R414-502-6. Criteria for Behaviorally Complex Program

For the Department to authorize Medicaid coverage for the Behaviorally Complex Program, a nursing facility must: (1) demonstrate that the resident has a history of persistent disruptive behavior that is not easily altered and requires an increase in resources from nursing facility staff as documented by one or more of the following behaviors: (a) the resident engages in wandering behavior with no rational purpose, is oblivious to self needs or safety, and places self and others at significant risk of physical illness or injury; (b) the resident engages in verbally abusive behavior where the resident threatens, screams, or curses at others; (c) the resident presents a threat of hitting, shoving, scratching, or sexually abusing other residents; or (d) the resident engages in socially inappropriate and disruptive behavior by doing of one of the following: (i) makes disruptive sounds, noises, and screams; (ii) engages in self-abusive acts; (iii) engages in inappropriate sexual behavior; (iv) disrobes in public; (v) smears or throws food or feces; (vi) hoards; and (vii) rummages through others belongings. (e) the resident refuses assistance with medication administration or activities of daily living; or (f) the resident's behavior interferes significantly with the stability of the living environment and interferes with other residents' ability to participate in activities or engage in social interactions; and (2) demonstrate that an appropriate behavioral intervention program has been developed for the resident as follows: (a) behavior intervention programs shall: (b) plan the systematic application of methods and experimental findings of behavioral science with the intent to reduce observable negative behaviors; (c) incorporate processes and methodologies that are the least restrictive alternatives available for producing the desired outcomes; (d) be conducted following identification and, if feasible, remediation of environmental and social factors that likely precipitate or reinforce the inappropriate behavior; (e) incorporate a process for identifying and reinforcing a desirable replacement behavior; (f) include a program data sheet; and (g) include a behavior baseline profile that consists of the following: (i) include the applicant name; (ii) include the date, time, location, and specific description of the undesirable behavior; (iii) include persons and conditions present before and at the time of the undesirable behavior; (iv) demonstrate interventions for the undesirable behavior and their results; and (v) provide recommendations for future action; and (h) the interdisciplinary team shall include a behavior intervention plan that consists of the following: (i) the applicant's name, the date the plan is prepared, and when the plan will be used; (ii) the objectives stated in terms of specific behaviors; (iii) the names, titles, and signatures of persons responsible for conducting the plan; and (iv) the methods and frequency of data collection and review.