Regulatory Issues
A thorough knowledge of state and federal laws, rules, and regulations that may impact a severe behavior program is essential. Program features or activities that are often associated with laws, rules, and regulations are listed below.
Note: This list is not intended to be exhaustive because laws, rules, and regulations may differ by state, by payor, by the method the program is reimbursed for services, and other factors.
Building codes and licenses
Before you begin service delivery, you must ensure that your facility meets the building, fire, mechanical, energy, health-department, and other relevant codes that your state, county, city, or municipality have adopted. Additional codes may apply, depending on how you bill for services. Check your state’s laws, rules, and regulations to determine whether your practice requires a specific license (e.g., healthcare-facility license).
Physical restraint and seclusion
In some cases, it may be necessary to implement restraint or seclusion as a programmatic intervention to reduce occurrences of destructive behavior that have not responded to less intrusive procedures. Program administrators should determine whether and under what conditions their state allows restraint, seclusion, or both if the program plans to use any form of restraint or seclusion.
Maintaining and releasing records
- Health Insurance Portability and Accountability Act (HIPAA): This federal law required the creation of national standards to protect disclosure of patient health information without the patient’s consent or knowledge (Annas, 2003). Program professionals should review the HIPAA privacy rule and the HIPAA security rule to understand whether the rules apply to the program.
- Mandatory reporting: Most, if not all, states have mandatory reporting laws for child abuse and neglect. The law typically dictates which professionals are mandatory reporters, operational definitions of abuse and neglect, the time frame in which professionals must report abuse and neglect, the content of the report, and the method of reporting.
- Medical records use and retention: States typically have laws that specify how long a provider must retain records. The Centers for Medicare & Medicaid Services (CMS) also has medical-records standards for providers who bill Medicare, Medicaid, or both.
Professional licensing and credentialing
Most states regulate the professions of the individuals who are likely to provide services in a severe behavior program, such as board-certified behavior analysts – doctoral (BCBA-D) and licensed psychologists. The state’s rules, regulations, and statutes will define the scope of practice of a profession. Practitioners are responsible for holding the appropriate license or credential the state requires and adhering to rules and regulations for maintaining the license, credential, or both (e.g., continuing education).
