1. (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:

   1. (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;
   2. (b) the resident engages in verbally abusive behavior where the resident threatens, screams, or curses at others;
   3. (c) the resident presents a threat of hitting, shoving, scratching, or sexually abusing other residents; or

   4. (d) the resident engages in socially inappropriate and disruptive behavior by doing of one of the following:

      1. (i) makes disruptive sounds, noises, and screams;
      2. (ii) engages in self-abusive acts;
      3. (iii) engages in inappropriate sexual behavior;
      4. (iv) disrobes in public;
      5. (v) smears or throws food or feces;
      6. (vi) hoards; and
      7. (vii) rummages through others belongings.
   5. (e) the resident refuses assistance with medication administration or activities of daily living; or
   6. (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. (2) demonstrate that an appropriate behavioral intervention program has been developed for the resident as follows:

   1. (a) behavior intervention programs shall:
   2. (b) plan the systematic application of methods and experimental findings of behavioral science with the intent to reduce observable negative behaviors;
   3. (c) incorporate processes and methodologies that are the least restrictive alternatives available for producing the desired outcomes;
   4. (d) be conducted following identification and, if feasible, remediation of environmental and social factors that likely precipitate or reinforce the inappropriate behavior;
   5. (e) incorporate a process for identifying and reinforcing a desirable replacement behavior;
   6. (f) include a program data sheet; and

   7. (g) include a behavior baseline profile that consists of the following:

      1. (i) include the applicant name;
      2. (ii) include the date, time, location, and specific description of the undesirable behavior;
      3. (iii) include persons and conditions present before and at the time of the undesirable behavior;
      4. (iv) demonstrate interventions for the undesirable behavior and their results; and
      5. (v) provide recommendations for future action; and

   8. (h) the interdisciplinary team shall include a behavior intervention plan that consists of the following:

      1. (i) the applicant's name, the date the plan is prepared, and when the plan will be used;
      2. (ii) the objectives stated in terms of specific behaviors;
      3. (iii) the names, titles, and signatures of persons responsible for conducting the plan; and
      4. (iv) the methods and frequency of data collection and review.

For the Department to authorize Medicaid coverage for the Behaviorally Complex Program, a nursing facility must:

KEY: Medicaid

Date of Last Change: July 28, 2025

Notice of Continuation: May 29, 2024

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108