Form 1740, Service Backup Plan

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Documents

Effective Date: 9/2014


Instructions

Updated: 10/2024

Purpose

To document the service backup plan developed by the employer or designated representative (DR) for each program service required by program rules or the service planning team has identified as critical to the health, safety or welfare of the person when normal service delivery is interrupted, in the absence of the regular service provider or in an emergency.

Procedure

When to Prepare

The employer or DR completes this form:

  • after the person’s service planning team has identified which services to be delivered through the Consumer Directed Services (CDS) option are critical to the health and welfare of the person, and
  • any time a revision to the service backup plan is needed based on problems with implementation of the plan or changes in the resources required to carry out the plan.

Note: The case manager or service coordinator must review the service backup plan when services are initiated and annually thereafter. If the backup plan does not require revisions, the case manager or service coordinator may initial and date the current backup plan.

Number of Copies

Original and at least two copies.

Transmittal

The employer or DR keeps a copy in the file for the person receiving services through the CDS option and sends a copy to the Financial Management Services Agency (FMSA) and to the case manager or service coordinator. The employer or DR sends copies to other service planning team members as applicable.

The employer or DR must provide a copy of the initial and revised service backup plans and, if a revision is required, the revised budget to the FMSA within five working days after a plan's approval by the case manager or service coordinator.

Form Retention

The employer or DR, the FMSA, and the case manager or service coordinator keep this form while in effect and for five years thereafter.

Detailed Instructions

Name of Person — Enter the name of the person receiving services.

Program — Enter the program name.

Service — Enter the service identified by the service planning team as critical to the person’s health, safety or welfare.

Employer — Enter the employer's name. If the person receiving services is the employer, enter the person’s name again.

Designated Representative — Enter the DR’s name if applicable.

Support Advisor — Enter the support advisor's name if a support advisor helped develop the plan.

Type of Service Backup Plan — Check the type of service backup plan, as applicable.

Date of Service Planning Team Meeting — Enter the date the person’s service planning team met, identified the program service as critical and required a service backup plan to be developed.

Effective Date of Service Backup Plan — Enter the date the service backup plan will be effective.

Reason(s) a service backup plan is required for this service — State each reason the team, case manager or service coordinator determined this service is critical. A person’s service planning team must describe each service the team determines is critical and the length of time that constitutes a service interruption, absence of the regular provider or type of situations that would cause an emergency for the person.

Backup Plan Strategies and Sequence* — The employer or DR must develop a service backup plan that ensures the delivery of the service when the employer's regular service provider is not available to deliver the service or in an emergency, and may include the use of:

  • paid service providers;
  • unpaid service providers, such as family members, friends or non-program services; or
  • respite if included in the authorized service plan.

Specific Action(s) to Be Taken in Absence of Service Delivery* — The employer or DR must list the steps the employer or DR will follow to implement the backup plan.

Resource Person, Area Code and Phone Number* — The employer or DR will enter the name of the resource person to be contacted per the backup plan and the resource person's phone number.

* This field will expand to contain up to 2,000 characters. All text entered will show when the form is printed.

ePlan Approval — A person’s case manager or service coordinator must approve each service backup plan and any revision before they are implemented by the employer or DR. The case manager or service coordinator may schedule a service planning team meeting to review the proposed service backup plan.

Annual Review — A person’s case manager or service coordinator must review each service backup plan on an annual basis. The case manager or service coordinator will ask questions about backup plan implementation and request revision if needed. The case manager or service coordinator will initial and date the form if the backup plan is still deemed effective.

Note: An employer must:

  • budget sufficient funds in the service budget to implement a service backup plan and complete any budget revisions per Texas Administrative Code (TAC), Title 26, Part 1, Chapter 264, Section 264.511, Budget Revisions and Approvals;
  • review each service backup plan at least annually; and
  • revise a service backup plan if:
    • the employer experiences a problem implementing a service backup plan,
    • availability of resources change, or
    • the employer redistributes funds that are not used to carry out a service backup plan.

The employer or DR must receive approval from the case manager or service coordinator for initial, revised and annual reviews for each service plan.