The Individualized Program Plan (IPP) is based on the findings of the assessment and must address all deficit areas noted therein. All planned and needed services for the participant must be documented in the IPP. All interdisciplinary team (IDT) members must participate in developing the IPP, and must document their participation as shown by their attendance on sign-in sheets with signatures. The IDT meets to develop the IPP after the assessment is completed, but no later than 30 days after a participant's admission to the program. After the initial IPP is developed it must be reviewed every 30 days unless otherwise specified for a specific service array. The CRS counselor and the participant's representative, if applicable, are notified at least one week in advance about the date, time, and location of the IPP review meeting.

The IDT process is designed to allow team members to review and discuss information and make recommendations that are relevant to the participant's needs. The IDT reaches decisions as a team, rather than individually, about how best to address the participant’s needs. Everyone involved in the participant's care must work together to provide a uniform and consistent approach to implementation of the IPP.

Note: The word participate means to provide input through whatever means is necessary to ensure that the participant's IPP meets the participant's needs.

The IPP must identify means to prevent or slow regression and prevent the loss of current optimal functional status.

The IPP must include opportunities for participant choice and self-management and identifies the following:

  • Assessments performed by licensed professionals in the areas of service, including but not limited to occupational therapy, physical therapy, speech therapy, cognitive rehabilitation therapy, neuropsychological, or other assessments used to develop and provide therapy services.
  • The frequency and duration of therapy services (as noted in the recommendations section of the assessments), if the assessments indicated that services are warranted.
  • The goals and objectives to be met, including long-and short-term goals that are stated in measurable terms and that relate to increasing a participant's ability to live more independently.
  • The team member who will implement the plan and the specific strategies that will be used.

The provider must provide a copy of the assessment report and the IPP to the CRS program staff member within 10 working days of the IPP meeting. A copy is made available to the participant and to the participant's representative. The results of the assessment and the IPP may be combined into a single report, signed by all pertinent IDT members (as applicable).

Each participant must receive a continuous program of needed interventions and services in sufficient intensity and frequency to support the achievement of the IPP objectives. Except for those facets of the IPP that must be implemented only by licensed personnel, each participant’s IPP must be implemented by all staff members who have been trained to work with the participant, including professional and paraprofessional staff members.