Revision 17-1; Effective March 15, 2017
Eligibility
Does the individual continue to meet all eligibility requirements for the Community Care Services Eligibility (CCSE) services that are authorized?
- Does the individual continue to be financially eligible? Have there been any changes in income, resources, or categorical status?
- Does the individual appear still to be functionally eligible? (See "Individual Condition" below.)
- Does the individual need and want CCSE services?
- Does the individual still need assistance that would not be met without this CCSE service?
Condition
Has there been any change in the individual's condition that affects service delivery or the adequacy of the service plan?
- What is the individual's current medical, physical and mental condition? Has it changed?
- Has the individual been hospitalized? Has there been an accident or illness? Is the individual getting medical services as needed?
- Has there been a change in the individual's degree of self-sufficiency?
- Has there been a change in the tasks the individual can perform?
- What are the individual's current needs? Have these changed?
- What is the individual's risk status?
Situation
Has there been any change in the individual's situation that affects service delivery or the adequacy of the service plan?
- Has the individual moved? Has there been another change in the individual's home or environment? Does any change affect the individual's safety or service needs?
- Who (if anyone) has moved in with the individual? Who has moved out of the individual's residence?
- Has there been any change in the individual's social support or resources? Has there been any change in the assistance that is given by family or community resources?
- Does the individual continue to have the same caregivers? Has there been any change in the amount or type of assistance they give the individual? Has there been any change in the ability, dependability, or availability of the individual's caregiver?
CCSE Services
Have CCSE services been delivered according to the service plan?
- Were services initiated as scheduled? Has the provider agency delivered the correct amount of services at the scheduled times?
- Is the individual satisfied with the service? Does the service meet the individual's needs?
- What is the quality of the services that are being provided to the individual? Are there any problems with the quality of the services? Does the paid attendant carry out the required tasks? Does the attendant arrive on time? Is there a problem that needs to be reported to the agency supervisor or the contract manager?
- Has the individual been away from his residence when in-home services were scheduled? Has the individual used out-of-home services as authorized? Has the individual in some other way prevented the delivery of authorized services?
Service Plan
Does the service plan need to be changed?
- Are the authorized services meeting the individual's current needs?
- Does the individual still concur with the service plan?
- Does the individual continue to need the same amount of services?
- Is the current schedule effective for meeting the individual's needs?
- Does the individual need additional service(s)?
- Does the individual need a referral to some other agency or community resource?