Code of Colorado Regulations
2505 - Department of Health Care Policy and Financing
2505 - Medical Services Board (Volume 8; Medical Assistance, Children's Health Plan)
10 CCR 2505-10-8.600 - MEDICAL ASSISTANCE - SECTION 8.600 Case Management, Family Support, Laboratory and X-Ray
Section 10 CCR 2505-10-8.608 - SERVICE AND SUPPORT PLANNING, SUPPORTING PEOPLE WITH CHALLENGING BEHAVIOR, AND PROTECTIONS

Universal Citation: 2505 CO Code Regs 10 CCR 2505-10-8.608

Current through Register Vol. 47, No. 5, March 10, 2024

Pursuant to section 25.5-10-101, C.R.S., these rules establish requirements for planning and providing humane services and supports in humane physical environments. These rules are designed to assist and guide the provision of services and supports within the best practices known to the Department, encourage the maintenance and continued development of best practices within community centered boards, service agencies, and regional centers, and to protect persons from abuse, mistreatment, neglect, and exploitation.

All community centered boards, service agencies, and regional centers shall actively work to make available to each person with a developmental disability the full opportunity to be included in community life, make increasingly sophisticated and responsible choices, exert greater control over his or her life, establish and maintain relationships and a sense of belonging, develop and exercise their competencies and talents, and experience personal security and self respect.

These agencies shall also actively work to make available to each person the patterns and conditions of everyday life, which are consistent with those of persons without disabilities, including jobs and homes to the maximum extent possible. All services and supports offered will be appropriate to the chronological age of the person and shall take individual preferences into consideration.

8.608.1 SERVICE AND SUPPORT PLANNING AND DEVELOPMENT

A. Written Individual Service and Support Plans shall be developed by service agencies to address the prioritized needs for training (i.e., instruction, skill acquisition), habilitation and/or supports as developed by the interdisciplinary team in the Individualized Plan in such areas as personal, physical, mental and social development and to promote self-sufficiency and community inclusion.

1. Program approved service agencies providing comprehensive services shall develop Individual Service and Support Plans for all persons receiving services in accordance with the Individualized Plan.

2. Individual Service and Support Plans for support services shall be developed, as needed, to ensure that services and supports are provided consistently and reach the intended results, and as determined by the Interdisciplinary Team.

3. An Individual Service and Support Plan is not required for case management services, family support services, transportation services, or other such services as specified by the Department.

4. An Individual Service and Support Plan is required whenever a restrictive procedure is to be used. Any Individual Service and Support Plan including a restrictive procedure must meet the requirements outlined at section 8.608.2.

B. The purposes and content of the Individual Service and Support Plan document shall be to provide:

1. A written statement of the objective or result that the Individual Service and Support Plan is to accomplish;

2. A written explanation of the specific methodology, strategy or procedure that will be implemented;

3. A means for consistent implementation between the various service agencies providing services and supports provided for the person; and,

4. Criteria against which the effectiveness of the Individual Service and Support Plan shall be measured, the data to be collected, and timelines for reviews.

C. The development and implementation of the written Individual Service and Support Plan shall be the responsibility of the program approved service agency(ies) from which the person receives services or supports, and a copy shall be submitted to the community centered board or regional center. The person receiving service, guardian and/or authorized representative, as appropriate, shall be made aware that a copy of the Individual Service and Support Plan will be made available to them upon request. The CCB shall document the request in the Individualized Plan if asked to do so. If requested, the ISSP shall be provided within 30 days of the date given in the IP for it to be written.

D. The Individual Service and Support Plan and subsequent reviews shall be written and become part of the master record.

E. When a person needs assistance with challenging behavior, including a person whose behavior is dangerous to himself, herself or others, or engages in behavior which results in significant property destruction, the program approved service agency in conjunction with other members of the person's interdisciplinary team shall complete a comprehensive review of the person's life situation including:

1. The status of friendships, the degree to which the person has access to the community, and the person's satisfaction with his or her current job or housing situation;

2. The status of the family ties and involvement, the person's satisfaction with roommates or staff and other providers, and the person's level of freedom and opportunity to make and carry out decisions;

3. A review of the person's sense of belonging to any groups, organizations or programs for which they may have an interest, a review of the person's sense of personal security, and a review of the person's feeling of self-respect;

4. A review of other issues in the person's current life situation such as staff turnover, long travel times, relationship difficulties and immediate life crises, which may be negatively affecting the person;

5. A review of the person's medical situation which may be contributing to the challenging behavior; and,

6. A review of the person's Individualized Plan and any Individual Service and Support Plans to see if the services being provided are meeting the individual's needs and are addressing the challenging behavior using positive approaches.

F. If any aspects of this review suggests that the person's life situation could be or is adversely affecting his or her behavior, these circumstances shall be evaluated by the interdisciplinary team, and specific actions necessary to address those issues shall be included in the Individualized Plan and/or Individual Service and Support Plan, prior to the use of any restrictive procedures to manage the person's behavior.

G. Issues identified in this comprehensive review that cannot be addressed by the interdisciplinary team should be documented in the Individualized Plan or Individual Service and Support Plan, and the community centered board or regional center administration should be notified of these issues and the present or potential effect they will have on the person involved.

8.608.2 INDIVIDUAL SERVICE AND SUPPORT PLAN (ISSP) INCLUDING A RESTRICTIVE PROCEDURE

A. When restrictive procedures, as defined in section 8.600.4 , are recommended or used to change a person's challenging behavior, the following steps must be completed:

1. The program approved service agency in conjunction with other members of the person's interdisciplinary team shall complete a comprehensive review of the person's life situation;

2. The program approved service agency shall complete a functional analysis of the person's challenging behavior for review by the interdisciplinary team; and,

3. In conjunction with the interdisciplinary team, the program approved service agency shall prepare an Individual Service and Support Plan that explains the use of any restrictive procedure and includes, at a minimum:

a. A description of the behavior to be changed or improved, described when possible, in observable and measurable terms;

b. Baseline data which demonstrates why the behavior has been targeted for change;

c. A description of the specific methodology and procedures that will be used to implement the Individual Service and Support Plan;

d. Identification of the person(s) who will monitor the implementation of the Individual Service and Support Plan;

e. A description of the behavior to be developed, if necessary and appropriate;

f. Identification of the person(s) who will implement the Individual Service and Support Plan and assurance that they have demonstrated competency in its implementation;

g. Criteria which will measure the effectiveness of the Individual Service and Support Plan;

h. Data to be collected; and,

i. Specific timelines for review.

4. The person receiving services, parents of a minor, or legal guardian shall grant informed consent for the use of the Individual Service and Support Plan with a restrictive procedure prior to its implementation.

8.608.3 REQUIREMENTS WHEN USING RESTRAINT

A. Physical or mechanical restraint can only be used by employees or contractors trained in its use,

in an emergency situation, when alternatives have failed, and when necessary to protect the person from injury to self or others.

1. The individual shall be released from physical or mechanical restraint as soon as the emergency condition no longer exists.

2. Physical or mechanical restraint cannot be a part of an Individual Service and Support Plan and can only be used as an emergency or safety control procedure in accordance with these rules and regulations.

3. No physical or mechanical restraint of a person receiving services shall place excess pressure on the chest or back of that person or inhibit or impede the person's ability to breathe.

4. During physical restraint, the person's breathing and circulation shall be checked to ensure that these are not compromised.

5. Each community centered board, program approved service agency, and regional center shall have written policies and procedures on the use of physical restraint exceeding fifteen (15) minutes. Such policies and procedures shall allow for physical restraint exceeding fifteen (15) minutes only when absolutely necessary for safety reasons and shall provide for backup by appropriate professional and/or agency staff.

6. Relief periods of, at a minimum, ten (10) minutes every one (1) hour shall be provided to an individual in mechanical restraint, except when the individual is sleeping. A record of relief periods shall be maintained.

7. An individual placed in a mechanical restraint shall be monitored at least every fifteen (15) minutes by employees or contractors trained in the use of mechanical restraint to ensure that the individual's physical needs are met and the individual's circulation is not restricted or airway obstructed. A record of such monitoring shall be maintained.

B. Mechanical restraints used for medical purposes following a medical procedure or injury shall be authorized by a physician's order which shall be renewed every twenty-four (24) hours. Requirements of section 8.608.3.A applicable to mechanical restraint shall also apply.

C. Mechanical or physical restraints used for a diagnostic or other medical procedure conducted under the control of the agency (e.g., drawing blood by an agency nurse) shall be dually authorized by a licensed medical professional and agency administrator, and its use documented in the person's record.

8.608.4 REQUIREMENTS FOR EMERGENCY AND SAFETY CONTROL PROCEDURES

A. An Emergency Control Procedure is the unanticipated use of a restrictive procedure or restraint in order to keep the person receiving services and others safe.

1. Each Community Centered Board, program approved service agency, and regional center shall have written policies on the use of emergency control procedures, the types of procedures which may be used, and requirements for staff training.

2. Behaviors requiring emergency control procedures are those which are infrequent and unpredictable.

3. Emergency control procedures shall not be employed as punishment, for the convenience of staff, or as a substitute for services, supports or instruction.

4. Within twenty-four (24) hours after the use of an emergency control procedure, the responsible staff person shall file an incident report. The incident report shall meet all requirements of Section 8.608.6.B and shall also include:

a. A description of the emergency control procedure employed, including beginning and ending times;

b. An explanation of why the procedure was judged necessary; and,

c. An assessment of the likelihood that the behavior that prompted the use of the emergency control procedure will recur.

5. Within three (3) days after use of an emergency control procedure, the Community Centered Board, case management agency or regional center, parent of a minor, guardian, and authorized representative if within the scope of his or her duties, shall be notified.

B. Safety control procedures must be developed when it can be anticipated that there will be a need to use restrictive procedures or restraints to control a previously exhibited behavior which is likely to occur again. The use of safety control procedures shall comply with the following:

1. Each Community Centered Board, program approved service agency, and regional center shall have written policies on the use of safety control procedures, the types of procedures which may be used, and requirements for staff training;

2. When a safety control procedure is used, the service agency shall file an incident report within three (3) days with the Community Centered Board, case management agency or regional center which meets all requirements of Section 8.608.6.B and the conditions associated with each use of a safety control procedure; and,

3. If the safety control procedure is used more than three times within the previous thirty (30) days, the person's interdisciplinary team shall meet to review the situation and to endorse the current plans or to prepare other strategies.

8.608.5 HUMAN RIGHTS COMMITTEES (HRC)

A. Each community centered board and regional center shall establish at least one Human Rights Committee (HRC) as a third party mechanism to safeguard the rights of persons receiving services. The Human Rights Committee is an advisory and review body to the administration of the community centered board or regional center.

B. Such committee shall be constituted as required by section 25.5-10-209(2) h, C.R.S.

C. If a consultant to the community centered board, regional center, or service agency serves on the Human Rights Committee, procedures shall be developed by the community centered board or regional center and the Human Rights Committee related to potential conflicts of interest.

D. The community centered board and regional center shall orient members regarding the duties and responsibilities of the Human Rights Committee.

E. The community centered board and regional center shall provide the Human Rights Committee with the necessary staff support to facilitate its functions.

F. Each program approved service agency shall make referrals as required in rules and regulations for review by the Human Rights Committee(s) in the manner required by the community centered board or regional center.

G. The recommendations of the Human Rights Committee shall become a part of the community centered board's, service agency's or regional center's record as well as a part of the individual's master record.

H. The Human Rights Committee shall develop operating procedures which include, but are not limited to, Human Rights Committee responsibilities for the committee's organization, the review process, and provisions for recording dissenting opinions of committee members in the committee's recommendations.

I. The Human Rights Committee shall establish and implement operating and review procedures to determine that the practices of the community centered board, service agencies and regional centers are in compliance with section 25.5-10, C.R.S., are consistent with the mission, goals and policies of the Department, community centered board or regional center, and ensure that:

1. Informed consent is obtained when required from the person receiving services, the parent of a minor, or the guardian as appropriate;

2. Suspension of rights of persons receiving services occurs only within procedural safeguards as stipulated in section 8.604.3 and that continued suspension of such rights is reviewed by the interdisciplinary team at a frequency decided by the team, but not less than every six months;

3. Emergency control procedures, safety control procedures and Individual Service and Support Plans with restrictive procedures are used in accordance with the requirements of these rules;

4. The use of psychotropic medications and other medications used for the purpose of modifying a person's behavior by persons receiving comprehensive services and supports are used in accordance with the requirements of section 8.609.6.D.7 and 8, and are monitored by the Human Rights Committee on a regular basis; and,

5. Allegations of mistreatment, abuse, neglect and exploitation are investigated and the investigation report reviewed.

8.608.6 INCIDENT REPORTING

A. Community centered boards, service agencies and regional centers shall have a written policy and procedure for the timely reporting, recording and reviewing of incidents which shall include, but not be limited to:

1. Injury to a person receiving services;

2. Lost or missing persons receiving services;

3. Medical emergencies involving persons receiving services;

4. Hospitalization of persons receiving services;

5. Death of person receiving services;

6. Errors in medication administration;

7. Incidents or reports of actions by persons receiving services that are unusual and require review;

8. Allegations of abuse, mistreatment, neglect, or exploitation;

9. Use of safety control procedures;

10. Use of emergency control procedures; and,

11. Stolen personal property belonging to a person receiving services.

B. Reports of incidents shall include, but not be limited to:

1. Name of the person reporting;

2. Name of the person receiving services who was involved in the incident;

3. Name of persons involved or witnessing the incident;

4. Type of incident;

5. Description of the incident;

6. Date and place of occurrence;

7. Duration of the incident;

8. Description of the action taken;

9. Whether the incident was observed directly or reported to the agency;

10. Names of persons notified;

11. Follow-up action taken or where to find documentation of further follow-up; and,

12. Name of the person responsible for follow-up.

C. Allegations of abuse, mistreatment neglect and exploitation, and injuries which require emergency medical treatment or result in hospitalization or death shall be reported immediately to the agency administrator or designee, and to the community centered board within 24 hours.

D. Reports of incidents shall be-placed in the record of the person.

E. Records of incidents shall be made available to the community centered board, and the Department upon request.

F. Community centered boards, program approved service agencies and regional centers shall review and analyze information from incident reports to identify trends and problematic practices which may be occurring in specific services and shall take appropriate corrective action to address problematic practices identified.

G. Community centered boards must follow all critical incident reporting requirements outlined at Section 8.519.16.

8.608.7 RESEARCH

A. Any experimental research performed by or under the supervision of the community centered board, service agency or regional center shall be governed by policies/procedures which shall:

1. Require adherence to ethical and design standards in the conduct of research;

2. Require review by the Human Rights Committee;

3. Address the adequacy of the research design;

4. Address the qualifications of the individuals responsible for coordinating the project;

5. Address the benefits of the research in general;

6. Address the benefits and risks to the participants;

7. Address the benefits to the agency;

8. Address the possible disruptive effects of the project on agency operations;

9. Require obtaining informed consent from participants, their guardians or the parents of a minor. Such consent may be given only after consultation with:

a. The interdisciplinary team; and,

b. A developmental disabilities professional not affiliated with the service agency from which the person receives services; and

10. Require procedures for dealing with any potentially harmful effects that may occur in the course of the research activities.

B. No person shall be subjected to experimental research or hazardous treatment procedures if the person implicitly or expressly objects to such procedures or such procedures are prohibited.

8.608.8 ABUSE, MISTREATMENT, NEGLECT, AND EXPLOITATION

A. Pursuant to Section 25.5-10-221, C.R.S., all Community Centered Boards, case management agencies, service agencies and regional centers shall prohibit abuse, mistreatment, neglect, or exploitation of any person receiving services.

B. Community Centered Boards, case management agencies, program approved service agencies and regional centers shall have written policies and procedures for handling cases of alleged or suspected abuse, mistreatment, neglect, or exploitation of any person receiving services. These policies and procedures must be consistent with state law and:

1. Definitions of abuse, mistreatment, neglect, or exploitation must be consistent with state law and these rules;

2. Provide a mechanism for monitoring to detect instances of abuse, mistreatment, neglect, or exploitation. Monitoring is to include, at a minimum, the review of:

a. Incident reports;

b. Verbal and written reports of unusual or dramatic changes in behavior(s) of persons receiving services; and,

c. Verbal and written reports from persons receiving services, advocates, families, guardians, and friends of persons receiving services.

3. Provide procedures for reporting, reviewing, and investigating all allegations of abuse, mistreatment, neglect, or exploitation;

4. Ensure that appropriate disciplinary actions up to and including termination, and appropriate legal recourse are taken against employees and contractors who have engaged in abuse, mistreatment, neglect, or exploitation;

5. Ensure that employees and contractors are made aware of applicable state law and agency policies and procedures related to abuse, mistreatment, neglect or exploitation;

6. Require immediate reporting when observed by employees and contractors according to agency policy and procedures and to the agency administrator or his/her designee;

7. Require reporting of allegations within 24 hours to the parent of a minor, guardian, authorized representative, and Community Centered Board or regional center;

8. Ensure prompt action to protect the safety of the person receiving services. Such action may include any action that would protect the person(s) receiving services if determined necessary and appropriate by the service agency or Community Centered Board pending the outcome of the investigation. Actions may include, but are not limited to, removing the person from his/her residential and/or day services setting and removing or replacing staff;

9. Provide necessary victim supports;

10. Require prompt reporting of the allegation to appropriate authorities in accordance with statutory requirements and pursuant to Section 8.608.8.C;

11. Ensure Human Rights Committee review of all allegations; and,

12. Ensure that no individual is coerced, intimidated, threatened or retaliated against because the individual, in good faith, makes a report of suspected abuse, mistreatment, neglect or exploitation or assists or participates in any manner in an investigation of such allegations in accordance with Section 8.608.8.D.

C. Any and all actual or suspected incidents of abuse, mistreatment, neglect, or exploitation shall be reported immediately to the agency administrator or designee. The agency shall ensure that employees and contractors obligated by statute, including but not limited to, Section 19-3-304, C.R.S., (Colorado Children's Code), Section 18-6.5-108, C.R.S., (Colorado Criminal Code - Duty To Report A Crime), and Section 26-3.1-102, C.R.S., (Human Services Code - Protective Services), to report suspected abuse, mistreatment, neglect, or exploitation, are aware of the obligation and reporting procedures.

D. All alleged incidents of abuse, mistreatment, neglect, or exploitation shall be thoroughly investigated in a timely manner using the specified investigation procedures. However, such procedures must not be used in lieu of investigations required by law or which may result from action initiated pursuant to Section C, above.

1. Within 24 hours of becoming aware of the incident, a critical incident report shall be made available to the agency administrator or designee and the Community Centered Board or regional center.

2. The agency shall maintain a written administrative record of all such investigations including:

a. The incident report and preliminary results of the investigation;

b. A summary of the investigative procedures utilized;

c. The full investigative finding(s);

d. The actions taken; and,

e. Human Rights Committee review of the investigative report and the action taken on recommendations made by the committee.

3. The agency shall ensure that appropriate actions are taken when an allegation against an employee or contractor is substantiated, and that the results of the investigation are recorded, with the employee's or contractor's knowledge, in the employee's personnel or contractor's file.

Disclaimer: These regulations may not be the most recent version. Colorado may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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