HCBS Modification DecisionMaking Tree for Sections 21 29

HCBS Modification Decision-Making Tree for Sections 21 & 29 Maine Department of Health and Human Services Office of Aging and Disability January 2021

HCBS Modifications Include Any of the Following: • Use of restraints • Use of restrictive measures • Restriction on access to food at any time • Restriction on having visitors at any time • Restriction on freedom to control and choose daily schedule and activities • Restrictions on having key or other way to independently open locked doors in residential setting at any time • Restriction on choice of housemate if sharing living unit and/or roommate if sharing bedroom in residential setting • Restriction on choice to share bedroom in residential setting • Restriction on freedom to furnish and decorate living unit and bedroom in residential setting START HERE Sections 21 -29 PROCESS STEP #1 If none, the Modification cannot be implemented. What Category of HCBS Modification is Being Considered By the PCP Team? What is the Specific Modification that is Needed? What is the health and/or safety reason(s) for the Modification? Why is the Specific Modification Needed? What Else Has Been Tried But Has Not Worked? How do we know these health and/or safety issues exist for the person? What are the less restrictive and less intrusive strategies that have already been tried but were unsuccessful?

HCBS Modifications Include Any of the Following: • Use of restraints • Use of restrictive measures • Restriction on access to food at any time • Restriction on having visitors at any time • Restriction on freedom to control and choose daily schedule and activities • Restrictions on having key or other way to independently open locked doors in residential setting at any time • Restriction on choice of housemate if sharing living unit and/or roommate if sharing bedroom in residential setting • Restriction on choice to share bedroom in residential setting • Restriction on freedom to furnish and decorate living unit and bedroom in residential setting Sections 21 -29 PROCESS STEP #2 Section 21 or 29 Enrollee Person is Own Guardian Legal Guardian

HCBS Modifications Include Any of the Following: • Use of restraints • Use of restrictive measures • Restriction on access to food at any time • Restriction on having visitors at any time • Restriction on freedom to control and choose daily schedule and activities • Restrictions on having key or other way to independently open locked doors in residential setting at any time • Restriction on choice of housemate if sharing living unit and/or roommate if sharing bedroom in residential setting • Restriction on choice to share bedroom in residential setting • Restriction on freedom to furnish and decorate living unit and bedroom in residential setting Sections 21 -29 PROCESS STEP #3 No Legal Guardian Appointed Person is Own Guardian Does Justification of Need for HCBS Modification Include Challenging Behavior? YES NO Does Person Consent to HCBS Modification? YES NO Use Positive Support Plan to Incorporate HCBS Modification into PCP Neither Behavior Management Plan nor HCBS Modification Can be Included in PCP and Implement by Providers(s) HCBS Modification Can be Included in PCP and Can be Implemented by Providers(s) HCBS Modification Cannot be Included in PCP and Cannot be Implemented by Provider(s) IMPORTANT: Implementing an HCBS Modification does not eliminate obligation to use Safety Device Plan if required under 14 -197 CMR ch. 5

HCBS Modifications Include Any of the Following: • Use of restraints • Use of restrictive measures • Restriction on access to food at any time • Restriction on having visitors at any time • Restriction on freedom to control and choose daily schedule and activities • Restrictions on having key or other way to independently open locked doors in residential setting at any time • Restriction on choice of housemate if sharing living unit and/or roommate if sharing bedroom in residential setting • Restriction on choice to share bedroom in residential setting • Restriction on freedom to furnish and decorate living unit and bedroom in residential setting Sections 21 -29 PROCESS STEP #3: Legal Guardian Appointed Person Has Legal Guardian Does Justification of Need for HCBS Modification Include Challenging Behavior? YES NO Does Person Consent to HCBS Modification? Does Legal Guardian Consent to HCBS Modification? YES Use Positive Support Plan to Incorporate HCBS Modification into PCP NO YES NO Does Legal Guardian Consent to HCBS Modification? HCBS Modification Can be Included in PCP and Can be Implemented by Provider(s) HCBS Modification Cannot be Included in PCP and Cannot be Implemented by Provider(s) YES NO Use Behavior Management Plan to Incorporate HCBS Modification into PCP HCBS Modification Cannot be Included in PCP and Cannot be Implemented by Provider(s) IMPORTANT: Implementing an HCBS Modification does not eliminate obligation to use Safety Device Plan if required under 14 -197 CMR ch. 5

Sections 21 -29 PROCESS STEP #4 IMPORTANT: Implementing an HCBS Modification does not eliminate obligation to use Safety Device Plan if required under 14 -197 CMR ch. 5 Document Modification in PCP Challenging Behavior IS Part of Justification for Modification Challenging Behavior IS NOT part of Justification for Modification Based on Outcome of Process Step #3, Incorporate Positive Support Plan or Behavior Management Plan by Reference into PCP and Attach to PCP Based on Outcome of Process Step #3, if Modification Can Be Included in PCP, Complete PCP HCBS Modification Addendum and Attach to PCP PSP or BMP must include a plan that: (1) identifies the ongoing process for evaluating the effectiveness of the modification; and (2) identifies timeframes ensuring the modification must be periodically reviewed and reevaluated. PSP or BMP must include steps being taken to remove or reduce modification as soon as feasible. PSP or BMP must include evidence of informed consent is documented. Addendum must include a plan that: (1) identifies the ongoing process for evaluating the effectiveness of the modification; and (2) identifies timeframes ensuring the modification must be periodically reviewed and reevaluated. Addendum must include steps being taken to remove or reduce modification as soon as feasible. Addendum must include evidence of informed consent is documented.