Timeline for Services If the IEP team agrees that services are appropriate, the goals and services will be listed on an Addendum to the IEP including the service code number 535 for behavioral intervention services and/or supervision, the class number for each service, provider code for the NPA (400), projected start date, duration, and frequency. The Addendum should be forwarded to the Program Manager for Resolution Support Services at the SELPA. Within five business days of receipt of the Addendum to the IEP, the Program Manager for Resolution Support Services at the SELPA will develop an ISA and forward it to the appropriate NPA for signature who will then initiate services. Behavioral Intervention Supports Only Pre-Referral Local Education Agency (LEA) Responsibility 1. Convene an Individualized Education Program (IEP) meeting to document the team’s decision to refer the student for behavioral intervention supports. 2. Complete the Authorization for Use and/or Disclosure of Information form (D/M 63) and obtain the parent/guardian signature. Specify the receiving agency’s name, if known. If not, leave the field blank. Referral Procedures Forward the following completed documents to the attention of the Program Manager for Resolution Support Services at the SELPA. • Cover letter requesting the addition of Nonpublic Agency (NPA) behavioral intervention supports and the name of the selected NPA • D/M 63 Authorization for Use and/or Disclosure of Information form • IEP or IEP Addendum dated within one year referring the student for behavioral intervention supports that includes the NPA on the service line with a start date • Psycho-educational evaluation dated within three years of the referral for behavioral intervention supports • Other assessments (private evaluations) • Behavior plans (original and revised versions) • Incident reports • Discipline reports/log
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
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