Section 8. Safeguards Concerning Restraints, Restrictions And Seclusion

A. Seclusion and isolation is prohibited during waiver services. B. Use of restraints or restrictions is only permitted during the course of delivery of waiver services under strict limitations and oversight. (1) Certain specific interventions are considered ethically unacceptable for application and, as such, are unequivocally prohibited. Interventions that are prohibited include but are not limited to: (a) contingent electrical aversion procedures; (b) seclusion and isolation; (c) use of time out (for an adult); (d) use of mechanical or chemical restraints; (e) use of manual application of any physical restraint, except in emergent situations involving imminent risk of harm to self or others (personal restraints); (f) overcorrection; 8.314.5 NMAC 3 (g) forced physical guidance; (h) forced exercise; (i) withholding food, water, or sleep; (j) public or private humiliation; (k) privacy violations; (l) restricting exit from home with locks on windows or doors; (m) application of water mist; and (n) application of noxious taste, smell, or skin agents; etc. (2) Use of restrictive interventions must be documented in the individual’s positive behavior support plan or behavioral crisis intervention plan or risk management plan and must be reviewed by the human rights committee prior to implementation. (3) Chemical restraint is defined as the administration of medication at a dose or frequency to intentionally and exclusively preclude behavior without identifying an underlying anxiety, fear or severe emotional distress or other symptoms of psychiatric/emotional disturbance to be eased, managed or treated. The administration may be regularly scheduled or on a pro re nata (PRN), or “as needed” basis. The use of chemical restraints is prohibited. (4) The administration of PRN psychotropic medication is allowed when prescribed in advance by the prescribing professional. A PRN psychotropic medication plan is a collaborative document that outlines the behavioral indications for using the medication ated. The administration may be regularly scheduled or on a pro re nata (PRN), or “as needed” basis. The use of chemical restraints is prohibited. (4) The administration of PRN psychotropic medication is allowed when prescribed in advance by the prescribing professional. A PRN psychotropic medication plan is a collaborative document that outlines the behavioral indications for using the medication. A human rights committee must approve use of PRN psychotropic medication prior to its implementation and the procedures that DSP must use to gain approval for its implementation. (5) Mechanical restraints are defined as the use of a physical device to restrict the individual’s capacity for desired or intended movement including movement or normal function of a portion of their body. The use of mechanical restraints is prohibited. (6) Use of any emergency physical restraints must be written into a behavioral crisis intervention plan only and approved by a human rights committee prior to its use. Personal restraints (i.e. emergency physical restraints) are used as a last resort, only when other less intrusive alternatives have failed and under limited circumstances that include protecting an individual or others from imminent, serious physical harm, or to prevent or minimize any physical or emotional harm to the individual. Staff must be trained in both nonphysical and physical interventions. (7) Any individual for whom the use of emergency physical restraints or PRN psychotropic medications is allowed is required to have a positive behavioral supports assessment, positive behavior support plan, and a behavioral crisis intervention plan or PRN psychotropic medication plan completed by a behavior support consultant in conjunction with the individual’s agency nurse and interdisciplinary team Any individual for whom the use of emergency physical restraints or PRN psychotropic medications is allowed is required to have a positive behavioral supports assessment, positive behavior support plan, and a behavioral crisis intervention plan or PRN psychotropic medication plan completed by a behavior support consultant in conjunction with the individual’s agency nurse and interdisciplinary team. (8) Ethical, medical or behavioral concerns, use of live or recorded video monitoring/observational systems, and resolution of plans contested on the individual team or provider agency level in local human rights committees are heard and resolved in a statewide and state coordinated super human rights committee. [8.314.5.8 NMAC - N, 4/1/2022] 8.314.5.9 DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY-BASED SERVICES WAIVER: The New Mexico medical assistance division (MAD) has obtained a waiver from certain medicaid payment and benefit statutes (42 CFR 441.300) to provide home and community-based services (HCBS) to eligible recipients as an alternative to institutionalization. DDW services are intended to enhance, not replace, existing natural supports and other available community resources. Services will emphasize and promote the use of natural and generic supports to address the eligible recipient’s assessed needs in addition to paid supports. Provider agencies are required to ensure the settings in which they provide services meet the below requirements. All providers have a responsibility to monitor settings for compliance; monitor that waiver recipients are given choices; and, ensure rights are respected. DDW services must be provided in a setting that: A. is integrated in and facilitates full access to the greater community; B. ensures the individual receives services in the community to the same degree of access as individuals not receiving medicaid HCBS; C. maximizes independence in making life choices; D liance; monitor that waiver recipients are given choices; and, ensure rights are respected. DDW services must be provided in a setting that: A. is integrated in and facilitates full access to the greater community; B. ensures the individual receives services in the community to the same degree of access as individuals not receiving medicaid HCBS; C. maximizes independence in making life choices; D. is chosen by the individual (in consultation with the guardian if applicable) from among residential and day options, including non-disability specific settings; E. ensures the right to privacy, dignity, respect and freedom from coercion and restraint; 8.314.5 NMAC 4 F. supports health and safety based upon the individual’s needs, decisions or desires; G. optimizes individual initiative, autonomy and independence in making life choices; H. provides an opportunity to seek competitive employment; I. provides individuals an option to choose a private unit in a residential setting; and J. facilitates choice of services and who provides them.