411-046-0140 Behavior Support Services (1) Behavior Support Services assist individuals with behavioral challenges, due to their disability, in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks. (2) Behavior Support Services include consultation to the caregiver on mitigating behavior that may place the individual's health and safety at risk and to prevent institutionalization. (3) All referrals must be made by the individual’s case manager, on the Department's mandatory form, which is sent to the Behavior Support Service provider. (4) Behavior Support Service providers, their employees, or subcontractors acting as behavior consultants, must provide the following services to individuals they accept for services: (a) Review of Referral. (A) The Behavior Support Service consultant or provider must provide a documented decision regarding denial or acceptance of the referral within 2 business days. (B) Service activation dates that are more than 7 days past the referral acceptance date must be approved by the referring Case Manager. (C) Providers must ensure adequate numbers of behavior consultants are available to meet the service needs of all individuals accepted for service. (D) The following entities must be informed of accepted referrals by the case manager: (i) The individual or their legal representative; and (ii) The person in charge of the individual's Medicaid residential or home-based service plan. (b) Person-Centered Evaluations. (A) An initial person-centered evaluation shall be started within 5 business days of the service activation date. The evaluation may be updated at the discretion of the behavior consultant, based on information gathered from coaching activities. (B) Person-centered evaluation activities must support the Behavior Support Plan interventions, the scope of services provided, and include, at a minimum the content noted on the Department’s mandatory form. (C) The evaluation must be documented on the Department’s mandatory form and provided to the case manager upon request. (D) As part of the person-centered evaluation, the behavior consultant must conduct an activity evaluation. (c) Behavior Support Plan. (A) The Behavior Support Plan shall be documented on the Department’s mandatory form and completed within 20 business days of the initial person-centered evaluation or updated within 5 business days of any new evaluation activity. The plan must support the interventions and scope of the services provided. (B) The behavior consultant is responsible for developing a Behavior Support Plan that considers the resources available at the individual’s home. (C) All strategies in the Behavior Support Plan must align with the individual’s residential service or care plan and activity program required under licensing or Medicaid Program rules. (D) The Behavior Support Plan must be explained to the individual in a manner the individual can understand. (E) The plan must include: (i) An Activity Plan that is developed following an activity evaluation. The activity evaluation must examine, but is not limited to examining, the individuals: (I) Past and current interests; (II) Current abilities and skills as they relate to activities of daily living, instrumental activities of daily living, and health-related tasks; (III) Emotional and social needs and patterns; (IV) Physical abilities and limitations; (V) Adaptations necessary for the resident to participate in their activities of choice; (ii) A list of person-centered activities must be identified based on the evaluation and included as a distinct part of the Behavior Support Plan. The list must include structured and non-structured activities that meet the individual's current preferences. Activities include, but are not limited to: (I) Occupation or chore related tasks; (II) Scheduled and planned events (e.g. entertainment, outings); (III) Spontaneous activities for enjoyment or that may help diffuse a behavior; (IV) One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); (V) Spiritual, creative, and intellectual activities; (VI) Sensory stimulation activities; (VII) Physical activities that enhance or maintain a resident’s ability to ambulate or move; (VIII) Outdoor activities; and (IX) Night time activities. (F) Identification of strategies to help caregivers provide activities and address emergent behaviors. (G) Completed Behavior Support Plans, and any subsequent updates, must be reviewed with, and provided to, the people responsible for the individual’s residential or home-based service plan and provided to the case manager. (H) The behavior consultant must document a minimum of one review of the Behavior Support Plan with a designated caregiver on the Department’s mandatory form. (I) Behavior Support and Activity Plans must be modified based on feedback from coaching activities, to ensure caregiver participation and to evaluate the proposed strategies. (d) Coaching Caregivers. (A) The behavior consultant must develop a coaching plan describing how they will coach each caregiver to implement the Behavior Support Plan. The coaching plan may be included in the Behavior Support Plan. (B) The behavior consultant must schedule and initiate onsite coaching to the designated caregivers within 30 business days of service activation. (C) The behavior consultant should review information with the caregiver's employer and include, at a minimum the following content: (i) Review of the Behavior Support Plan; (ii) Discussion on how activities can be incorporated into the individual’s daily routine; (iii) Demonstration of desired interventions by the behavior consultant; (iv) Observation or role play by the caregiver on implementing portions of the Behavior Plan; and (v) Gathering of feedback from caregivers on how to modify the plan or activities. (vi) The review may be conducted as part of a coaching activity. (vii) The Behavior consultant will advise caregivers to contact primary the health care provider or long term care nurse, as a part of coaching, when it relates to an individual possibly experiencing a medical issue that may be impacting their behaviors, or if medication interaction may be a concern related to behaviors. (D) Documentation of all coaching activity, including dates and participants, must be provided on the Department’s mandatory form and, upon request, provided to the employers or supervisors of the designated caregivers who received coaching. (e) Monitoring. (A) The behavior consultant must provide at least two onsite monitoring visits to: (i) Conduct observations; (ii) Gather information; (iii) Evaluate caregiver and individual responses to the Behavior Support and the Activity Plans; and (iv) Carry out coaching activities. (B) After the Behavior Support Plan is completed and a minimum of two on-site coaching visits are conducted, monitoring can be provided by phone or through secure video conferencing, if all parties agree. (C) Documentation of all monitoring must be provided on the Department’s mandatory form. (f) Service Plan Coordination. (A) Completed Behavior Support Plans are considered part of the individual’s activity, service, or care plan required by the home and community-based care license or Medicaid Program. (i) Home and community-based care contractors must assign enough designated caregivers to ensure the interventions described in the Behavior Support Plan, including the Behavior Support Interventions, can be implemented in accordance with licensing or Medicaid Program standards. (ii) Home and community-based care contractors must identify charting protocols for the behavior consultant to document any onsite activity provided to the eligible individual or their caregiver. (iii) If the behavior consultant identifies any barriers that prevent the implementation of the Behavior Plan, they must notify the home and community-based care contractor within 2 business days. (iv) Home and community-based care contractors must report to case managers, within 5 business days, if the Behavior Support Plan cannot be implemented or if the behavior consultant is not utilizing input from caregivers or the service planning team. (B) Behavior consultants who are not providing services as part of a supplemental or specific needs setting contract may participate on the individual’s service planning team or mental health treatment team only to review the individual’s Behavior Support Plan. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 17-2014, f. & cert. ef. 6-23-14