Section 197-5-7 - PROCEDURES FOR REVIEW AND APPROVAL OF POSTIVE SUPPORT PLANS AND BEHAVIOR MANAGEMENT PLANS5.07-1Review Levels and Review TeamsA. There are three different review tiers for Positive Support Plans and Behavior Management Plans, based on the level of restriction proposed. Planning Teams are responsible for obtaining the designated level of approval prior to implementation of any plan. 1. The Planning Team, the Person or Guardian, and Case Manager must review and approve all plans before they are implemented or sent for further review.2. A Review Team is responsible for review and disposition of all Behavior Management Plans at Level 3 or above.3. The Statewide Review Panel is responsible for review of all Behavior Management Plans at Level 5, prior to review by the Commissioner or designee.B. Review Teams must be maintained as governed by a memorandum of understanding between the Department, the Protection and Advocacy Agency and the Maine Developmental Services Oversight and Advisory Board. Each team shall be composed of: 1. A representative from the Department;2. A representative from the Protection and Advocacy Agency; and3. A representative designated by the Maine Developmental Services Oversight and Advisory Board; andC. A Statewide Review Panel shall be designated and governed by a memorandum of understanding between the Department, the Protection and Advocacy Agency and the Maine Developmental Services Oversight and Advisory Board.5.07-2Review ProceduresA.Review Requirements1. Positive Support Plans at Levels 1 and 2 may be implemented with Planning Team, including Case Manager approval.2. Each proposed plan must be reviewed at the appropriate level corresponding to the most intrusive proposed restriction of Rights or the use of Restraint before it can be implemented.3. At each level of review, the requirements for the preceding level of review must have been met and approval obtained.4. Any member of the Planning Team may request review or involvement by an Advocate. The Advocate must be notified when a Planning Team is considering a Behavior Management Plan at Level 3 or above.5. Plans requiring approval at Level 3 and above must have the approval and signature of the Case Manager and Case Management Supervisor.B.Review Team Practices Behavior Management Plans at Level 3 and above require consideration by the Review Team. The voting members of the Review Team are the representatives from the Department and the Maine Developmental Services Oversight and Advisory Board. The Protection and Advocacy representative is a participating non-voting member of the Review Team. The Review Team's role is to ensure compliance with and raise concerns related to, the applicable statutes and regulations.
1. The approval of the Behavior Management Plan at Level 3 and above requires both voting members to vote in favor of the Behavior Management Plan or the Behavior Management Plan with conditions.2. The Review Team may require additional information prior to approval of any plan.3. The voting members of the Review Team have the discretion to determine duration of Behavior Management Plan approval to a maximum of one year. If less than one year, the duration of Behavior Management Plan approval must be indicated in writing.4. The voting members of the Review Team may elect to approve part of a plan, or provide time-limited or conditional approval based on written conditions to be met as defined by the voting members of the Review Team.5. If either voting member of the Review Team does not approve all or part of a Behavior Management Plan, the voting members of the Review Team must specify the reasons for disapproval in writing.6. The Case Manager or Case Management Supervisor must participate in the review process.7. After initial approval of a Behavior Management Plan, the Review Team may refer cases for continued monitoring to the Planning Team, the Case Manager and the case management supervisor. The Review Team must review for approval each Behavior Management Plan at least once a year.8. The Review Team may, at its discretion, refer any Behavior Management Plan for review by the Statewide Review Panel. The Review Team should consider a referral in cases where resources are an issue in meeting the Person's support needs without the use of Behavior Management.9. No Behavior Management Plan component requiring approval at Level 3 or above shall be implemented without appropriate approval as provided by these regulations.10. Each Review Team must establish a process for review and disposition of Behavior Management Plans requested for emergencies. The Review Team may grant written provisional approval of all or part of an emergency Behavior Management Plan. Provisional approval must be agreed upon by the representative of the Department and Maine Developmental Services Oversight and Advisory Board and must not exceed sixty (60) days. After sixty (60) days the Planning Team must meet all regular requirements for review and disposition of the Behavior Management Plan.C.ExceptionsBehavior Management Plans requiring approval at Level 5 are rare exceptions and must meet a higher standard of review and approval. Level 5 Behavior Management Plans must have been approved by the Review Team and reviewed by the Statewide Review Panel before being submitted to the Commissioner for disposition.
1. Prior to submitting a Behavior Management Plan for initial approval at Level 5, the Planning Team is required to seek a second opinion from a licensed psychologist or psychiatrist. At the discretion of the Review Team a second opinion may be requested before any annual review. a. That clinician shall meet with the Person and the Person's support staff and confer with the Person's family if they are involved, and the Guardian, if there is one, and Correspondent, if one has been appointed.b. The clinician must provide a written opinion of the potential risks and benefits of the proposed program.c. If the clinician providing the second opinion concurs in the need for the program, the Statewide Review Panel will review the plan and make recommendations to the Commissioner.2. If the Commissioner approves the Behavior Management Plan, the Review Team will assume responsibility for monitoring the Behavior Management Plan.3. Level 5 Behavior Management Plans must comply with the foregoing review and approval requirements.5.07-3Data Collection and MonitoringA. The Department shall be responsible for collecting and tracking data regarding Behavior Management Plans in each region as directed within the memorandum of understanding governing the statewide Review Teams.B. The Statewide Review Panel will be responsible for monitoring for quality and consistency. 1. The Statewide Review Panel will examine all new Behavior Management Plans at Level 4 for quality assurance purposes, including concerns regarding the review process, inconsistencies or quality of Behavior Management Plans.2. The Statewide Review Panel may request data regarding Behavior Management Plans. The team may also request a random sample of Behavior Management Plans for a quality review.3. The Statewide Review Panel shall review and advise the Department regarding interventions that may put consumers at risk and assure that applicable policies, regulations and laws are being followed.4. The Statewide Review Panel will provide an annual report to the Commissioner regarding all active and approved Level 5 Behavior Plans.14- 197 C.M.R. ch. 5, § 7