff person who developed the ITP.
(i) The ITP and all updates shall be reviewed, signed and dated by the supervisor of the staff person who developed the ITP.
(j) This section does not apply to all of the following:
(1) ABA services.
(2) Group services.
§ 5240.23. Service provision.
(a) IBHS shall be provided in accordance with each child's, youth's or young adult's ITP.
(b) IBHS shall be delivered in community-based, clinically appropriate settings as identified in the written order and ITP.
(c) IBHS shall be provided in accordance with the IBHS agency's approved service description under § 5240.5 (relating to service description).
DISCHARGE § 5240.31. Discharge.
(a) An IBHS agency may discharge a child, youth or young adult when one of the following occurs:
(1) The child, youth or young adult has completed the goals and objectives in the ITP and no new goals or objectives have been identified.
(2) The child, youth or young adult is not progressing towards the identified goals as described in the ITP after 180 days from the initiation of the IBHS and other clinical services are in place to provide continuity of care.
(3) The child, youth or young adult requires a more restrictive service to meet the child's, youth's or young adult's needs.
(4) The parent or caregiver of a child or youth who provided consent to receive services requests to discontinue services.
(5) The youth or young adult requests to discontinue services.
(b) An IBHS agency shall provide all of the following information to the youth, young adult, or at least one parent or caregiver of the child upon discharge:
(1) If the child, youth or young adult has been referred to other services, contact information for each service.
(2) Contact information for the local crisis intervention service.
(c) An IBHS agency may continue to serve a child, youth or young adult after the child, youth or young adult is discharged for up to 90 days if the youth, young adult, or parent or caregiver of the child or youth requests reinitiation of services within 60 days after the child, youth or young adult has been discharged from services when:
(1) The condition of the child, youth or young adult has regressed and impacts the child's, youth's or young adult's ability to maintain functioning at home, school or in the community.
(2) The written order meets the requirements in § 1155.32(1)(ii)—(iv) or § 1155.33(1)(ii)—(iv) (relating to payment conditions for individual services; and payment conditions for ABA).
§ 5240.32. Discharge summary.
(a) An IBHS agency shall complete a discharge summary for each child, youth or young adult that includes all of the following:
(1) Summary of the service outcomes.
(2) Reason for discharge.
(3) Referral for services other than IBHS if needed.
(4) Documentation of at least two telephone contacts within the first 30 days after discharge to monitor the status of maintaining treatment progress.
(b) An IBHS agency shall ensure that the discharge summary is:
(1) Completed within 45 days after the date of discharge.
(2) Reviewed and signed by the IBHS agency's clinical director.
(3) Provided to the youth, young adult, or at least one parent or caregiver of the child.
RECORDS § 5240.41. Individual records.
(a) An IBHS agency shall maintain a record for each child, youth or young adult served which includes all of the following:
(1) Identifying information.
(2) A written order for IBHS in accordance with § 1155.32(1) or § 1155.33(1) (relating to payment conditions for individual services; and payment conditions for ABA).
(3) An assessment in accordance with § 5240.21, § 5240.85, § 5240.92 or § 5240.105.
(4) Presenting problems.
(5) The ITP and any updates in accordance with § 5240.22, § 5240.86, § 5240.92 or § 5240.106.
(6) Documentation of any efforts to coordinate care with other services and community supports if needed.
(7) Documentation of each service provided that includes all of the following:
(i) Date and time services were provided, duration of services and setting where services were provided.
(ii) Identification of the service provided to address a goal in the ITP.
(iii) Description of the outcome of the services provided.
(iv) Signature of the staff person providing the service.
(8) If services are not provided in accordance with the ITP and written order, an explanation of the reason why services were not provided in accordance with the ITP and written order.
(9) Consent to treatment and consent to release information forms.
(10) Discharge summary in accordance with § 5240.32 (relating to discharge summary).
(11) Documentation of any use of a manual restraint procedure and a description of how the use of the manual restraint procedure was in accordance with § 5240.6 (relating to restrictive procedures) and used to prevent self-injury or to prevent injury to others by a child, youth or young adult, including all of the following:
(i) The specific behavior addressed.
(ii) The less intrusive methods of intervention used to address the behavior prior to initiating the manual restraint procedure used.
(iii) The specific manual restraint procedure used.
(iv) The name of the staff person who used the manual restraint procedure.
(v) The duration of the manual restraint procedure.
(vi) The name of the staff person who observed the child, youth or young adult during the application of the manual restraint procedure.
(vii) The child's, youth's or young adult's condition following the manual restraint procedure.
(viii) The date and time the manual restraint procedure was used.
(b) The record shall be maintained as follows:
(1) Legible.
(2) Signed and dated by the staff member writing in the record.
(3) Reviewed for quality at least every 6 months by the administrative director, clinical director or designated quality improvement staff. After initial review, subsequent reviews may be limited to new additions to the record since the prior review.
(c) The record shall be maintained for a minimum of 10 years after the last date of service.
§ 5240.42. Agency records.
(a) An IBHS agency shall maintain records that contain all of the following:
(1) Inspection reports, certifications or licenses issued by State and local agencies.
(2) A detailed agency service description in accordance with § 5240.5 (relating to service description).
(3) A written emergency plan that includes, at a minimum, a plan for natural disasters, inclement weather and medical emergencies.
(4) Human resources policies and procedures that address all of the following:
(i) Job descriptions for staff positions.
(ii) Staff work schedules and time sheets.
(iii) Criminal history checks, child abuse certifications and training on and compliance with the mandated reporter requirements in 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law).
(5) Written agreements to coordinate services in accordance with § 5240.7 (relating to coordination of services).
(6) Daily schedules for group services if providing group services.
(7) Quality improvement plans in accordance with § 5240.61 (relating to quality improvement requirements).
(b) An IBHS agency shall maintain staff personnel records that include all of the following:
(1) Documentation of staff's credentials or qualifications.
(2) Documentation of completion of required training for all staff, including completion of continuing education credits required for professionally licensed staff to maintain licensure in accordance with the applicable professional regulations.
(3) All criminal history checks and child abuse certifications.
(4) The staff's individual training plan in accordance with § 5240.13 (relating to staff training plan).
§ 5240.43. Record retention and disposal.
An IBHS agency shall ensure that all records that contain protected health information, both written and electronic, are secured, maintained and disposed of in accordance with all applicable Federal and State privacy and confidentiality statutes and regulations.
NONDISCRIMINATION § 5240.51. Nondiscrimination.
An IBHS agency may not discriminate against staff or children, youth or young adults receiving services on the basis of race, color, creed, disability, religious affiliation, ancestry, gender, gender identity or expression, sexual orientation, national origin or age, and shall comply with all applicable Federal and State statutes and regulations.
QUALITY IMPROVEMENT § 5240.61. Quality improvement requirements.
(a) An IBHS agency shall establish and implement a written quality improvement plan that meets all of the following requirements:
(1) Provides for an annual review of the quality, timeliness and appropriateness of services that includes all of the following:
(i) Individual record reviews.
(ii) Review of individual and family satisfaction information.
(iii) Assessment of the outcomes of services delivered and if ITP goals have been completed.
(iv) An evaluation of compliance with the agency's service description and licensure requirements.
(2) Identifies the type of review and the methodology for the review that includes all of the following:
(i) Method for establishing sample size.
(ii) Frequency of review.
(iii) Staff's qualifications to perform the review.
(b) An IBHS agency shall prepare a report that includes all of the following:
(1) Documentation and analysis of the findings of the annual review required under subsection (a).
(2) Identification of the actions to address annual review findings.
(c) An IBHS agency shall make annual quality reports available to the public upon request.
(d) An IBHS agency shall provide written notification that a copy of the annual quality report may be requested by the youth, young adult, or parent or caregiver of a child, youth or young adult upon admission to services.
INDIVIDUAL SERVICES § 5240.71. Staff qualifications.
(a) Except as set forth in subsection (b), a behavior specialist who provides individual services shall meet one of the following:
(1) Be licensed in this Commonwealth as a behavior specialist.
(2) Have a current certification as a BCBA from the Behavior Analyst Certification Board or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute.
(3) Have a graduate degree in psychology, ABA, social work, education, counseling or related field that includes a clinical or mental health direct service practicum from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults.
(4) Have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(b) Behavior specialists who provide individual services to children diagnosed with ASD for the treatment of ASD shall meet the qualifications for a behavior specialist analyst in § 5240.81(c) (relating to staff qualifications).
(c) A mobile therapist who provides individual services shall meet one of the following:
(1) Be licensed in this Commonwealth as a psychologist, professional counselor, marriage and family therapist, or clinical social worker.
(2) Be licensed in this Commonwealth as a social worker with a graduate degree that required a clinical or mental health direct service practicum.
(3) Have a graduate degree in psychology, social work, education or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults.
(4) Have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(d) A BHT who provides individual services shall have or obtain within 18 months of being hired by an IBHS agency as a BHT or by ______ (Editor's Note: The blank refers to 730 days after the effective date of adoption of this proposed rulemaking.), whichever is later, a current RBT, BCAT or other behavior analysis certification that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute, or a current BHT certification from the Pennsylvania Certification Board. If the BHT does not have the required certification, the BHT can provide individual services for 18 months after being hired by an IBHS agency as a BHT or by ______ (Editor's Note: The blank refers to 730 days after the effective date of adoption of this proposed rulemaking.), whichever is later, if the BHT meets one of the following:
(1) Has a bachelor's degree in psychology, social work, counseling, sociology, education or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation.
(2) Has an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(3) Has an associate's degree or at least 60 credits towards a bachelor's degree and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults.
(4) Has a Pennsylvania license as a registered nurse and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults.
§ 5240.72. Supervision.
(a) Supervision shall be provided by an IBHS supervisor to all staff that provide individual services. Supervision shall include all of the following:
(1) One hour of supervision of behavior specialists and mobile therapists two times a month.
(2) One individual face-to-face session a month for each IBHS staff person.
(3) Thirty minutes of direct observation of services being provided by each IBHS staff person every 3 months.
(4) Case reviews for each IBHS staff person each month that include all of the following:
(i) The interventions being implemented.
(ii) ITP implementation status.
(iii) Adjustments needed to the ITP goals.
(iv) Staff person's skill in implementing the ITP interventions.
(b) In addition to the requirements in subsection (a)(2)—(4), an IBHS supervisor shall provide a BHT with the following supervision:
(1) Six hours of onsite supervision during the provision of services to a child, youth or young adult prior to providing services independently.
(2) Onsite supervision during the provision of services to a child, youth or young adult at least quarterly for a minimum of 30 minutes.
(3) One hour of supervision each week if the BHT works at least 37.5 hours per week or 1 hour of supervision two times a month if the BHT works less than 37.5 hours a week.
(c) An IBHS supervisor shall meet one of the following:
(1) Be licensed in this Commonwealth as a psychologist, professional counselor, marriage and family therapist, or clinical social worker.
(2) Be licensed in this Commonwealth as a certified registered nurse practitioner and have a mental health certification.
(3) Be licensed in this Commonwealth as a social worker with a graduate degree that required a clinical or mental health direct service practicum.
(4) Have a graduate degree in psychology, ABA, social work, education or a related field that includes a clinical or mental health direct service practicum from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults.
(5) Have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and a minimum of 1 year of full-time experience providing mental health direct services to children, youth or young adults. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(d) An IBHS supervisor may supervise a maximum of nine full-time equivalent BHT staff.
(e) Group supervision may be provided to no more than nine mobile therapists, behavior specialists and BHTs in each session.
(f) Face-to face supervision may be delivered through secure, real-time, two-way audio and video transmission that meets technology and privacy standards required by the Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191, 110 Stat. 1936).
(g) An IBHS supervisor shall maintain documentation which includes all of the following of all supervision sessions as part of each staff's personnel file:
(1) The date of the supervision session.
(2) The location and modality of the session, such as in-person or through secure audio or video medium.
(3) The format of the session, such as individual, group or onsite.
(4) The start and end time of the supervision session.
(5) A narrative summary of the points discussed during the session.
(6) The dated signature of the supervisor and the staff person receiving supervision.
(h) An IBHS supervisor shall be available to consult with staff during all hours that individual services are being provided, including evenings and weekends.
(i) The clinical director may provide supervision if the IBHS agency employs nine or less full-time equivalent staff that provide individual services and have no staff that meet the qualifications of an IBHS supervisor.
§ 5240.73. Staff training requirements.
(a) An IBHS agency that provides individual services shall ensure that all staff complete initial and annual training requirements.
(b) A behavior specialist who is licensed in this Commonwealth or who does not have a current professional license shall complete at least 16 hours of Department-approved training annually that is related to the behavior specialist's specific job functions and is in accordance with the behavior specialist's individual training plan as required under § 5240.13 (relating to staff training plan).
(c) A mobile therapist who is not licensed in this Commonwealth as a psychologist, professional counselor, marriage and family therapist, clinical social worker or social worker shall complete at least 16 hours of Department-approved training annually that is related to the mobile therapist's specific job functions and is in accordance with the mobile therapist's individual training plan as required under § 5240.13.
(d) A BHT shall complete at least 30 hours of Department-approved training before independently providing services to a child, youth or young adult that includes all of the following topics:
(1) Sections 6301—6386 of 23 Pa.C.S. (relating to Child Protective Services Law) and mandated reporting requirements.
(2) Crisis intervention skills, including risk management, de-escalation techniques and safety planning.
(3) Behavior management skills and coaching.
(4) Child and adolescent development.
(5) Overview of serious emotional disturbance and other behavioral and psychosocial needs of the individuals with whom the BHT works.
(6) Professional ethics, conduct and confidentiality.
(7) First aid, universal precautions and safety.
(8) Psychotropic medications, including common side effects.
(e) Within the first 6 months of employment as a BHT, the BHT shall complete at least 24 hours of Department-approved training that includes all of the following topics:
(1) Documentation skills.
(2) Systems of care principles.
(3) Overview of functional behavioral assessment.
(4) Ethnic, cultural and linguistic considerations of the community served.
(5) Strategies and interventions to engage children, youth or young adults and parents or caregivers in services, including family systems theory.
(6) Skills and techniques for working with families.
(7) Overview of community resources and child and youth-serving systems and processes.
(8) Cross-systems collaboration.
(9) Communication and conflict resolution skills.
(10) Basic individual education plan and special education information.
(11) Safe use of restrictive procedures in accordance with § 5240.6 (relating to restrictive procedures).
(f) A BHT who has a current RBT, BCAT or other behavior analysis certification that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute may count hours of training required for certification towards the training requirements in subsections (d) and (e).
(g) A BHT who is certified as a BHT through the Pennsylvania Certification Board is deemed to have completed and is exempt from the training requirements in subsections (d) and (e).
(h) A BHT may substitute completed college coursework for any of the required training topics in subsection (d) or (e) by providing an official transcript and if needed other documentation to the IBHS agency that reflects that the coursework addressed a required training topic.
(i) A BHT shall complete at least 20 hours of Department-approved training annually that is related to the BHT's specific job functions and is in accordance with the BHT's individual training plan required under § 5240.13.
(j) A BHT who has a current RBT, BCAT or other behavior analysis certification that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute may count hours of continuing training required to maintain the BHT's certification towards the continuing training requirement in subsection (i).
§ 5240.74. Individual services initiation requirements.
(a) An IBHS agency shall provide individual services to a child, youth or young adult in accordance with a written order under § 1155.32(1) (relating to payment conditions for individual services).
(b) Prior to the initiation of individual services, the IBHS agency shall obtain written consent to receive the individual services identified in the written order from the youth, young adult, or parent or caregiver of a child or youth.
§ 5240.75. Individual services provision.
(a) A behavior specialist shall provide only the following services:
(1) Assessment of behavioral needs.
(2) Design and direction of the implementation of behavioral interventions in the ITP.
(3) Identification of behavioral goals in measurable terms and selection of appropriate interventions for inclusion in the ITP.
(4) Review, analysis and interpretation of data to determine any changes to goals and objectives included in the ITP.
(5) Consultation to mobile therapists or BHTs on behavioral management protocols.
(6) Review of clinical outcomes for the behavioral interventions being implemented in the treatment plan with the youth, young adult, or parent or caregiver of the child to determine effectiveness of the individual services on a monthly basis.
(b) A mobile therapist shall provide only the following services:
(1) Individual therapy.
(2) Family therapy.
(3) Assessment of the strengths and therapeutic needs of the child, youth or young adult and family or caregiver.
(4) ITP development.
(5) Assistance with crisis stabilization.
(6) Assistance with addressing problems the child, youth or young adult has encountered.
(c) A BHT shall provide only the following services as part of implementing the ITP:
(1) Support of problem solving skill development.
(2) Instruction on how to understand, direct, interpret, manage and control feelings and emotional responses to situations.
(3) Assistance to the parent or caregiver to address the therapeutic needs of the child, youth or young adult.
(4) Psychoeducational services related to mental health, including the development of improved decision making skills to manage behavior.
(5) Assistance with the development of social skills and socially acceptable behaviors.
(6) Instruction on stress reduction techniques.
(7) Collection of data.
(8) Behavioral stabilization and interventions to support services provided by a behavior specialist or mobile therapist.
(9) Referrals to other necessary services and supports.
(d) A BHT may not provide interventions requiring skills, experience, credentials or licensure that the BHT does not possess.
(e) A BHT may not develop or revise the ITP goals, objectives or interventions.
APPLIED BEHAVIORAL ANALYSIS § 5240.81. Staff qualifications.
(a) An administrative director of an IBHS agency that provides ABA services shall have one of the following:
(1) A graduate degree in ABA, psychology, social work, counseling, education, public administration, business administration or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation.
(2) An equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(b) A clinical director of an IBHS agency that provides ABA services shall be licensed in this Commonwealth as a psychiatrist, psychologist, certified registered nurse practitioner, professional counselor, marriage and family therapist, clinical social worker, behavior specialist, social worker or as a professional who within the scope of the licensed professional's practice may provide or supervise the provision of ABA. If the clinical director is licensed as a certified registered nurse practitioner, the clinical director shall have a mental health certification. If the clinical director is licensed as a social worker, the clinical director shall have a graduate degree that required a clinical or mental health direct service practicum. A clinical director shall also have one of the following:
(1) A current certification as a BCBA from the Behavior Analyst Certification Board or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute.
(2) A graduate degree or graduate certificate in ABA from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and a minimum of 1 year of full-time experience in the provision of ABA, provided that the clinical director obtains a BCBA certification from the Behavior Analyst Certification Board or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute within 3 years of the date the individual starts working as a clinical director for any IBHS agency.
(3) An equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and a minimum of 1 year of full-time experience in the provision of ABA, provided that the clinical director obtains a BCBA certification from the Behavior Analyst Certification Board or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute within 3 years of the date the individual starts working as a clinical director for any IBHS agency. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(c) A behavior specialist analyst who provides ABA services shall have a Pennsylvania license as a psychologist, professional counselor, marriage and family therapist, clinical social worker, social worker or behavior specialist and have one of the following:
(1) A current certification as a BCBA from the Behavior Analyst Certification Board or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute.
(2) A current certification as a BCaBA from the Behavior Analyst Certification Board or other undergraduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute.
(3) A current certification as a behavior specialist analyst with a competency in ABA from the Pennsylvania Certification Board.
(4) A minimum of 12 credits in ABA from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and 1 year of full-time experience in the provision of ABA.
(5) A minimum of 1 year of full-time experience in the provision of ABA under the supervision of a professional with a certification as a BCBA from the Behavior Analyst Certification Board or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute.
(d) An ABSA who provides ABA services shall meet one of the following:
(1) Have all of the qualifications for licensure as a behavior specialist under 49 Pa. Code § 18.524 (relating to criteria for licensure as behavior specialist) except the experience required under subsection (c).
(2) Have a bachelor's degree in psychology, social work, counseling, education or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and a current certification as a BCaBA from the Behavior Analyst Certification Board or other undergraduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute.
(3) Have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and a current certification as a BCaBA from the Behavior Analyst Certification Board or other undergraduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(4) Have a bachelor's degree in psychology, social work, counseling, education or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and at least 12 credits in ABA from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation and 6 months of experience in providing ABA.
(5) Have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and at least 12 credits in ABA from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services and 6 months of experience in providing ABA. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(e) A BHT-ABA who provides ABA services shall have or obtain within 18 months of being hired by an IBHS agency as a BHT-ABA or by ______ (Editor's Note: The blank refers to 730 days after the effective date of adoption of this proposed rulemaking.), whichever is later, a current RBT, BCAT or other behavior analysis certification that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute or a current BHT certification with a competency in ABA from the Pennsylvania Certification Board. If the BHT-ABA does not have the required certification, the BHT-ABA can provide ABA services for 18 months after being hired by an IBHS agency as a BHT-ABA or by ______ (Editor's Note: The blank refers to 730 days after the effective date of adoption of this proposed rulemaking.), whichever is later, if the BHT-ABA meets one of the following:
(1) Has a bachelor's degree in psychology, sociology, social work, nursing, counseling, education or related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation.
(2) Has an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.
(3) Has an associate's degree or at least 60 credits towards a bachelor's degree with 12 credits in providing ABA and a minimum of 1 year of full-time experience in the provision of ABA.
§ 5240.82. Supervision.
(a) The ABA clinical director shall provide supervision to all behavior specialist analysts that includes all of the following:
(1) One hour of supervision two times a month.
(2) One individual face-to-face session each month.
(3) Case reviews each month that include all of the following:
(i) The specific ABA interventions being implemented.
(ii) ITP implementation status.
(iii) Adjustments needed to the ITP goals.
(iv) Staff person's skills in implementing the interventions in the ITP that use ABA.
(b) A behavior specialist analyst shall provide supervision to all ABSA staff that include all of the following:
(1) One hour of supervision each week if the ABSA works at least 37.5 hours per week or 1 hour of supervision two times a month if the ABSA works less than 37.5 hours a week.
(2) One individual face-to-face session a month.
(3) Six hours of onsite supervision during the provision of ABA services to a child, youth or young adult prior to providing ABA services independently.
(4) Thirty minutes of direct observation of the provision of ABA services to a child, youth or young adult during the implementation of the ITP goals every 3 months.
(5) Case reviews each month that include all of the following:
(i) The specific ABA interventions being implemented.
(ii) ITP implementation status.
(iii) Adjustments needed to the ITP goals.
(iv) Staff person's skills in implementing the interventions in the ITP that use ABA.
(c) A behavior specialist analyst or an ABSA who has a current BCaBA from the Behavior Analyst Certification Board or other undergraduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute shall provide supervision to all BHT-ABA staff that includes all of the following:
(1) One hour of supervision each week if the BHT-ABA works at least 37.5 hours per week or 1 hour of supervision two times a month if the BHT-ABA works less than 37.5 hour a week.
(2) One individual face-to-face session a month.
(3) Six hours of onsite supervision during the provision of ABA services to a child, youth or young adult prior to providing ABA services independently.
(4) One hour of direct observation of the provision of ABA services to a child, youth or young adult during the implementation of the ITP goals every 3 months.
(5) Case reviews each month that include all of the following:
(i) The specific ABA interventions being implemented.
(ii) ITP implementation status.
(iii) Adjustments needed to the ITP goals.
(iv) Staff person's skills in implementing the interventions in the ITP that use ABA.
(d) The clinical director may provide supervision if an IBHS agency that provides ABA employs nine or less full-time equivalent ABSA and BHT-ABA staff.
(e) Group supervision may be provided to no more than nine behavior specialist analysts, ABSAs and BHT-ABAs in each session.
(f) A behavior specialist analyst or an ABSA who meets the qualification to provide supervision in subsection (c) may supervise a maximum of nine full-time equivalent BHT-ABA staff.
(g) A supervisor shall be available to consult with staff during all hours that ABA services are being provided, including evenings and weekends.
(h) Face-to face supervision may be delivered through secure, real-time, two-way audio and video transmission that meets technology and privacy standards required by the Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191, 110 Stat. 1936).
(i) A supervisor shall maintain documentation which includes all of the following of all supervision sessions as part of each staff's personnel file:
(1) The date of the supervision session.
(2) The location and modality of the session, such as in-person or through a secure audio or video medium.
(3) The format of the session, such as individual, group or onsite.
(4) The start and end time of the supervision session.
(5) A narrative summary of the points discussed during the session.
(6) The dated signature of the supervisor and the staff person receiving supervision.
§ 5240.83. Staff training requirements.
(a) An IBHS agency that provides ABA services shall ensure that all staff complete initial and annual training requirements.
(b) A behavior specialist analyst who is licensed in this Commonwealth as a behavior specialist shall complete all of the following:
(1) At least 45 hours of training related to ABA that is approved by the Behavior Analyst Certification Board or the Department before independently providing ABA services to a child, youth or young adult. ABA training completed prior to obtaining licensure as a behavior specialist may be counted towards the 45 hours of training related to ABA.
(2) At least 16 hours of training annually that is approved by the Behavior Analyst Certification Board or the Department that is related to the behavior specialist analyst's specific job functions and is in accordance with the behavior specialist analyst's individual training plan as required under § 5240.13 (relating to staff training plan).
(c) An ABSA who does not have a certification as a BCBA or BCaBA from the Behavior Analyst Certification Board, a certification as a BCAT from the Behavioral Intervention Certification Council, or another graduate or undergraduate certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute shall complete all of the following:
(1) At least 20 hours of training related to ABA that is approved by the Behavior Analyst Certification Board or the Department before independently providing ABA services to a child, youth or young adult.
(2) At least 20 hours of training annually that is approved by the Behavior Analyst Certification Board or the Department that is related to the ABSA's specific job functions and is in accordance with the ABSA's individual training plan as required under § 5240.13.
(d) A BHT-ABA who does not have a certification as a BCaBA or RBT from the Behavioral Analyst Certification Board, a certification as a BCAT from the Behavioral Intervention Certification Council, BHT certification from the Pennsylvania Certification Board, or another undergraduate certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute shall complete all of the following:
(1) Training in accordance with § 5240.73(d), (e) and (h) (relating to staff training requirements).
(2) At least 20 hours of training related to ABA that is approved by the Behavior Analyst Certification Board or the Department before independently providing ABA services to a child, youth or young adult.
(3) At least 20 hours of training annually that is approved by the Behavior Analyst Certification Board or the Department that is related to the BHT-ABA's specific job functions and is in accordance with the individual training plan as required under § 5240.13.
§ 5240.84. ABA initiation requirements.
(a) An IBHS agency shall provide ABA services to a child, youth or young adult in accordance with a written order under § 1155.33(1) (relating to payment conditions for ABA).
(b) Prior to the initiation of ABA services, the IBHS agency shall obtain written consent to receive the ABA services identified in the written order from the youth, young adult, or parent or caregiver of a child or youth.
§ 5240.85. Assessment.
(a) A comprehensive face-to-face assessment shall be completed by a behavior specialist analyst for each child, youth or young adult prior to developing the ITP.
(b) The assessment shall be completed in collaboration with the youth, young adult, or parent or caregiver of the child or youth, and child as appropriate.
(c) The assessment shall be individualized and include all of the following:
(1) The strengths and needs across developmental and behavioral domains of the child, youth or young adult.
(2) The strengths and needs of the family system in relation to the child, youth or young adult.
(3) Existing and needed natural and formal supports.
(4) Clinical information that includes all of the following:
(i) Survey data gathered from a parent or caregiver.
(ii) Treatment history.
(iii) Medical history.
(iv) Developmental history.
(v) Family structure and history.
(vi) Educational history.
(vii) Social history.
(viii) Trauma history.
(ix) Adaptive skills assessment.
(x) Other relevant clinical information.
(5) Completion of standardized behavioral assessment tools as needed.
(6) Compilation of observational data to identify developmental, cognitive, communicative, behavioral and adaptive functioning across the home, school and other community settings.
(7) Identification and analysis of skill deficits or targeted behaviors, or both, in measurable terms to address needs.
(8) The cultural, language or communication needs and preferences of the child, youth or young adult and the parent or caregiver.
(d) The assessment shall include a summary of the treatment recommendations received from health care providers, school or other service providers involved with the child, youth or young adult.
(e) The assessment shall be reviewed and updated at least annually and when one of the following occurs:
(1) A parent or caregiver of a child or youth requests an update.
(2) A youth or young adult requests an update.
(3) A child or youth experiences a change in living situation that results in a change of the child's or youth's primary caregivers.
(4) The child, youth or young adult completes an ITP goal.
(5) The child, youth or young adult is not progressing towards the goals identified in the ITP within 90 days from the initiation of the ABA services identified in the ITP.
(6) The child, youth, young adult or the family experiences a crisis event.
(7) The behavior specialist analyst, ABA clinical director, primary care physician, other treating clinician, case manager or other professional involved the child's, youth's or young adult's services determines an update is needed.
(f) The assessment and all updates shall be signed and dated by the behavior specialist analyst that completed the assessment and the ABA clinical director.
§ 5240.86. Individual treatment plan.
(a) A written ITP shall be developed by the behavior specialist analyst within 30 days after the initiation of ABA services and be based on the assessment completed in accordance with § 5240.85 (relating to assessment).
(b) The ITP must include the recommendations from the licensed professional who completed the written order for ABA services in accordance with § 1155.33(1) (relating to payment conditions for ABA).
(c) The ITP must be strength-based with individualized goals and objectives to address the identified skill deficits or target behaviors, or both, for the child, youth or young adult to function at home, school or in the community.
(d) The ITP must include all of the following:
(1) Service type and number of hours for each service.
(2) Specific measurable long, intermediate and short-term goals and objectives to address socially significant behaviors or skill deficits, or both.
(3) Delineation of the frequency of baseline behaviors, the treatment planned to address behaviors or skill deficits, or both, and the frequency at which the child's, youth's or young adult's progress in achieving each goal is measured.
(4) Time frames to complete each goal.
(5) Whether and how parent or caregiver training, support and participation is needed to achieve the identified goals and objectives.
(6) ABA interventions that are tailored to achieving the child's, youth's or young adult's goals and objectives.
(7) Type of staff providing the services.
(8) Settings where services may be provided.
(9) Number of hours of service at each setting.
(e) The ITP shall be developed in collaboration with the youth, young adult, or at least one parent or caregiver of a child.
(f) The ITP shall be reviewed and updated at least every 6 months and if:
(1) An ITP goal is completed.
(2) No significant progress is made within 90 days from the initiation of ABA services identified in the ITP.
(3) A youth or young adult requests a change.
(4) A parent or caregiver of a child or youth requests a change.
(5) The child, youth or young adult experiences a crisis event.
(6) The ITP is no longer clinically appropriate for the child, youth or young adult.
(7) A behavior specialist analyst, ABA clinical director, primary care physician, other treating clinician, case manager or other professional involved in the child's, youth's or young adult's services recommends a change.
(g) An ITP update must include the elements in subsection (d) and all of the following:
(1) A description of progress or lack of progress toward the goals and objectives.
(2) A description of any new goals, objectives and interventions.
(3) A description of any changes made to goals, objectives or interventions.
(4) A description of any new interventions to be used to reach previously identified goals and objectives.
(h) The ITP and all updates shall be reviewed, signed and dated by the youth, young adult, or at least one parent or caregiver of a child or youth, and the behavior specialist analyst who developed the ITP.
(i) The ITP and all updates shall be reviewed, signed and dated by the ABA clinical director.
§ 5240.87. ABA services provision.
(a) A behavior specialist analyst utilizes behavioral interventions and environmental modifications to reduce or eliminate problem behaviors or skill deficits to achieve a positive change in the targeted behavior or skill deficit. A behavior specialist analyst shall provide only the following services:
(1) Assessment of skill deficits and behavioral needs.
(2) ITP goals and objectives development to address the identified skill deficits and targeted behaviors.
(3) Selection and design of the appropriate behavioral interventions for the implementation of ABA services.
(4) Review, analysis and interpretation of data to determine any changes to selected behavioral interventions that may be needed to achieve identified goals and objectives.
(5) Supervision of staff providing ABA to the child, youth or young adult.
(6) Implementation of the ITP to assist the child, youth or young adult in achieving the goals of the ITP.
(b) An ABSA assists a behavior specialist and provides face-to-face behavioral stabilization and behavioral interventions. An ABSA shall provide only the following services:
(1) Assistance to the behavior specialist analyst with the development of goals and objectives to address the skill deficits and targeted behaviors and the selection of appropriate behavioral interventions.
(2) Data collection.
(3) Review, analysis and interpretation of data to determine any changes to selected behavioral interventions under the supervision of a behavior specialist analyst.
(4) Implementation of the ITP to assist the child, youth or young adult in achieving the goals of the ITP.
(5) Training for the BHT-ABA or family in the implementation of behavioral interventions.
(c) A BHT-ABA implements the ITP by providing face-to-face behavioral stabilization and support interventions, which includes only the following services:
(1) Collection of data under the direction of a behavior specialist analyst.
(2) Model interventions needed to assist the parent or caregiver to address the child's, youth's or young adult's goals and objectives specified in the ITP.
(3) Instruction on how the child, youth or young adult can direct, manage and control targeted behaviors.
(4) Assistance with the development of socially acceptable behaviors.
(5) Problem solving skill development to address skill deficits.
(6) Referrals to other necessary services and supports.
(d) An ABSA and BHT-ABA may not provide interventions requiring skills, experience, credentials or licensure that the ABSA or BHT-ABA does not possess.
EVIDENCE-BASED THERAPY § 5240.91. EBT initiation requirements.
(a) An IBHS agency shall provide EBT to a child, youth or young adult in accordance with a written order under § 1155.34(1) (relating to payment conditions for EBT).
(b) Prior to the initiation of EBT service, the IBHS agency shall obtain written consent to receive the EBT services identified in the written order from the youth, young adult, or parent or caregiver of a child or youth.
§ 5240.92. Assessment and individual treatment plan.
(a) A comprehensive face-to-face assessment shall be completed by a staff person with the qualifications required by the EBT for each child, youth or young adult within 15 days of the initiation of the service in accordance with § 5240.21(b)—(d) and (f) (relating to assessment) and prior to developing the ITP.
(b) The assessment shall be reviewed and updated in accordance with § 5240.21(e) and (f).
(c) A written ITP shall be developed, reviewed and updated in accordance with § 5240.22 (relating to individual treatment plan).
§ 5240.93. EBT requirements.
(a) An IBHS agency shall have a certification or license from the National certification organization or entity that developed or owns the EBT if required to provide the EBT.
(b) An IBHS agency shall ensure that EBT is provided by staff that meet the qualifications and receive supervision as set forth in the EBT.
(c) An IBHS agency that is using an EBT shall have written policies and procedures to measure all of the following:
(1) The adherence to the implementation of the specific EBT.
(2) The outcomes of the EBT that incorporate review standards associated with the EBT.
(d) An IBHS agency using an EBT shall continuously monitor the fidelity to the EBT.
(e) An IBHS agency shall ensure that procedures related to and decisions about continuing services and discharge are made in accordance with the specific EBT.
(f) An IBHS agency that does not meet the standards of the EBT that is provided shall do all of the following:
(1) Have a corrective action plan that is approved by the National certification organization or the Department.
(2) Track the corrective action plan to ensure that the plan has been implemented.
(3) Complete the corrective action plan to meet the standards of the EBT within the time frame identified in the corrective action plan.
GROUP SERVICES § 5240.101. Staff requirements and qualifications.
(a) In addition to the staff required under § 5240.11 (relating to staff requirements), an IBHS agency that provides group services shall have a mental health professional.
(b) A mental health professional shall meet the qualifications for a mobile therapist in § 5240.71(c) (relating to staff qualifications).
(c) A mental health worker who provides group services shall have one of the following:
(1) A bachelor's degree in a recognized clinical discipline including social work, psychology, nursing, rehabilitation or activity therapy from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation, or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or equivalency.
(2) A graduate degree in a recognized clinical discipline from a college or university accredited by an agency recognized by the United States Department of Education or Council for Higher Education Accreditation, or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or equivalency.
(d) A BHT who provides group services shall meet the qualifications in § 5240.71(d).
(e) An IBHS agency that provides group services which include specialized therapies such as music, dance and movement, play or occupational therapies shall use clinical staff to provide the specialized therapies that meet one of the following:
(1) Nationally certified in the specific therapy.
(2) Mental health professionals with at least 12 graduate-level credit hours in the specialized therapy and at least 1 year of supervised experience in the use of the specialized therapy technique.
(3) Mental health professionals supervised by a Nationally credentialed activities therapist.
§ 5240.102. Supervision.
(a) Supervision shall be provided to all staff that provide group services and include all of the following:
(1) The clinical director shall provide 1 hour of face-to-face supervision to each mental health professional at least two times a month.
(2) A mental health professional shall provide 1 hour of supervision each week for each mental health worker that works at least 37.5 hours per week and 1 hour of supervision two times a month for each mental health worker that works less than 37.5 hours a week.
(3) A mental health professional shall provide 1 hour of supervision each week for each BHT that works at least 37.5 hours per week, 1 hour of supervision two times a month for each BHT that works less than 37.5 hours a week and 6 hours of onsite supervision during the provision of group services to a child, youth or young adult prior to the BHT providing services independently.
(4) One individual face-to-face session each month for each IBHS staff person that provides group services.
(5) Group supervision may be provided to no more than nine IBHS staff that provide group services in each session.
(6) Case reviews for each IBHS staff person each month that include all of the following:
(i) The interventions being implemented.
(ii) ITP implementation status.
(iii) Adjustments needed to ITP goals.
(iv) Staff person's skills in implementing the ITP interventions.
(b) A mental health professional may supervise a maximum of nine full-time equivalent IBHS staff providing group services.
(c) A mental health professional shall be available to consult with staff during all hours that group services are provided, including evenings and weekends.
(d) Face-to face supervision may be delivered through secure, real-time, two-way audio and video transmission that meets technology and privacy standards required by the Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191, 110 Stat. 1936).
(e) A mental health professional shall maintain documentation which includes at least the following of all supervision sessions as part of each staff person's personnel file:
(1) The date of the supervision session.
(2) The location and modality of the session, such as in-person or through secure audio or video medium.
(3) The format of the session, such as individual, group or onsite.
(4) The start and end time of the supervision session.
(5) A narrative summary of the points discussed during the session.
(6) The dated signature of the supervisor and the staff person receiving the supervision.
§ 5240.103. Staff training requirements.
(a) An IBHS agency that provides group services shall ensure that all staff complete initial and annual training requirements.
(b) A mental health professional that is not licensed in this Commonwealth as a psychologist, professional counselor, marriage and family therapist, clinical social worker or social worker shall complete at least 16 hours of Department-approved training annually that is related to the mental health professional's specific job functions and is in accordance with the mental health professional's individual training plan as required under § 5240.13 (relating to staff training plan).
(c) A mental health worker shall complete at least 20 hours of Department-approved training annually that is related to the mental health worker's specific job functions and is in accordance with the mental health worker's individual training plan as required under § 5240.13.
(d) A BHT shall complete training in accordance with § 5240.73(d)—(j) (relating to staff training requirements) and the individual training plan as required under § 5240.13.
§ 5240.104. Group services initiation requirements.
(a) An IBHS agency shall provide group services to a child, youth or young adult in accordance with a written order under § 1155.35(1) (relating to payment conditions for group services).
(b) Prior to the initiation of group services, the IBHS agency shall obtain written consent to receive the group services identified in the written order from the youth, young adult, or parent or caregiver of a child or youth.
§ 5240.105. Assessment.
(a) A comprehensive face-to-face assessment shall be completed by a mental health professional for each child, youth or young adult within 5 days of the initiation of group services in accordance with § 5240.21(b)—(d) and (f) (relating to assessment) and prior to developing the ITP.
(b) The assessment shall be reviewed and updated in accordance with § 5240.21(e) and (f).
§ 5240.106. Individual treatment plan.
(a) A written ITP shall be developed by the mental health professional within 10 days after the initiation of group services and be based on the assessment completed in accordance with § 5240.105 (relating to assessment).
(b) The ITP must include the recommendations from the licensed professional who completed the written order for group services in accordance with §§ 1155.32(1) and 1155.35(1) (relating to payment conditions for individual services; and payment conditions for group services).
(c) The ITP shall be strength-based with individualized goals and objectives to address the identified therapeutic needs for the child, youth or young adult to function at home, school or in the community.
(d) The ITP must include all of the following:
(1) Specific goals and objectives to address the identified therapeutic needs with definable and measurable outcomes.
(2) Whether and how parent or caregiver participation is needed to achieve the identified goals and objectives.
(3) Structured therapeutic activities, community integration activities and individual interventions to address identified therapeutic needs for the child, youth or young adult to function in the home, school or community.
(4) Type of staff providing the services.
(5) Time frames to complete each goal.
(6) Settings where group services may be provided.
(7) Number of hours that group services will be provided to the child, youth or young adult.
(e) The ITP shall be developed in collaboration with the youth, young adult, or at least one parent or caregiver of a child.
(f) The ITP shall be reviewed and updated at least every 6 months and if:
(1) An ITP goal is completed.
(2) No significant progress is made within 45 days from the initiation of the services identified in the ITP.
(3) A youth or young adult requests a change.
(4) A parent or caregiver of a child or youth requests a change.
(5) The child, youth or young adult experiences a crisis event.
(6) The ITP is no longer clinically appropriate for the child, youth or young adult.
(7) An IBHS agency staff person, primary care physician, other treating clinician, case manager or other professional involved in the child's, youth's or young adult's services recommends a change.
(g) An ITP update must include the elements in subsection (d) and all of the following:
(1) A description of progress or lack of progress towards the goals and objectives.
(2) A description of any new goals, objectives and interventions.
(3) A description of any changes made to the goals, objective or interventions.
(4) A description of new interventions to be used to reach previously identified goals and objectives.
(h) The ITP and all updates shall be reviewed, signed and dated by the youth, young adult, or at least one parent or caregiver of a child or youth, and the mental health professional who developed the ITP.
(i) The ITP and all updates shall be reviewed, signed and dated by the IBHS clinical director.
§ 5240.107. Group services provision.
(a) A mental health professional shall provide only the following services:
(1) Individual psychotherapy.
(2) Group psychotherapy.
(3) Family psychotherapy.
(4) Design of psychoeducational group activities.
(5) Assessment of the strengths and therapeutic needs of the child, youth or young adult.
(6) ITP development.
(b) A mental health worker shall provide only the following services:
(1) Assistance in conducting group psychotherapy.
(2) Facilitation of psychoeducational group activities.
(3) Implementation of the ITP to assist the child, youth or young adult achieve a goal.
(4) Support of the child, youth or young adult with the development of appropriate behaviors and interpersonal relationships in the community.
(5) Help for the child, youth or young adult to develop coping skills to aid in the development of age appropriate interpersonal relationships with peers.
(c) A BHT shall provide only the following services:
(1) Assistance with the facilitation of psychoeducational group activities.
(2) Instruction on how to manage and control emotional responses in group settings.
(3) Behavioral stabilization and interventions that support the child, youth or young adult in community settings.
(4) Problem solving skills modeling.
(d) Group services shall be structured to address the goals and objectives identified in each child's, youth's or young adult's ITP.
(e) Group services shall be provided in a school or other community setting and may be provided in an IBHS agency site if approved in the service description in accordance with § 5240.5(a)(12) (relating to service description).
(f) An IBHS agency that provides group services and ABA services shall also comply with §§ 5240.81—5240.87 (relating to applied behavioral analysis).
(g) An IBHS agency that provides group services and EBT shall comply with §§ 5240.91—5240.93 (relating to EBT initiation requirements; assessment and individual treatment plan; and EBT requirements).
§ 5240.108. Requirements for group services in school settings.
A licensed IBHS agency that provides group services and identified a school as a location where services will be provided in its approved service description shall meet all of the following requirements:
(1) Have a written agreement with the authorized representative for each school location in which it provides group services that includes all of the following:
(i) Identification of the IBHS agency's and the school's lead contacts and their contact information.
(ii) Delineation of roles and responsibilities of the school staff and the IBHS agency staff.
(iii) Assurances of the collaborative relationship between school staff and IBHS agency staff.
(iv) A requirement for quarterly meetings between IBHS staff and school administration to review performance, collaboration issues and the written agreement.
(v) Crisis management protocols.
(vi) Procedures for school staff to refer students for group services.
(vii) Identification of the space and equipment allocated for use by IBHS agency staff.
(viii) Process for revising or updating the written agreement.
(2) IBHS agency staff and the school staff involved with the child, youth or young adult receiving group services shall meet on a quarterly basis to discuss the student's behavioral health services and progress related to school performance.
(i) A youth, young adult, or parent or caregiver of the child or youth shall be invited to participate in the quarterly meeting.
(ii) Other professionals as requested by a youth, young adult, or parent or caregiver of the child or youth shall be invited to participate in the quarterly meeting.
(3) An IBHS agency shall document the outcome of the quarterly meeting and include all of the following:
(i) Attendance.
(ii) Date of meeting.
(iii) Summary of the discussion.
(iv) Recommendations for any change in group service participation if discussed.
(v) Reason a meeting was not convened as required.
(4) An IBHS agency providing group services shall keep the child's, youth's or young adult's records in accordance with § 5240.41 (relating to individual records).
(5) An ITP for group services provided in school settings shall be developed in accordance with § 5240.106 (relating to individual treatment plan) and include all of the following:
(i) Continuity of services when school is not in session.
(ii) Interventions that specifically address the child's, youth's or young adult's functioning in school.
(iii) Input from the teachers and guidance counselor directly involved with the child, youth or young adult receiving group services.
(6) An IBHS agency that provides group services and ABA services and provides the services in school settings shall comply with §§ 5240.81—5240.87 (relating to applied behavioral analysis).
(7) An IBHS agency that provides group services and EBT and provides the services in school settings shall comply with §§ 5240.91—5240.93 (relating to EBT initiation requirements; assessment and individual treatment plan; and EBT requirements).
WAIVERS § 5240.111. Waivers.
(a) An IBHS agency may submit a written request to the Department for a waiver of a specific requirement in this chapter.
(b) The Department may grant a waiver unconditionally or subject to conditions that shall be met. The Department may revoke a waiver if conditions required by the waiver are not met.
(c) A waiver request will be granted only in exceptional circumstances and if all of the following are met:
(1) The waiver does not jeopardize the health and safety of the children, youths or young adults served by the IBHS agency.
(2) The waiver will not adversely affect the quality of services provided by the IBHS agency.
(3) The intent of the requirement to be waived will still be met.
(4) Children, youth or young adults will benefit from the wavier of the requirement.
(5) The waiver does not violate any Federal or State statute or other regulation.
[Pa.B. Doc. No. 18-1222. Filed for public inspection August 3, 2018, 9:00 a.m.]
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