Current through September 24, 2024
A. Behavioral
Supervised Living is not a separate service than Supervised Living Services but
allows an increased reimbursement rate for persons enrolled in ID/DD Waiver
with significant behavioral issues. Additional eligibility requirements for
persons who receive this level of support and requirements for Supervised
Living Services settings to receive the increased reimbursement rate are
outlined in this section. Rule
30.1 Supervised Living Services for
people with intellectual/developmental disabilities service components and Rule
30.4 Environment and Safety for
Supervised Living Services for people with intellectual/developmental
disabilities applies to Behavioral Supervised Living.
B. Behavioral Supervised Living provides a
level of service intended to support people with high frequency disruptive
behaviors that pose serious health and safety concerns to self or others,
including destructive behaviors that may or will result in physical harm or
injury to self or others. To receive Behavioral Supervised Living, there must
be a documented history of the behavior(s) listed below that is likely to
re-occur without supervision and structure in the person's living arrangement.
Behavioral Supervised Living must receive prior approval by the DMH Bureau of
Intellectual/Developmental Disabilities and Specialized Needs
Committee.
C. In order to provide
Behavioral Supervised Living, a provider must first be approved to do so by the
Bureau of Intellectual/Developmental Disabilities (BIDD). The following must be
submitted through the Division of Certification:
1. Documentation and procedures to ensure the
required team members are available to perform required duties. Refer to Rule
11.4.C.
2. Documentation and procedures for how the
team will address requirements for each Behavioral Supervised Living
site.
3. Documentation and
procedures describing that all staff in each approved home have the required
training.
4. Documentation and
procedures describing how trained staff coverage for the home, dependent upon
the needs of the person/people receiving Behavioral Supervised Living and
others who may be living in the home, will be provided.
D. Documentation supporting that the person
requires the level of support offered in Behavioral Supervised Living is
gathered by the Supervised Living Services provider and Support Coordinator or
Transition Coordinator and submitted to the DMH Specialized Needs Committee for
eligibility determination.
E.
Eligibility Criteria for each person include a documented history of
behavior(s) listed below that is likely to reoccur without supervision and
structure in the person's living arrangement:
1. Acts as a person who may have or have
caused great emotional harm to self or others;
2. Inability of a person to control behaviors
to the extent it impedes his/her day-to-day functioning at home, in a community
living arrangement and/or at a day service;
3. The person engages in self-injurious
behaviors that cause him/her to harm him/herself because of both internal and
external stimuli; and,
4.
One-to-one (1:1) staffing hours are necessary to ensure the health and safety
of the person and/or others.
F. The Behavior Supervised Living provider
must consider compatibility with other person(s) living in the home. The person
receiving a higher level of support must not pose a threat to others living in
the home.
G. Behavioral Supervised
Living Personnel Training
1. All employees who
have any direct contact with the person must be MANDT © certified or hold
another nationally recognized certification approved by DMH. The certification
must be obtained before the employee can begin working with the
person.
2. All employees working
with the person must receive timely person-specific training before the person
moves into the home. If a person is already living in the supervised living
arrangement, the Behavior Consultant and/or Behavior Interventionist will
train/re-train employees once the Behavior Support Plan is developed.
3. Documentation of Employee Training
(a) Documentation of MANDT © or other
nationally recognized training must be in the personnel record.
(b) Documentation of person-specific training
must be signed and dated by the employees receiving the training as well as the
person providing the training. For
people moving from an institution, employees that have been
serving the person may provide the training.
4. Documentation Requirements for Behavioral
Supervised Living
(a) The Behavior Consultant
must begin the Functional Behavioral Assessment (FBA) upon notification from
the Support Coordinator that Behavioral Supervised Living has been approved for
the person. The Functional Behavioral Assessment must be completed within
fifteen (15) days of the notification of approval for the person to begin
Behavioral Supervised Living. The Behavior Support Plan must be completed
within fifteen (15) days of the completion of the Functional Behavioral
Assessment. A Ph.D. Psychologist or Licensed Behavior Analyst must review and
approve the Functional Behavior Assessment and Behavior Support Plan.
(b) Service Notes must reflect the person's
and the employee's activities throughout the day, with at least one (1) entry
every two (2) hours while the person is awake and in the home. Overnight
entries can be every four (4) hours. Service Notes must also reflect when and
the amount of time a person receives one-to-one (1:1) staffing.
(c) Data must be collected as directed by the
Behavior Consultant.
(d) There must
be quarterly review reports that reflect the supports provided and the amount
of progress made during each quarter. Based on data gathered during each
quarter, the Behavior Consultant composes a report that reflects target
behavior(s), medication changes, information about Behavior Support Plan
implementation, and narrative information about baseline data, data from the
previous quarterly review report, and narrative information about the current
quarter's data.
(e) The quarterly
review report must include the next steps to be taken in implementation of the
Behavior Support Plan. Next steps could include actions such as continuing with
the Behavior Support Plan as it is written or modifying it to meet any changing
needs. Modifications can be made to the intervention, intervention techniques,
target behaviors, training needs, timelines, etc.
(f) A Ph.D. Psychologist or Licensed Behavior
Analyst must be available for consultation when adjustments to the Behavior
Support Plan are needed.
H. Provider responsibilities for services
provided away from the Behavioral Supervised Living Home
1. The agency provider must be prepared to
send employees with the person to his/her day activities in order to ensure
continuity for the person. The Behavior Consultant and/or Interventionist must
train employees wherever the person is during the day how to manage behavior(s)
that are identified in the Behavior Support Plan. This is true even if the
agency provider of Day Services is different than the agency provider of
Behavioral Supervised Living. As long as the person is in Behavioral Supervised
Living, it is the responsibility of the agency provider to ensure the Behavior
Support Plan is implemented where the person goes during the day. This can be
done by the Behavior Consultant/Interventionist or direct care personnel,
depending on the situation.
2.
Once employees have been trained and the identified behavior(s) begin to
mitigate, the Behavioral Supervised Living personnel can be faded. However, the
situation must be monitored. If changes in the person's behavior(s) occur,
Behavioral Supervised Living personnel must return to the setting where the
behaviors are occurring and either retrain employees or revise the Behavior
Support Plan.
I. Ongoing
Review of Need for Behavioral Supervised Living
1. The DMH Specialized Needs Committee will
determine the need for ongoing Behavioral Supervised Living at least
annually.
2. The following
documentation must be submitted to the person's Support Coordinator within
ninety (90) days of the end of a person's certification period. The Support
Coordinator will submit the documentation to the DMH Specialized Needs
Committee within five (5) days of receipt of all required documentation. All
documentation must be received by the Support Coordinator at one (1) time;
partial submissions of required information will not be accepted.
(a) Service Notes (previous three [3]
months)
(b) Serious Incident
reports (previous six [6] months)
(c) Behavior reports (previous six [6]
months)
(d) Functional Behavior
Assessment (for 1st annual review)
(e) Behavior Support Plan (for
1st annual review)
(f) Quarterly Review reports (previous two
[2] quarters)
(g) Documentation of
employee training MANDT& copy; or other approved training certificates for
all employees and as well as person-specific training
J. Use of Other Behavior Services
1. People who receive Behavioral Supervised
Living cannot also receive Behavior Support or Crisis Intervention Services.
The goal is for the agency provider's Behavioral Supervised Living Team to be
able to resolve/mitigate issues/behaviors where the person lives/receives day
services. Alternate living arrangements may be used for short-term
purposes.
2. If the issue is
determined to be a medication issue which requires Medical Intervention, Crisis
Support may be considered. There must be adequate supporting documentation, and
it must be approved by the Bureau of Intellectual/Developmental
Disabilities.
3. Crisis Support
should be the last resort.
Section
41-4-7
of the Mississippi Code, 1972, as Amended
