CMS SOM App. J, Tag W262

inappropriate behavior and other programs that, in the opinion of the committee, involve

risks to client protection and rights;

Guidance §483.440(f)(3)(i)

Any program that utilizes restrictive or intrusive techniques must be reviewed and approved by

the specially constituted committee prior to implementation. This includes, but is not limited

to:

• restraints;

• drugs to manage behavior;

• restrictions on community access;

• contingent denial of any right; or

• restrictions of materials or locations in the home.

The committee should ensure that consequences within a written behavior management

program do not violate the client’s rights.

There is no requirement for the committee to evaluate whether the proposed program is

consistent with current practices in the field. Documentation should verify that the specially

constituted committee considered factors, such as whether less intrusive methods have been

attempted, whether the severity of behavior outweighs the risks of the proposed program and

whether replacement behaviors are included within the plan.

Any revision to a behavior plan that increases the level of intrusiveness must be re-reviewed by

the specially constituted committee. The committee need not reapprove a program when

revisions are made in accordance with the approved plan. For example, if the physician changes

the dosage of a medication in accordance with the drug treatment component of the active

treatment plan to which the legally authorized person has given consent and which has already

been approved by the committee, then there is no need for the committee or the legally

authorized person to reapprove the plan. Generally, this would also apply if the medication was

changed to another within the same therapeutic class or family.