37.40.1420    HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SERVICE PLANS

(1) A service plan is a written plan of supports and interventions based on an assessment of the status and needs of a consumer. The service plan describes the needs of the consumer and the services available through the program and otherwise that are to be made available to the consumer in order to maintain the consumer at home and in the community.

(2) The services that a consumer may receive through the program and the amount, scope, and duration of those services must be specifically authorized in writing through an individual service plan.

(3) The service plan is initially developed upon the person's entry into the program. The plan must be reviewed and, if necessary, revised at intervals of at least six months beginning with the date of the initial service plan.

(4) The service plan is developed in conjunction with the consumer or the consumer's legal representative, with treating and other appropriate health care professionals and others who have knowledge of the consumer's needs.

(5) Each service plan must include the following:

(a) diagnosis, symptoms, complaints, and complications indicating the need for services;

(b) a description of the consumer's functional level;

(c) consumer's goals and objectives;

(d) medication;

(e) treatments;

(f) restorative and rehabilitative services;

(g) activities;

(h) therapies;

(i) social services;

(j) diet;

(k) other special procedures recommended for the health and safety of the consumer to meet the objectives of the service plan;

(l) the specific services to be provided, the frequency of the services, and the type of provider to provide them;

(m) the projected annualized costs of each service; and

(n) names and signatures of all persons who have participated in developing the service plan (including the consumer, unless the consumer's inability to participate is documented) which will verify participation, agreement with the service plan, and acknowledgement of the confidential nature of the information presented and discussed.

(6) The consumer must be provided a copy of the service plan to the consumer.

(7) Service plan approval is based on:

(a) completeness of plan;

(b) consistency of plan with screening criteria; and

(c) feasibility of service provision, including cost-effectiveness of plan as provided for in ARM 37.40.1421.

History: 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA; IMP, 53-2-201, 53-6-101, 53-6-402, MCA; NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.