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How does a state comply with the service planning assurance?

For service planning a state must have policies related to:

  • The qualifications of those who develop and monitor service plans.

  • Who should be involved in the service planning process.

  • The frequency and method (e.g. phone or in-person) for monitoring service plans.

  • Methods for preventing conflicts of interest that can occur when the same entity is responsible for both service planning and service delivery.(click here for more information about preventing conflicts of interest)

A state monitors whether service plans are developed and implemented in accordance with established policies and procedures. For example:

  • Assessments are comprehensive and accurately reflect participant needs.

  • Service plans address the assessed needs, goals, preferences, and health and safety risk factors of participants.

  • Service plans include the type, amount, scope and frequency of services.

  • Services are delivered in accordance with and only after the service plan is authorized.

  • Service plans are updated at regular intervals or when needs change.

  • Back-up plans are developed and responsible parties understand their roles in emergencies.

  • Participants are informed of available services and are provided choice of services.

  • Frequency of the case manager contact with a participant (either by phone or in person).

A state uses many methods to monitor how well service planning and monitoring are working, including:

  • Review of case management agency records.

  • Review of a sample of participant records.

  • Review of provider bills.

  • Interviews and surveys of participants, family members, caregivers and other direct care providers.

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