Utah Admin. Code 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.

Notes

Utah Admin. Code R414-502-6

Amended by Utah State Bulletin Number 2023-22, effective 10/30/2023