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Standards2022-06-12T22:57:37-04:00

ACQ Applied Behavior Analysis Accreditation Program Standards and Guide (version 1.0)

Standard 1.01 – Guiding Principles2022-06-12T12:42:25-04:00

The Organization shall have a set of guiding principles that prioritizes patient care and the ethical provision of services.

Standard 1.02 – Business Administration and Jurisdictions2022-06-12T12:43:01-04:00

The Organization shall be licensed and authorized to deliver ABA services by the appropriate regulatory agencies in the location(s) where it operates, if applicable.

Standard 1.03 – Governance and Management2022-06-12T12:43:29-04:00

The Organization shall be governed by a leadership structure appropriate to its scale with oversight of its operations.

Standard 1.04 – Scope of Services2022-06-12T12:44:05-04:00

The Organization clearly and accurately differentiates and defines the scope of its ABA services.

Standard 1.05 – Policies and Procedures2022-06-12T12:44:36-04:00

The Organization shall document, review, and update its written policies and procedures at least annually, in response to regulatory requirements, or when a need arises.

Standard 1.06 – Organizational Capacity2022-06-12T13:21:31-04:00

The Organization shall define capacity expectations and have a process for evaluating whether these expectations are being met for each location and type of ABA service.

Standard 1.07 – Written Agreements2022-06-12T12:45:38-04:00

The Organization shall maintain written agreements relating to ABA services and related functions, describing key terms such as the scope of the services to be provided with all patients or legal guardians, participating providers, vendors, and subcontractors.

Standard 1.08 – Delegation of Duties2022-06-12T12:45:59-04:00

The Organization shall actively oversee all delegated or outsourced functions, retaining final oversight authority, and have a written delegation policy and agreement when it subcontracts ABA services or functions.

Standard 1.09 – Insurance Coverage2022-06-12T12:54:25-04:00

The Organization shall have business insurance coverage commensurate with its size and scope of services.

Standard 1.10 – Marketing Practices2022-06-12T12:46:54-04:00

The Organization shall:

  1. Accurately depict its services across its marketing initiatives;
  2. Abstain from anticompetitive conduct that can harm patient access to care; and
  3. Respect limitations on referrals, including not offering remuneration or compensation to current patients in exchange for assistance with patient referrals.
Standard 1.11 – Testimonials2022-06-12T12:47:14-04:00

The Organization shall remain in compliance with all applicable regulations and ethical guidelines if it collects and uses testimonials from current and former patients or their caregivers.

Standard 2.01 – Human Resource Management2022-06-12T12:48:52-04:00

The Organization shall:

  1. Implement and maintain a human resource (HR) management program that addresses key elements related to the employee experience (e.g., hiring, performance reviews, terminations, employee satisfaction) in compliance with applicable regulations;
  2. Assign staff or hire consultants with an appropriate level of access, experience, and expertise to manage common human resource functions; and
  3. Make available an up-to-date Employee or Personnel Handbook to its employees.
Standard 2.02 – Recruitment and Hiring2022-06-12T12:49:19-04:00

The Organization shall:

  1. Provide equal opportunities for employment consistent with applicable regulations;
  2. Verify that job candidates have qualifying backgrounds and credentials relevant to the position before hiring;
  3. Conduct background checks in compliance with applicable regulations;
  4. Use fair hiring practices in compliance with applicable regulations; and
  5. Prohibit non-executive job candidates from signing non-compete agreements.
Standard 2.03 – Training2022-06-12T12:49:46-04:00

The Organization shall:

  1. Provide and document orientation training for new hires, with applicable checklists for their respective functions;
  2. Offer and document ongoing staff training relevant to their positions and according to applicable regulations; and
  3. Ensure training occurs at sufficient intervals to effectively keep staff properly updated.
Standard 3.01 – Financial and Fiduciary Management2022-06-12T12:55:18-04:00

The Organization shall:

  1. Review on a predetermined schedule its budget, financial reports, and revenue cycle; and
  2. Appoint an executive internally or contract with a professional with the relevant background and expertise to oversee its financial operations in accordance with established accounting principles and business practices.
Standard 3.02 – Fee Schedule2022-06-12T12:55:42-04:00

The Organization shall:

  1. Document the value of its services in its fee schedule;
  2. Document its contracted rates; and
  3. Invoice/bill its services according to its documented fee schedule.
Standard 3.03 – Fee Disclosure2022-06-12T12:56:15-04:00

The Organization shall:

  1. Only bill for services rendered;
  2. Disclose applicable cost-sharing responsibilities, including when balance billing arrangements are made for out-of-network services; and
  3. Upon request, share its applicable fee schedule with current and prospective patients or legal guardians.
Standard 3.04 – Patient Payments2022-06-12T12:56:49-04:00

The Organization shall:

  1. Take reasonable steps to collect coinsurance, copays and deductibles for clinical services rendered;
  2. Not routinely waive, discount, or refuse to collect payment in violation of service contract terms or applicable regulations;
  3. Implement a process for patients to demonstrate and attest to financial hardship before waiving or discounting payments for clinical services; and
  4. Make reasonable attempts to return any overpayments with 60 days or sooner pursuant to insurance coverage documents and in compliance with applicable regulations.
Standard 3.05 – Service Authorizations2022-06-12T12:57:20-04:00

The Organization shall:

  1. Receive and document preauthorization from payers prior to starting services when applicable;
  2. Comply with reasonable concurrent and retrospective authorization requests from payers when applicable;
  3. Submit updated treatment plans in an accordance with internal policies or funder requirements to ensure continuity of care when seeking authorization for services;
  4. Make reasonable efforts to appeal adverse determinations that contradict recommendations from its qualified professionals; and
  5. Have a process in place to make patients or caregivers aware of their right to appeal and to provide a letter in support of the provider’s recommendations.
Standard 4.01 – Compliance Program2022-06-12T12:58:31-04:00

The Organization shall:

  1. Implement and maintain a compliance system to detect and prevent fraud, waste, and abuse;
  2. Comply with all applicable regulations related to its business and clinical operations;
  3. Respond swiftly when risks and noncompliance are detected, and develop preventative recommendations to share with its leadership; and
  4. Assign staff or hire consultants with the appropriate level of access, experience, and expertise to oversee its compliance programs.
Standard 4.02 – Privacy and Security2022-06-12T12:58:18-04:00

The Organization shall:

  1. Draft and maintain policies, procedures, and processes targeting privacy and security of patient PHI pursuant to all applicable regulations;
  2. Use HIPAA-compliant electronic communication and data storage system for securing patient PHI;
  3. Document that its Notice of Privacy Practices was shared with patients and honor the provisions included in compliance with applicable regulations; and
  4. Assign a Privacy and Security Officer with the appropriate level of access, experience, and expertise responsible for creating, training, and executing policies and procedures that protect the privacy and security of electronic PHI.
Standard 4.03 – Health and Safety2022-06-12T12:58:58-04:00

The Organization shall:

  1. Ensure the development and maintenance of an effective health and safety program;
  2. Investigate and respond to patient injuries, illness, and safety incidents in compliance with applicable regulations;
  3. Investigate and respond to workplace injuries, illness, and safety incidents in compliance with applicable regulations;
  4. Analyze its health and safety data, at least annually, to identify and respond to trends and recurring areas of concern, assess individual employee performance, and ascertain department-specific versus systemic issues; and
  5. Assign staff or hire consultants with appropriate level of access, experience, and expertise to oversee its health and safety program.
Standard 4.04 – Disaster, Crisis, and Emergency Management2022-06-12T12:59:28-04:00

The Organization shall:

  1. Implement disaster, crisis, and emergency management programs that incorporate applicable regulatory requirements;
  2. Conduct training on its disaster, crisis, and emergency management plans; and
  3. Assign staff or hire consultants with the appropriate level of access, experience, and expertise to execute its disaster, crisis, and emergency management plans.
Standard 5.01 – Provider Credentialing2022-06-12T13:00:01-04:00

The Organization shall:

  1. Maintain an active credentialing process for new hires and a recredentialing process for existing clinical providers;
  2. Identify and use credentialing criteria that include primary and secondary source verification;
  3. Complete the credentialing process for new clinical providers on a timely basis before they can see patients or sooner in accordance with applicable regulations and contractual requirements; and
  4. Re-credential existing clinical providers in accordance with applicable regulations.
Standard 5.02 – Clinical Leader2022-06-12T13:03:40-04:00

The Organization shall hire Clinical Leaders who:

  1. Oversee ABA services at each location and at the executive level;
  2. Only oversee and use empirically supported ABA clinical practices that fall within their scope of competence;
  3. Are assigned the following baseline responsibilities:
    1. Implement quality assurance programs,
    2. Oversee service development and delivery,
    3. Supervise and provide feedback to direct reports,
    4. Coordinate care including caregiver support services,
    5. Provide mentorship and staff development opportunities,
    6. Participate in development and research activities when available,
    7. Maintain and seek out credentials and training relevant to the position,
    8. Ensure regulatory compliance with policies and procedures, and
    9. Guide the development of policies and procedures to ensure alignment between clinical best practices and operational decisions; and
  4. At a minimum have a Licensed Behavior Analyst credential or equivalent graduate-level credential in good standing for a minimum of 3 years post-credential experience providing, supervising, or administering ABA services to patients with ASD.
Standard 5.03 – Behavior Analysts2022-06-12T13:05:40-04:00

The Organization shall hire Behavior Analysts who:

  1. Only oversee and use empirically supported ABA clinical practices that fall within their scope of competence;
  2. Are assigned the following baseline responsibilities:
    1. Summarize and analyze data,
    2. Evaluate and report patient progress towards treatment goals,
    3. Supervise implementation of treatment,
    4. Adjust treatment protocols based on data,
    5. Monitor treatment integrity,
    6. Train and consult with caregivers and other professionals,
    7. Ensure compliance with risk management and crisis management protocols,
    8. Ensure satisfactory implementation of treatment protocols,
    9. Develop and oversee transition/discharge plans,
    10. Document provision of services,
    11. Act in accordance with all applicable ethical codes of conduct, and
    12. Comply with applicable supervision standards, including documentation, when applicable; and
  3. At a minimum, have:
    1. A Licensed Behavior Analyst credential in good standing;
    2. An equivalent ABA graduate-level credential in good standing; or
    3. Appropriate qualifications to independently practice ABA as specified by applicable regulations.
Standard 5.04 – Assistant Behavior Analysts2022-06-12T13:07:25-04:00

The Organization shall hire Assistant Behavior Analysts who:

  1. Only oversee and use empirically supported ABA clinical practices that fall within their scope of competence;
  2. Are assigned the following baseline responsibilities under the supervision of a Behavior Analyst:
    1. Summarize and analyze data,
    2. Evaluate and report patient progress towards treatment goals,
    3. Supervise implementation of treatment,
    4. Adjust treatment protocols based on data,
    5. Monitor treatment integrity,
    6. Train and consult with caregivers and other professionals,
    7. Ensure compliance with risk management and crisis management protocols,
    8. Ensure satisfactory implementation of treatment protocols,
    9. Develop and oversee transition/discharge plans,
    10. Document provision of services,
    11. Act in accordance with all applicable ethical codes of conduct, and
    12. Comply with applicable supervision standards, including documentation, when applicable; and
  3. At a minimum, have one of the following:
    1. A Licensed Assistant Behavior Analyst credential in good standing;
    2. An equivalent ABA undergraduate-level credential in good standing; or
    3. Appropriate qualifications to practice ABA under the supervision of a Behavior Analyst as specified by applicable regulations.
Standard 5.05 – Behavior Technicians2022-06-12T13:08:34-04:00

The Organization shall hire Behavior Technicians who:

  1. Only use empirically supported ABA clinical practices that fall within their scope of competence;
  2. Are assigned the following baseline responsibilities under the supervision of a Behavior Analyst or Assistant Behavior Analyst:
    1. Measure patient progress towards treatment goals,
    2. Assist with assessment procedures,
    3. Implement skill acquisition programming,
    4. Implement behavior reduction programming,
    5. Document the provision of services,
    6. Comply with all applicable ethical codes of conduct, and
    7. Comply with applicable supervision standards, including documentation; and
  3. At minimum, have within 180 days of employment and before implementing protocols independently with patients at least one of the following:
    1. A Registered Behavior Technician®(RBT®) credential in good standing;
    2. An equivalent ABA paraprofessional credential in good standing; or
    3. Appropriate qualifications to assist in delivering ABA services under the direction and close supervision of a Behavior Analyst or Assistant Behavior Analyst as specified by applicable regulations and have completed 40 hours of training in ABA before successfully passing a competency assessment administered by a Behavior Analyst.
Standard 5.06 – Clinical Supervision and Direction2022-06-12T13:08:58-04:00

The Organization shall assign a clinical supervisor to all Assistant Behavior Analysts, Behavior Technicians, and trainees, with the qualifications, time, and expertise necessary to evaluate competency, monitor performance, train new skills, remediate skill deficits, and enhance services.

Standard 6.01 – Access to Care2022-06-12T13:09:29-04:00

The Organization shall:

  1. Provide clear and up to date communication regarding the timeline for accessing ABA services to prospective and current patients;
  2. Educate prospective and current patients about the importance of, and their right to, timely access to services, and offer referrals if appropriate alternatives are available;
  3. Adopt clinical practice guidelines that support equitable access to effective care and align with its scope of services, professional competencies, and available resources;
  4. Ensure a standardized and documented approach to maintaining and deploying clinical practice guidelines that promote evidenced-based care; and
  5. Review the adequacy of its clinical practice guidelines at least annually, when an identified need arises, or in response to regulatory requirements.
Standard 6.02 – Medical Necessity2022-06-12T13:09:56-04:00

The Organization shall:

  1. Document and determine medical necessity based on the clinical judgement of its treating providers, prevailing research, and generally accepted standards of care; and
  2. Have a system for reviewing health plan guidelines for medical necessity for informational purposes.
Standard 6.03 – Caseload Management2022-06-12T13:20:48-04:00

The Organization shall:

  1. Individually assign caseloads based on the unique needs of its patients and the expertise, time, and resources available to its clinical providers; and
  2. Individually determine the dosage or intensity (i.e., hours spent on) of caseload management by considering the unique and changing needs of each patient.
Standard 6.04 – Patient Intake2022-06-12T13:10:48-04:00

The Organization shall use a standard intake packet to collect and provide relevant information to its patients.

Standard 6.05 – Clinical Assessments2022-06-12T13:11:16-04:00

The Organization shall:

  1. Provide its clinical providers with secure access to conduct reviews of patient medical records at the outset of the assessment process;
  2. Administer individualized clinical assessments that are evidenced-based, developmentally appropriate, selected based on patient need, and inform patient treatment plans;
  3. Include reasonable safeguards to mitigate risk when assessing behaviors dangerous to the patient or others; and
  4. Interpret clinical assessment results using language that is understandable and meaningful to the audience.
Standard 6.06 – Treatment Planning2022-06-12T13:11:40-04:00

The Organization shall:

  1. Create individualized treatment plans informed by clinical assessment results;
  2. Select treatment goals aimed at remediating, rehabilitating, or ameliorating the symptoms and other negative effects of diagnosed conditions;
  3. Make reasonable efforts to include patients and caregivers in the selection and participation of medically necessary treatment goals; and
  4. Make periodic adjustments to patient treatment plans based on an ongoing assessment of progress toward treatment goals at least every six months.
Standard 6.07 – Service Settings2022-06-12T13:12:05-04:00

The Organization shall:

  1. Deliver services in settings that support progress towards treatment goals and objectives;
  2. Have a process for evaluating the health and safety of all settings where services are delivered;
  3. Assign oversight from qualified supervisors in every service setting; and
  4. Ensure its owned, rented, or leased physical location(s) where services are delivered are compliant with applicable regulations.
Standard 6.08 – Active Treatment2022-06-12T13:12:31-04:00

The Organization shall:

  1. Only offer ABA services that align with generally accepted professional standards;
  2. Deliver individualized ABA services that are informed by patient data and the goals outlined in the patient’s treatment plan;
  3. Regularly collect, graph, and analyze behavioral data to assess progress toward treatment goals;
  4. Monitor the integrity of its treatment protocols by training implementers and measuring fidelity; and
  5. Have a system to limit and monitor the use of high-risk procedures deemed to pose a significant risk to patients or providers.
Standard 6.09 – Coordination of Care2022-06-12T13:12:56-04:00

The Organization shall:

  1. Take reasonable steps to participate in coordination of care activities for the benefit of the patient;
  2. Recommend patients or legal guardians seek guidance from other qualified professionals when presented with a behavior or condition outside the scope of competence of its providers;
  3. Maintain a record of the patient’s primary healthcare provider and, as necessary for care coordination, other members of the patient’s health and education communities; and
  4. Assist in transitioning patients when possible.
Standard 6.10 – Treatment Utilization2022-06-12T13:13:22-04:00

The Organization shall:

  1. Utilize recommended treatment hours for each patient barring unforeseen complications or barriers outside its control;
  2. Regularly monitor utilization across service codes; and
  3. Have a system for identifying, addressing, and reporting under- or over-utilization of authorized hours.
Standard 6.11 – Telehealth2022-06-12T13:13:44-04:00

If applicable, the Organization shall:

  1. Implement telehealth virtual care protocols designed to mitigate risks and address barriers to care;
  2. Assess the adequacy and quality of telehealth as a service modality when applicable;
  3. Secure informed consent from patients or legal guardians prior to initiating telehealth services;
  4. Provide telehealth specific training to and oversight of its clinical providers;
  5. Have individualized telehealth safety plans and emergency response protocols; and
  6. Have a contingency plan for technology failures impacting access to services.
Standard 6.12 – Clinical Documentation2022-06-12T13:14:11-04:00

The Organization shall:

  1. Train its clinical providers and support staff on the key principles and workflows for proper documentation and maintenance of patient medical records;
  2. Adopt a standardized method for clinical documentation; and
  3. Periodically conduct internal audits across payers to ensure ongoing compliance with documentation policies, related payer protocols and regulatory requirements.
Standard 7.01 – Patient Rights and Responsibilities2022-06-12T13:14:40-04:00

The Organization shall promote patient rights and responsibilities that incorporate applicable regulatory requirements and ethical standards.

Standard 7.02 – Patient Handbook2022-06-12T13:15:16-04:00

The Organization shall publish, update, and share a Patient Handbook or patient packet with patients or caregivers.

Standard 7.03 – Patient Consent2022-06-12T13:15:51-04:00

The Organization shall secure written consent from patients or their legal guardians prior to initiating services or research, when there is a substantial change to treatment or the research plan, or when exchanging or releasing confidential information or records.

Standard 7.04 – Restraint and Seclusion Procedures2022-06-12T13:16:24-04:00

The Organization shall:

  1. Support the principle of least restrictiveness;
  2. Only use seclusion or restraint procedures to respond to behavior that poses imminent danger or serious harm to self or others after other non-restrictive interventions have failed and legal informed consent has been obtained;
  3. Only use systematic and manualized seclusion and restraint procedures implemented by formally trained staff after securing consent;
  4. Implement a system to approve and monitor the use of restraint and seclusion procedures; and
  5. Document, debrief, and communicate the use of restraint and seclusion procedures within 24 hours or sooner in compliance with applicable regulations.
Standard 8.01 – Patient and Caregiver Satisfaction2022-06-12T13:16:54-04:00

The Organization shall:

  1. Measure and review patient and caregiver satisfaction at least annually; and
  2. Use the feedback received to improve its operations.
Standard 8.02 – Quality Management2022-06-12T13:17:25-04:00

The Organization shall:

  1. Implement and maintain a quality assurance program engaged in ongoing measurement, review, and reporting of progress toward self-identified quality indicators across its business and clinical operations; and
  2. Assign staff or hire consultants with the appropriate level of access, experience, and expertise to oversee its quality assurance program.
Standard 8.03 – Clinical Outcomes2022-06-12T13:18:04-04:00

The Organization shall use evidence-based, developmentally appropriate assessments that align with its stated program goals to evaluate clinical outcomes for each patient at least every 6 months.

Standard 9.01 – Organizational Code of Ethics2022-06-12T13:18:33-04:00

The Organization shall document, train, and disseminate an organizational code of ethics.

Standard 9.02 – Complaints and Grievances2022-06-12T13:19:00-04:00

The Organization shall:

  1. Have a straightforward grievance reporting mechanism that strives to preserve the confidentiality of parties involved and does not result in retaliation;
  2. Have grievance policies and procedures that incorporate applicable regulations, including reporting to external oversight agencies when applicable; and
  3. Assign a staff or hire consultants with appropriate level of access, experience, and expertise to manage its complaints and grievances system for patients and staff.
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