What this Looks like in Practice:

• Everyone, including people who receive waiver services, has the right to make choices, even when those choices might result in poor outcomes. Providers and Support Coordinators maximize an individual’s ability to make choices while working to minimize the risk to the person or others.
• Any modification of the rights specified in the HCBS rule is supported by a specific assessed need that clearly and adequately explains why the modification is needed.
• Any modification of the rights specified in the HCBS rule is documented in the person-centered plan, including all of the following:
  • Positive interventions and supports used prior to any modifications to the service delivery plan
  • Less intrusive methods of meeting the need that have been tried but did not work
  • Regular collection and review of data to measure the ongoing effectiveness of the modification
  • Established time limits for periodic reviews to determine if the modification is still necessary or can be terminated
  • An assurance that interventions and supports will cause no harm to the person
  • Informed consent. The person’s informed consent is obtained prior to a necessary modification, and the setting does not implement a modification without such consent.
• The setting ensures all modifications are implemented in the least restrictive manner necessary to protect the person and provides support to reduce or eliminate the need for the modification in the most integrated setting and inclusive manner.
• Modifications are reviewed regularly and reduced or ended as soon as possible.
• The provider has and follows clear policies and procedures that outline how and when to pursue approval for a modification.
• The provider maintains an open line of communication with the person about modifications (and guardian, when applicable.)