2100, Service Coordination Responsibilities

Revision 10-0; Effective June 1, 2010

2110 Service Coordination Assignment

Revision 22-2; Effective May 1, 2022

The Local Intellectual and Developmental Disability Authority (LIDDA) must assign a service coordinator (SC) to each enrolling Home and Community-based Services (HCS) applicant and HCS participant.

The LIDDA must notify the HCS participant (individual), legally authorized representative (LAR) and the HCS provider of the name and contact information of the assigned SC at time of assignment and as changes occur using Form 8583, Contact Information. The LIDDA is required to have a backup system for absences of the assigned SC that designates a staff person as the contact during the time the SC is unavailable.

The LIDDA enters the SC assignment into the HHSC data system and updates the assignment in the HHSC data system when the SC assignment is changed.

2120 Person-Directed Plan Development

Revision 22-2; Effective May 1, 2022

The SC uses person-directed planning to gather information for the Person-Directed Plan (PDP). Person-directed planning is a process that empowers the individual or the LAR, on the individual's behalf, to direct the development of a plan of supports and services that meets the individual's personal outcomes (preferences and needs). Section 3000, Person-Directed Plan, of the Local Intellectual and Developmental Disability Authority (LIDDA) Handbook instructs the SC on PDP. The PDP process:

  • identifies supports and services necessary to achieve the individual's desired outcomes;
  • identifies existing supports, including natural supports and other supports, available to the individual and negotiates needed services system supports; 
  • occurs with the support of a group of people chosen by the individual and the LAR on the individual's behalf (for example, a provider representative, neighbor or friend); and 
  • accommodates the individual's style of interaction and preferences regarding time and setting.

In addition to understanding person-directed planning, the SC must be familiar with the HCS Program Billing Requirements to facilitate the gathering of outcome information necessary for justifying the type of supports and services to be provided through the HCS Program.

Procedure for Completing Form 8665, Person-Directed Plan

The SC assists the individual and the LAR to designate members of the individual's service planning team (SPT). The required members of the SPT are the individual, LAR and the SC. Any other members are identified by the individual and the LAR and may include a provider representative, a teacher, a friend or a neighbor.

The SC conducts interviews with the individual, LAR, advocate, provider staff and others, as appropriate, who can provide information about the individual's desired outcomes and needs. The interviews are conducted using the probes in the PDP Discovery Tool (Appendix IV) to guide the information-gathering interviews.

The results of the information-gathering interviews identify the individual's preferences and needs, including the individual's desire to use the Consumer Directed Services (CDS) option. The preferences and needs form the basis for the individual's desired outcomes. The desired outcomes are included in the individual's PDP. The PDP must identify which desired outcomes will be met through HCS services and which will be met through non-HCS services. The SPT is responsible for documenting that the HCS services and non-HCS services on the PDP:

  • are necessary for the individual to continue living in the community; 
  • ensure the individual's health and safety; and
  • prevent the need for institutional services.

To document that HCS service components are justified*, the SC must determine that the:

  • type of each service component in the PDP is appropriate to meet a desired outcome or need of the individual; and
  • HCS service components do not replace existing supports, natural supports or other sources for the service (such as the Texas Workforce Commission for funding of supported employment services).

* Note: The SC is responsible for justifying the need for each HCS service type in the PDP and the HCS program provider is responsible for justifying the amount of each HCS service type in the Implementation Plan (IP).

The required minimum service coordination face-to-face contact for an HCS participant is every 90 days, but individual situations may necessitate more frequent contact. The PDP Discovery Tool, used by the SC for PDP development, assists the SC in determining frequency of contact for service coordination activities. 

Additional guidance and information about person-directed planning can be found in Section 3000 of the LIDDA Handbook and Person Directed Planning Guidelines (PDF).

2130 Enrollment Activities

Revision 22-2; Effective May 1, 2022

Refer to Section 13000, Medicaid Program Enrollment Requirements, of the LIDDA Handbook for requirements related to enrollment activities.

2140 Service Coordination Monitoring

Revision 22-2; Effective May 1, 2022

The SC must conduct and document monitoring activities, including:

  • determining whether the individual has made progress toward the outcomes identified on the PDP;
  • determining whether HCS service(s) are being delivered by the HCS provider or CDS provider, as appropriate;
  • determining whether non-HCS services (such as Texas Health Steps-funded nursing services) are being delivered;
  • ensuring coordination and compatibility of HCS and non-HCS services with the HCS provider; and
  • determining whether the individual's health or safety is at risk in the environments where the individual receives HCS and non-HCS services and, if necessary, taking action to protect the individual's health and safety. Action may include addressing the risk with the HCS provider or notifying the appropriate authorities.

If, as a result of monitoring, the SC identifies a concern with an individual's progress toward outcomes in the PDP, the delivery of HCS services, or the individual's health and safety, the SC must communicate such concern to the provider via a mechanism determined by the LIDDA and HCS provider. The SC and the provider are responsible for resolving any identified concern. If the concern cannot be resolved, the SC may report the concern to IDD Ombudsman at Texas Health and Human Services Commission (HHSC).

The SC maintains the following for an individual for an Individual Plan of Care (IPC) year:

  • a copy of the IPC (Form 3608);
  • the PDP (Form 8665);
  • a copy of Form 8578, Intellectual Disability/Related Condition Assessment;
  • documentation of the activities performed by the SC in providing service coordination; and
  • any pertinent information related to the individual and the services provided to the individual.

Suggestions for Monitoring

The SC is responsible for monitoring progress or lack of progress toward desired outcomes in the PDP and determining whether the HCS services on the IPC are being delivered. The documentation of progress or lack of progress toward desired outcomes should include references to all outcomes on the PDP. If the SC contact frequency is more often than quarterly, each desired outcome should be referenced at least once in the quarter. The SC may review information about utilized services in the HHSC data system, against the individual's IPC to help determine if HCS services are being delivered.

As a result of ongoing monitoring, the SC revises the PDP, as appropriate, as the individual's preferences and needs change. The SC uses the PDP and the Discovery Tool (Appendix IV) as guides to determine the individual's progress toward outcomes identified in the PDP, whether HCS Program services are being delivered and whether outcomes in the PDP need to be updated.

  • The SC conducts interviews with the individual, LAR, family and provider staff with a focus on the individual and the outcomes in the PDP. The SC should determine if the outcomes in the PDP are being achieved or have been accomplished. The SC should also focus on whether the outcomes previously identified in the PDP are still relevant or need to change.
  • For an individual who does not communicate with words, the SC will need to focus on the individual's actions by spending time observing the individual in different settings and developing a rapport with the individual. In some case, the SC may depend more on interviews with people who know the individual well to make decisions regarding whether the individual is making progress toward the desired outcomes.
  • The SC may access the individual's record maintained by the HCS provider, but this should usually be done to clarify information that was obtained through interviews and observations of the individual.

The SC does not monitor the HCS provider's Implementation Plan.

2150 Service Coordinator Role

Revision 10-0; Effective June 1, 2010

2151 Individual Plan of Care Renewal

Revision 22-2; Effective May 1, 2022

At least 60 but no more than 90 calendar days before an individual's IPC expires, the SC is responsible for notifying the service planning team of the need to review and update the individual’s PDP.

The SC should provide the LAR at least a 21-day notice that the PDP needs to be reviewed.

The SPT must review the PDP to determine if the information is accurate and reflects the individual’s current preferences and needs. The SC updates the PDP using instructions and forms provided by HHSC to indicate the necessary changes to the PDP. The SC must send the HCS provider a copy of the updated PDP within 10 calendar days after the PDP is updated.

At least 30 but no more than 60 calendar days before the expiration of the IPC, the SPT and the HCS provider must review the PDP and develop the renewal IPC, including the HCS Program services and Community First Choice (CFC), completion of the CDS portion of the renewal IPC, if applicable, and the non-HCS services.

The HCS provider is responsible for developing an Implementation Plan for the HCS services identified in the PDP and renewal IPC that will be delivered by the provider. The Implementation Plan must provide information that justifies the amount of each HCS service component on the renewal IPC.

The HCS provider is required to sign and date the renewal IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the renewal IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered in the HHSC data system.

The HCS provider is responsible for entering the renewal IPC data into the HHSC data system. The HCS provider keeps the original renewal IPC in the individual's record. If the SC is not physically present when the renewal IPC is developed, the provider is responsible for sending the SC a paper copy of the IPC within three calendar days after the HCS provider completes data entry into the HHSC data system.

Within seven calendar days after the HCS provider enters the renewal IPC into the HHSC data system, the SC must review the renewal IPC in the HHSC data system. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in the HHSC data system, enter their name and date, and indicate whether they agree or disagree with the renewal IPC. The foundation of the SC's agreement or disagreement is:

  • whether the renewal IPC is based on the PDP;
  • if the IPC specifies the type and amount of each service component to be provided to the individual, as well as services and supports to be provided by other non-HCS sources during the IPC year; and
  • whether the type and amount of each service component is supported by:
    • documentation that other non-HCS sources for the service component are unavailable and the service component does not replace existing supports, natural supports or other sources for the service;
    • assessments of the individual that identify specific service components necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and
    • documentation of deliberations and conclusions of the SPT that the service components are based on the desired outcomes in the PDP and are necessary for the individual to live in the community, to ensure health and welfare in the community, and to prevent the need for institutional services.

If the SC disagrees with the renewal IPC, the SC must notify HHSC and the HCS provider using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2152 Individual Plan of Care Revision

Revision 22-2; Effective May 1, 2022

The SC or the HCS provider may initiate a revision to the IPC to add a new HCS service or increase the amount of an existing service. A revision to the IPC must be done prior to the delivery of a new service or increased service amount, except in an emergency as described in Section 2153, Role of Service Coordinator Related to Emergency Provisions of Home and Community-based Services and Individual Plan of Care Revision.

  • Whoever determines the IPC needs to be revised (the SC or the HCS provider) must notify the other. Within 14 days after notification, the SC and the HCS provider must work together to revise the IPC.
  • The SPT and the HCS provider must develop a proposed revised IPC to address the issue that caused the SC or HCS provider to determine the individual's IPC needed to be revised.
  • The HCS provider must develop an Implementation Plan for the HCS services identified in the proposed revised IPC. The Implementation Plan must provide information that justifies the amount of each HCS service component on the revised IPC.
  • The SPT must revise the PDP if the existing PDP does not support the service type on the revised IPC. If the PDP is not revised, the SC must document the reason for the IPC revision in a contact note.
  • The HCS provider is required to sign and date the revised IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the revised IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered into the HHSC data system.
  • The HCS provider is responsible for entering the revised IPC data into the HHSC data system. The HCS provider keeps the original revised IPC in the individual's record. If the SC is not physically present when the IPC is developed, the provider is responsible for sending the SC a paper copy of the proposed revised IPC within three calendar days after the HCS provider completes data entry into the HHSC data system.
  • Within seven calendar days after the HCS provider enters the revised IPC data into the HHSC data system, the SC must review the IPC in the HHSC data system. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in the HHSC data system, enter their name and date, and indicate whether they agree or disagree with the revised IPC. The foundation of the SC's agreement or disagreement is:
    • whether the IPC is based on the PDP;
    • if the IPC specifies the type and amount of each service component to be provided to the individual, as well as services and supports to be provided by other non-HCS sources during the IPC year; and
    • whether the type and amount of each service component is supported by:
      • documentation that other non-HCS sources for the service component are unavailable and the service component does not replace existing supports, natural supports or other sources for the service;
      • assessments of the individual that identify specific service components necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and
      • documentation of deliberations and conclusions of the SPT that the service components are based on the desired outcomes in the PDP and are necessary for the individual to live in the community, to ensure health and welfare in the community, and to prevent the need for institutional services.

If the SC disagrees with the revised IPC, the SC must notify HHSC and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2153 Emergency Provision of Home and Community-based Services and Individual Plan of Care Revision

Revision 22-2; Effective May 1, 2022

If an emergency necessitates the provision of an HCS service to ensure the individual's health and welfare, and the service is not on the IPC or exceeds the amount on the IPC, the HCS provider may provide the service before revising the IPC. Within one business day after providing the service the HCS provider is responsible for:

  • documenting the circumstances that necessitated providing the new HCS service or the increase in the amount of the existing HCS service, including the type and amount of the service provided; and
  • notifying the SC of the emergency provision of the service and that the IPC must be revised. (The SC may request a copy of the documentation required in the bullet above.)

Within seven calendar days after providing the service, the SC and the HCS provider must work together to revise the IPC.

  • The SPT and the HCS provider must develop a proposed revised IPC to address the emergency.
  • The HCS provider must develop an Implementation Plan for the HCS services identified in the proposed revised IPC. The implementation plan must provide information that justifies the amount of each HCS service component on the revised IPC.
  • The SPT must revise the PDP, if the existing PDP does not support the revised IPC.
  • The HCS provider is required to sign and date the revised IPC and ensure that the IPC is signed and dated by the individual and LAR. If the SC is physically present when the revised IPC is developed, the SC signs the IPC and obtains a copy of the IPC. The SC is not required to sign the IPC before it is entered into the HHSC data system. 
  • The HCS provider is responsible for entering the revised IPC data into the HHSC data system. The HCS provider keeps the original revised IPC in the individual's record. If the SC is not physically present when the IPC is developed, the provider is responsible for sending the SC a paper copy of the proposed revised IPC within three calendar days after the HCS provider completes data entry into the HHSC data system. 
  • Within seven calendar days after the HCS provider enters the revised IPC data into the HHSC data system, the SC must review the IPC in the HHSC data system. The SC can send the IPC back to the HCS provider to correct obvious typographical errors on the IPC; however, the SC must notify the HCS provider of such. If the SC sends the IPC back for an error correction, the seven calendar-day time frame begins again once the HCS provider re-transmits the IPC. The SC must review the IPC in the HHSC data system, enter their name and date, and indicate whether they agree or disagree with the revised IPC. The foundation of the SC's agreement or disagreement is: 
    • whether the IPC is based on the PDP;
    • if the IPC specifies the type and amount of each service component to be provided to the individual, as well as services and supports to be provided by other non-HCS sources during the IPC year; and
    • whether the type and amount of each service component is supported by:
      • documentation that other non-HCS sources for the service component are unavailable and the service component does not replace existing supports, natural supports or other sources for the service;
      • assessments of the individual that identify specific service components necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and
      • documentation of deliberations and conclusions of the SPT that the service components are based on the desired outcomes in the PDP and are necessary for the individual to live in the community, to ensure health and welfare in the community, and to prevent the need for institutional services.

If the SC disagrees with the revised IPC, the SC must notify HHSC and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2154 Level of Care/Level of Need Renewal and Lapsed LOC/LON

Revision 22-2; Effective May 1, 2022

The HCS provider is responsible for ensuring an individual's level of care/level of need (LOC/LON) is current by electronically transmitting to HHSC Form 8578, Intellectual Disability/Related Condition Assessment, at least annually. If the HCS provider fails to transmit the ID/RC assessment before the LOC/LON expires, the HCS provider must transmit an ID/RC assessment for renewal and transmit an ID/RC assessment for the time period between the LOC/LON expiration date and the date the renewal became effective. This is the "lapsed" time period.

Within three calendar days after an HCS provider transmits an ID/RC assessment, either for renewal or lapsed, the HCS provider is responsible for providing the SC with a paper copy of the signed and dated assessment.

Within seven calendar days after an HCS provider transmits an ID/RC assessment, either for renewal or lapsed, the SC is responsible for:

  • reviewing the ID/RC assessment in the HHSC data system and the paper copy (Form 8578) provided by the HCS provider; and
  • entering in the HHSC data system their name and date and indicating whether they agree or disagree with the ID/RC assessment.

If the SC disagrees with the ID/RC assessment, the SC must notify HHSC and the HCS provider by using Form 8579, Notification of Service Coordinator (SC) Disagreement. See form instructions. The SC must also notify the individual/LAR.

2155 Home and Community-based Services Program Suspension

Revision 22-2; Effective May 1, 2022

An individual's HCS program services are suspended if the individual is temporarily admitted into one of the following settings:

  • hospital;
  • intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID);
  • nursing facility;
  • residential child care operation licensed or subject to being licensed by HHSC; 
  • facility licensed or subject to being licensed by DSHS; 
  • facility operated by the Texas Workforce Commission; or 
  • residential facility operated by the Texas Juvenile Justice Department, a jail or a prison. 

If the SC becomes aware that an individual's HCS services should be suspended, the SC must notify the HCS provider of the need to suspend the individual's HCS services. The SC must ensure the HCS provider enters the suspension data in the HHSC data system.

If the HCS provider becomes aware that an individual's HCS services should be suspended, the HCS provider is responsible for suspending the individual's HCS services and notifying the SC that the HCS provider has suspended the individual's HCS services. The SC must ensure the HCS provider enters the suspension data in the HHSC data system.

The SC reviews the suspension at least every 90 days following the effective date of the suspension by reviewing the individual's status and documenting in the individual's record the reasons for the continuing suspension.

To continue an individual's suspension past 270 days, the SC submits a completed Form 3615, Request to Continue Suspension of Waiver Program Services, requesting that the individual's suspension continue and includes documentation of the SC's periodic reviews.

For additional information about suspensions, refer to Section 9000, Suspensions.

2156 Termination of Home and Community-based Services

Revision 22-2; Effective May 1, 2022

Involuntary Termination of HCS Services

If the SC determines that a situation may lead to the termination of the individual's HCS services, the SC must discuss the situation with the individual and LAR and attempt to resolve the situation.

If the SC determines that an individual's HCS services should be terminated, the SC documents a description of the:

  • situation that resulted in the SC's determination that services should be terminated; and
  • attempts by the SC to resolve the situation.

The SC submits a written request to involuntarily terminate the individual's HCS services to HHSC using Form 3616, Request for Termination of Services Provided by HCS/TxHmL Waiver Provider, in accordance with Section 10000, Terminations.

Voluntary Termination of HCS Services

If an individual or LAR requests termination of all HCS program services, then within 10 calendar days of the request, the SC must inform the individual or LAR of:

  • the individual's option to transfer to another HCS provider;
  • the consequences of terminating HCS services; and
  • possible service resources upon termination.

The SC submits a written request to HHSC voluntarily terminating the individual's HCS services using Form 3616 in accordance with Section 10000.

For additional information about terminations, refer to Section 10000 Terminations.

2157 Transfers

Revision 22-2; Effective May 1, 2022

The SC is responsible for managing the following types of transfers in accordance with Section 8000, Transfers and Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments:

  • HCS provider to HCS provider 
  • HCS provider to Financial Management Services Agency (FMSA) 
  • FMSA to HCS provider 
  • FMSA to FMSA 

For an individual or LAR who has requested a transfer, the SC must inform the individual and LAR that the:

  • SC is responsible for managing all transfer processes for the individual; and 
  • individual or LAR may choose any available HCS provider (a program provider whose enrollment has not reached its service capacity) or FMSA. 

If the individual or LAR has not selected another HCS provider or FMSA, the SC must provide the individual or LAR a list of available HCS providers or FMSAs and contact information in the geographic locations preferred by the individual or LAR.

The SC may not influence the individual or LAR selection of an HCS provider or FMSA, but may assist the individual or LAR in identifying important aspects in an HCS provider or FMSA and considering those aspects in the selection of a provider or FMSA.

For additional information about transfers, refer to Section 8000.

2158 Consumer Directed Services

Revision 22-2; Effective May 1, 2022

The SC's role is described in Section 13000, Consumer Directed Services.

2160 Additional Service Coordinator Responsibilities

Revision 22-2; Effective May 1, 2022

Communication of Rights and Complaint Process

The service coordinator (SC) must assist an individual or legally authorized representative (LAR) in exercising the legal rights of the individual as a citizen and as a person with a disability.

The HCS rules require the SC to provide an individual, LAR or family member with a copy of the rights of the individual as described in §9.173(b), as well as a booklet entitled Your Rights in a Home and Community-Based Services Program (available here) and an oral explanation of such rights upon:

  • enrollment in the HCS program;
  • revision of the booklet;
  • request; and
  • change in an individual's legal status (for example, when the individual turns 18 or gains or loses a guardian).

In accordance with HHSC rules governing rights of individuals with intellectual disability (40 Texas Administrative Code, Chapter 4, Subchapter C), the LIDDA is responsible for providing an individual, LAR or family member with a copy of the rights of the individual as described in the booklet entitled Your Rights in Local Authority Services and an oral explanation of such rights upon enrollment into local authority services and annually thereafter. However, to provide a meaningful and complete explanation of all rights to individuals receiving HCS services, the SC is also expected to give a copy of the booklet, Your Rights in a Home and Community-based Services (HCS) Program, upon enrollment, as requested by the individual or LAR, as the booklet is revised, and if the individual’s legal status changes.

The SC must document every time the SC gives the booklets to the individual, LAR or family member and provides an oral explanation of the rights. The documentation must be signed by the individual or LAR and the SC.

The SC must ensure that, at the time an individual is enrolled, the individual or LAR is informed orally and in writing of the processes for:

  • filing complaints with the LIDDA about the provision of service coordination; and
  • filing complaints about the provision of HCS services, including the toll-free telephone number of:
    • the LIDDA to file a complaint;
    • HHSC to file a complaint; and
    • DFPS (1-800-647-7418) to report an allegation of abuse, neglect or exploitation.

Activities Related to Individuals Under 22 Years of Age Seeking or Receiving Supervised Living or Residential Support

Using Form 3605, HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age, the SC requests the LAR of an individual under the age of 22 receiving Supervised Living or Residential Support to provide the SC with the following information:

  • the LAR's name, address and telephone number;
  • the LAR's driver license number and state of issuance or personal identification card number issued by the Department of Public Safety (DPS);
  • the LAR's place of employment and the employer's address and telephone number;
  • the name, address and telephone number of a relative of the individual or other person HHSC or the SC may contact in an emergency, a statement indicating the relationship between that person and the individual and, at the LAR's option:
    • that person's driver license number and state of issuance or personal identification card number issued by DPS; and
    • the name, address and telephone number of that person's employer; and
  • a signed acknowledgement of responsibility stating that the LAR agrees to:
    • notify the SC of any changes to the contact information submitted; and
    • make reasonable efforts to participate in the individual's life and in planning activities for the individual.

If anyone, including the HCS program provider, notifies the SC that they are unable to locate the LAR, the SC must:

  • make reasonable attempts to locate the LAR by contacting a person identified by the LAR in the contact information described above; and 
  • notify the IDD Ombudsman, no later than 30 calendar days after the date the SC is unable to locate the LAR of the determination, and request that HHSC initiate a search for the LAR.

Within three business days after initiating Supervised Living or Residential Support to an individual under 22 years of age, the SC must:

  • provide the information listed in the bullet below to the following:
    • the CRCG for the county in which the individual's LAR lives (see hhs.texas.gov for a listing of CRCG chairpersons by county);
    • if the individual is at least three years of age, the local school district for the area in which the three- or four-person residence is located; and
    • if the individual is younger than three years of age, the early childhood intervention (ECI) program for the county in which the residence is located (see https://hhs.texas.gov/services/disability/early-childhood-intervention-services for a listing of ECI programs by county); and 
  • provide the following information to the entities described in the bullet above:
    • the individual's full name;
    • the individual's gender;
    • the individual's ethnicity;
    • the individual's birth date;
    • the individual's Social Security number;
    • the LAR's name, address and county of residence;
    • the date of initiation of Supervised Living or Residential Support;
    • the address where supervised living or residential support is provided; and
    • the name and phone number of the person providing the information.

For an applicant or individual under 22 years of age seeking or receiving Supervised Living or Residential Support, the SC will:

  • make reasonable accommodations to promote the participation of the LAR in all planning and decision-making regarding the individual's care, including participating in:
    • the initial development and annual review of the individual's person-directed plan (PDP);
    • decision-making regarding the individual's medical care;
    • routine service planning team meetings; and
    • decision-making and other activities involving the individual's health and safety;
  • ensure that reasonable accommodations include:
    • conducting a meeting in person or by telephone, as mutually agreed upon by the program provider and the LAR;
    • conducting a meeting at a time and location, if the meeting is in person, that is mutually agreed upon by the program provider and the LAR;
    • if the LAR has a disability, providing reasonable accommodations in accordance with the Americans with Disabilities Act, including providing an accessible meeting location or a sign language interpreter, if appropriate; and
    • providing a language interpreter, if appropriate;
  • provide written notice to the LAR of a meeting to conduct an annual review of the individual's PDP at least 21 calendar days before the meeting date and request a response from the LAR regarding whether the LAR intends to participate in the annual review;
  • before an individual who is under 18 years of age, or who is 18-22 years of age and has an LAR, moves to another residence operated by the HCS provider, attempt to obtain consent for the move from the LAR unless the move is made because of a serious risk to the health and safety of the individual or another person; and
  • document compliance with the activities described above in the individual's record.

Activities Related to Guardianship

The SC is responsible for determining, at least annually, if the guardianship for an individual is current. The letter of guardianship may be required to be renewed in the county court annually. The SC must request the current letter of guardianship and keep a copy in the individual’s record.

The SC must document in the PDP whether the letter of guardianship is current.

If the letter of guardianship is not current, the SC must provide a reminder to the guardian that a renewal needs to be completed and document that the guardian was provided this reminder.

If the letter of guardianship is not current, the SC should obtain signatures of both the individual and the person listed as guardian until appropriate steps can be taken to verify current guardianship.