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I.  Individual Plan (IP)

The PROVIDER shall assure IPs for all PARTICIPANTS are developed and written based on the POC, incorporating verbal and written information received from the PARTICIPANT, the DOH case manager, other agencies, the PARTICIPANT’S family, or the PARTICIPANT’S legal or designated representative for the following services:

1.

Personal Assistance

2.

Habilitation

3.

Adult Day Health

4.

Habilitation-Supported Employment

5.

Respite

6.

Skilled Nursing

7.

Specialized Services

1.The IP:

a.

Shall be developed and shall be approved by a qualified supervisor as defined

in the SCOPE OF SERVICES and STANDARDS;

b.Shall include the PARTICIPANT, the DOH case manager, and members of the PARTICIPANT’S circle of supports in its development, and shall be approved by the PARTICIPANT and/or legal guardian;

c.Shall be developed, written and implemented within seven (7) calendar days

of the service start date;

d.

Shall describe functional, and measurable person-centered goals, outcomes,

and interventions with time frames for achievement or completion, as applicable;

e.Shall detail the specific methods or approaches to be implemented, including

behavioral supports, to achieve the desired objective or outcome, as applicable;

f.Shall meet the requirements as specified in the SCOPE OF SERVICES and

STANDARDS of each DD/MR Medicaid Waiver Program service;

g.

Shall be written in terms easily understood by the PARTICIPANT, the primary

care giver, and direct support worker.

h.

The POC shall service as an interim IP for one (1) week following the service

start date.

2.The PROVIDER shall assure that:

a.

Direct support workers required to implement the IP are adequately and

appropriately trained;

b.

The training to be conducted prior to the implementation of the IP;

c.

The training be documented;

d.

The PARTICIPANT or the PARTICIPANT’S legal or designated

representative, and the DOH case manager receive copies of the IP within seven (7) calendar days of its initiation and subsequent revisions; and

e.The distribution of copies of the IP shall be documented.

Page 33 of 43

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