3600, CFC PAS/HAB or CLASS Transportation-Habilitation Services Documentation

Revision 17-1; Effective November 1, 2017

If the individual receives CFC PAS/HAB or CLASS transportation-habilitation services as part of their service plan, the DSA must document and maintain the following in the individual record (except for items that are not relevant):

  • the need for specific CFC PAS/HAB or CLASS transportation-habilitation tasks;
  • standing physician's orders for any delegated tasks;
  • any training and/or other support provided including support management to the individual to enable the individual to manage their own CFC PAS/HAB or CLASS transportation-habilitation services;
  • conflicts/problems between the individual and the CFC PAS/HAB or CLASS transportation-habilitation staff, and how these conflicts/problems were resolved; and
  • annual documentation of the satisfaction with CFC PAS/HAB or CLASS transportation-habilitation using Form 3599, Habilitation Service Provider Orientation/Supervisory Visits.

Tasks performed by CFC PAS/HAB or CLASS transportation-habilitation provider  must be provided with proper regard for the individual's health, safety, welfare and personal autonomy. CFC PAS/HAB must be performed in a manner that comports with the individual's personal, cultural or religious preferences.

The DSA must provide CFC PAS/HAB services that meet the individual's needs as specified in the IPC and IPP. The individual or LAR must be afforded an informed choice of settings, techniques and objectives. The individual or LAR may request CFC PAS/HAB services be modified to accommodate individual needs.

CFC PAS/HAB must be provided in community settings; that is, places where the individual lives or works and in settings similar to these. The training must teach skills the individual can practice and apply in daily life.

If any of the following services are provided, the DSA must evaluate and document the effectiveness at least once per quarter:

  • prevocational services;
  • employment assistance; or
  • supported employment services.

The evaluation must include an assessment of the individual's progress, evolving needs and plans to address identified needs.

The DSA must also inform the case manager of any significant changes in the service plan and provide the case manager with service summaries of the individual's progress and needs.

Form Resources

The following forms may need to be completed:

  • Form 2067, Case Information
  • Form 3596, PAS/Habilitation Plan - CLASS/DBMD/CFC
  • Form 3599, Habilitation Service Provider Orientation/Supervisory Visits
  • Form 3621, CLASS/CFC – Individual Plan of Care
  • Form 3625, Documentation of Services Delivered
  • Form 3629, Individual Program Plan Addendum
  • Form 8606, Individual Program Plan (IPP)