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Pennsylvania Office of Developmental ProgramsQuality Assessment & Improvement (QA&I) Questions Tool for Supports Coordination Organizations

Overview of the Quality Assessment & Improvement Process

The mission of the Office of Developmental Programs (ODP) is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives.

ODP’s vision is to continuously improve an effective system of accessible services and supports that are flexible, innovative and person-centered.

The Quality Assessment & Improvement Process is a way for ODP to evaluate our current system and identify ways to improve it for all individuals.

General Instructions

1. In preparation for completing the QA&I Tool, Administrative Entities (AEs), Supports Coordination Organizations (SCOs) and Providers should review all relevant materials regarding the QA&I process that are posted on the MyODP Training & Resource Center at https://www.myodp.org.

2. In case of questions, issues or concerns related to the questions asked in the tool or the QA&I Process, please contact the ODP QA&I Process Mailbox at [email protected] and copy the ODP Regional QA&I Coordinator.

3. If an incident is discovered during the course of the QA&I process that has not been reported, the incident must be immediately reported in the Enterprise Incident Management (EIM) system and Incident Management procedures should be followed. The AE, SCO and Provider shall ensure the health and welfare of individuals at all times. If any entity determines there is an imminent threat to the health and welfare of the individual, immediate steps should be taken to ensure the health and welfare of the individuals and the appropriate regional ODP office should be contacted. Based on circumstances, the entity shall proceed according to the policy established in ODP Bulletin #6000-04-01, Incident Management and as determined appropriate by the regional ODP office.

Tool Completion Instructions

The following guidelines are intended to help a user and complete this tool successfully.

1. Use the SCO MCI review spreadsheet to answer all questions related to the record review. The overall percentage from the SCO MCI review spreadsheet is the final answer and what should be entered into the web database.

2. All questions applicable to the entity have to be answered before the tool can be submitted.

Last updated: 6/29/17 1

mailto:[email protected]

https://www.myodp.org/

3. The timeframe for each question is 12 months from the date of the review unless otherwise specified. When looking back 12 months, always go to the 1st day of the month i.e. the review begins on July 15, 2017, look back to July 1, 2016.

4. It is strongly recommended that the guidance associated with each question is reviewed before answering the question as the guidance will assist you in your responses.

5. When responding to questions, the entity MUST retain all related documentation, including policy & procedure documentation, training curriculum, records and other training documentation as well as documentation associated with service/supports delivery. This documentary evidence along with this tool must be retained and made available to ODP or the AE upon request.

6. Questions that are labeled as exploratory are intended to inform the entity of new changes and requirements which may begin July 1, 2017.


# Question Guidance Source DocumentsDEMOGRAPHIC INFORMATION1. SCO Name Enter your organization’s name used in HCSIS during the enrollment process2. Master Provider Index (MPI) Number Enter your nine-digit Master Provider Index (MPI) number. This number is located in

HCSIS and is the first nine digits of your PROMISe ID.3. Region SCO is located Select the appropriate region for your SCO from the drop-down list.

If the SCO serves waiver participants in multiple regions, please designate the region in which the SCO serves the most waiver participants

4. Contact information for person completing QA&I Tool

Enter the contact information for the primary contact person for the organization who is responsible for the Quality Assessment & Improvement process organization.

This should be the person who received the link to the on-line version of the tool via email and the one who is entering the self-assessment for the Provider.


DATA & POLICY

# Question Guidance Source DocumentsQUALITY MANAGEMENT – There are systemic efforts to continuously improve quality.The SCO demonstrates continuous quality improvement.6. The SCO uses the self-assessment

results to work on quality improvement annually.

The reviewer determines if the SCO used their self-assessment results to work on quality improvement.

The reviewer will discuss how the SCO is using their self-assessment results. The SCO’s Quality Management Plan may include self-assessment data.

Mark YES if the SCO used their self-assessment results to work on quality improvement.

Mark NO if the SCO did not use their self-assessment results to work on quality improvement.

QA&I Process Document

7. The SCO has a Quality Management Plan that reflects ODP’s Mission, Vision and Values.

The mission of the Office of Developmental Programs is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives.ODP’s vision is to continuously improve an effective system of accessible services and supports that are flexible, innovative and person-centered.

The values articulated as principles in the Everyday Lives document and the values articulated in the Autism Task Force Report set the direction for the developmental disability service system. They provide context and guidance for policy development, service design and implementation, and decision-making.

The reviewer determines if the SCO’s QMP reflects ODP’s Mission, Vision and Values by reviewing the QMP.

Examples of what could be worked on in the QMP include:- Assuring effective communication- Increasing employment- Increasing community participation- Ensuring ISPs are updated timely when there is a change in need- Ensuring individuals are free from abuse, neglect and exploitation- Ensuring people with complex needs have supports they need

Mark YES if the QMP reflects the Mission, Vision and Values. Mark NO if the QMP does not reflect them.

** Identify what is missing from the QMP.

55 Pa. Code Chapter 51 Informational Memo 038-15

8. The SCO reviews and evaluates The reviewer determines if the SCO used performance data to develop their QMP Exploratory


# Question Guidance Source Documentsperformance data in selecting priorities for the QMP.

based on a review of the QMP.o Performance data can include but is not limited to:

- Performance results from QA&I self-assessments and full reviews, including individual interviews, targeting those areas where performance falls below 86%

- Employment Data - IM4Q Data- Data on individual with communication needs- Community Participation data- Data on self-direction, choice and control- Data on management of incidents of abuse, neglect, exploitation and

unexplained deaths- Data on use of restrictive interventions including restraints- SCO Performance Review Reports

Mark YES if the SCO used performance data in the development of the QMP. Mark NO if the SCO did not use performance data.

Everyday Lives

9. The SCO analyzes and revises the QMP at least every two years.

The reviewer determines if the QMP was revised every 2 years based on a review of the QMP. Mark YES if the QMP was revised every 2 years. Mark NO if the QMP was not revised every 2 years.

55 Pa. Code Chapter 51 Informational Memo 038-15

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The system of support is straightforward.The SCO is responsive to the individuals’ needs and identified issues.10. The SCO has an escalation process for

issues that need to be sent to the AE for assistance in resolution(non-enforcement)

The reviewer determines if the SCO has a process in place for escalating issues to the AE, especially provider issues.

The reviewer discusses the SCO’s process for addressing issues that require assistance in resolution. Mark YES if the SCO has a process for notifying AEs of issues Mark NO if the SCO does not have a process for notifying AEs of issues.

Exploratory

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – Individuals are afforded employment first.The SCO is responsive to the individuals’ employment goals.11. The SCO supports the SCs to offer

appropriate opportunities related to the individual’s skills and interests, and encourage the individual to seek competitive, integrated employment at the annual ISP meeting.

The reviewer determines if the SCO supports the SCs to offer appropriate opportunities via conversation.

Opened ended comment.

Exploratory Pathways of Employment guidance

document Executive Order 2016-03

12. The SCO identifies how they collaborate with OVR and the school

The reviewer determines if the SCO collaborates with both OVR and the local school districts.



# Question Guidance Source Documentsdistrict for transition age youth and employment.

Opened ended comment. document Executive Order 2016-03

13. The SCO has an employment lead. The reviewer determines if the SCO has an employment lead. Mark YES if the SCO has an employment lead. Mark NO if there is the SCO does not have an employment lead.



PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual is supported to communicate.The SCO assesses and addresses communication needs for the individual.14. The SCO currently has staff or available

contractors/language services who are trained to communicate with people who are deaf or hard of hearing (certified intermediate plus in ASL)

The reviewer determines if the SCO has staff or available contractors/language services to communicate with individuals who are deaf or hard of hearing.

Opened ended comment.

Exploratory

15. If an individual is deaf and receiving services through the intellectual disabilities system, the SCO ensures that when an SC gets an individual who is deaf on their caseload, the SC is trained in all required training within 30 days of the individual being added to the SC’s caseload.

The reviewer determines if any SC whose caseload includes an individual who is deaf received all of the trainings and received them all within 30 days of the individual being placed on the SCs caseload.

The reviewer looks at the SCO training records. This is based on the individual record review. If the individual is not deaf or hard of

hearing, this is not required.o Required trainings are:

- Department’s training on deaf culture - the unique needs of deaf waiver participants- relevant service descriptions- the role of the Deaf Services Coordinator- the SC’s responsibilities in serving the deaf

Mark YES if the SC received all trainings. Mark NO if the SC did not receive all trainings. Mark NA if the individual is not identified as deaf or hard of hearing.

Harry M. Settlement Agreement, Paragraph 2-e-ii, pages 6-7

16. If an individual is deaf and receiving services through the intellectual disabilities system, the SCO offers communication assistance when providing direct supports coordination services.

The reviewer determines if the SCO provided communication assistance to individuals who are deaf based on a review of service notes, Individual Monitoring Tools and the ISP. Mark YES if the SCO provided communication assistance. Mark NO if the SCO did not provide communication assistance. Mark NA if the individual is not identified as deaf or hard of hearing.

Bulletin 00-14-04, Accessibility of Intellectual Disability Services for Individuals Who Are Deaf

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual ‘s family receives the supports needed.The SCO provides information to address family support needs.


# Question Guidance Source Documents17. The SCO promotes information sharing

with families. The reviewer determines how the SCO supports the SC in offering/providing

information to families. The reviewer accepts evidence of information sharing such as SC trainings,

family/consumers mailings, newsletters, etc. Opened ended comment.

Exploratory Everyday Lives: Values in Action pg. 17,

Support Families throughout the Lifespan

HEALTH & WELFARE – There are systemic efforts to ensure health and welfare.The SCO has a certified investigator.18. The SCO maintains a certified

investigator. The reviewer determines whether the SCO has a certified investigator on staff or has

an agreement with another entity to investigate incidents directly related to SC services based on documentation.

If the SCO has a CI on staff, the CI certification is good for 3 years from the date on the certificate. Mark YES if the SCO has a certified investigator or agreement. Mark NO if the SCO does not have a certified investigator or agreement or the

date on the CI certificate is over 3 years old.

Bulletin 00-10-06, Supports Coordination Services

Bulletin 6000-04-01, Incident Management

The SCO assesses and addresses the need for additional monitoring.19. The SCO follows criteria triggers for

higher frequency monitoring for individuals.

The reviewer determines if the SCO has a process in place to increase monitoring frequency when needed.

The reviewer discusses the SCO’s process for determining if individuals need extra support and monitoring.

o Triggers can include but are not limited to:- Crisis situations- Homelessness- Loss of monthly service- Critical incidents- Reports of abuse, neglect, exploitation

Mark YES if the SCO has a process for determining if individuals need increased monitoring.

Mark NO if the SCO does not have a process for determining if an individual needs increased monitoring.


Support People with Complex Needs Waiver

QUALIFIED PROVIDERS – The individual’s providers meet necessary training requirements.The SCO ensures training requirements are met.


# Question Guidance Source Documents20. All SCs with a caseload (exclude any SC

with a discrete base caseload) attended/took all ODP required trainings in the training year.

The reviewer determines if SCs with a caseload completed ODP sponsored trainings, based on SCO training records (specifically training certificates).

Training must be taken within the timeframes as defined by ODP. Required training taken as Professional Development (PD) will be considered non-

compliant. Exclude staff that are no longer employed with SCO. Exclude SCs with a discreet base caseload.

Mark YES if all SCs took the ODP sponsored training as required. Mark NO if all of the SCs did not take the ODP sponsored training as required.


Bulletin 00-10-13, Supports Coordination Training Waiver Requirements

21. All SC Supervisors attended/took all ODP required trainings in the training year.

The reviewer determines if SC Supervisors completed ODP sponsored trainings based on SCO training records (specifically training certificates).

Training must be taken within the timeframes as defined by ODP. Required training taken as Professional Development (PD) will be considered non-

compliant. Exclude staff that are no longer employed with SCO.

Mark YES if all SC Supervisors took the ODP sponsored training as required. Mark NO if the SC Supervisors did not take the ODP sponsored training as

required.


Bulletin 00-10-13, Supports Coordination Training Waiver Requirements.

22. All SCs (with the exception of the discrete base caseload) completed the required number of training hours (a total of 24 hours/year) in the training year.

The reviewer determines if the SCs completed the required number of training hours in the training year based on SCO training records.

Exclude staff that are no longer employed with SCO. Mark YES if all SCs took the required number of hours. Mark NO if all of the SCs did not take the required number of hours.


Qualifications for Supports Coordination Organization

23. All SC Supervisors with a caseload (or who submitted billable service notes) completed the required number of training hours (a total of 24 hours/year) in the training year.

The reviewer determines if SC Supervisors completed the required number of training hours in the training year based on SCO records.

Exclude staff that are no longer employed with SCO. Mark YES if all SC Supervisors took the required number of hours. Mark NO if all of the SC Supervisors did not take the required number of hours.


Qualifications for Supports Coordination Organization.

24. The SCO’s staff completed Annual training that includes core courses as required.

The reviewer determines if all staff completed the annual training and all required core courses based on SCO records.

Exclude staff that are no longer employed with SCO.o Core courses are:

55 Pa. Code Chapter 51


# Question Guidance Source Documents- Department policy on intellectual disability principles and values- Training to meet the needs of a participant as identified in the ISP- QM plan- Identification and prevention of abuse, neglect and exploitation of a

participant- Recognizing, reporting and investigating an incident- Participant grievance resolution- Department issued policies or procedures- Accurate billing and documentation of HCBS delivery.

Mark YES if all staff took the required annual training core courses. Mark NO if all staff did not take the required annual training core courses.

25. All new SCO staff have completed the required number of hours of orientation and required topics within the first year of employment.

The reviewer looks at the SC Orientation packet and ensure the orientation was completed. Mark YES if all of the SC Orientation packets indicate completion. Mark NO if any of the SC Orientation packets do not indicate completion. Mark NA if there were no new hires.



26. All new SCs completed the required ODP SC Orientation prior to working independently with waiver participants.

The reviewer looks at the SC Orientation packet and use the date of the SC and SC Supervisor signature on the packet as the date orientation was completed.

Exclude discrete base caseloads as identified by the SCO. The reviewer searches service notes from the date of hire to the date of orientation

completed (per the SC Orientation certificate). PATH: HCSIS > SC > Service Notes > Search > Advanced Search > Comment Author

Last Name and First Name. The reviewer searches for waiver billable face-to-face service notes. Any waiver billable face-to-face activities shall have evidence that the SC did not

attend these independently (i.e. documenting supervisor or co-workers attendance). Mark YES if all of the service notes indicate that the new SC did not work

independently prior to completion of SC Orientation. Mark NO if any services notes indicate that the SC worked independently with an

individual prior to completion of SC Orientation. Mark NA if there were no new hires.



RECORD REVIEW – DESK REVIEW


# Question Guidance Source DocumentsADMINISTRATIVE AUTHORITY – The individual has a determination of urgency of need.The SC assures a current PUNS for the individual.27. There is a current PUNS for the

individual The reviewer determines if the individual has a current (Active) PUNS. (PATH: HCSIS > Individual > PUNS > PUNS Change). “Current” is defined as an active PUNS completed or updated within 365 days of the

date of desk review. Mark YES if there is a current PUNS. Mark NA if there is no PUNS or the PUNS is inactive or fully served.

Consolidated and PFDS waivers Bulletin 00-10-06, Supports

Coordination Services PUNS Manual

28. The SC completes a PUNS for the individual that reflects the individual’s needs.

The reviewer determines if the PUNS reflects the needs of the individual based on a review of service notes, Individual Monitoring Tools and the ISP to identify individual’s current needs.

(PATH: HCSIS > Individual > PUNS > PUNS Change). Mark YES if the PUNS is reflective of current needs. Mark NO if the PUNS does not reflect current needs or there is no PUNS and the

record indicates there should be a PUNS. ** Identify the current needs that were not included in the PUNS.

Mark NA if there is no PUNS or the PUNS is inactive or fully served.


Coordination Services PUNS Manual

The SC works with the individual to address all identified needs.29. The individual has an identified change

in need. The reviewer determines if a change in need was identified based on a review of

service notes, Individual Monitoring Tools and the ISP. The reviewer notes the date the change in need was identified. A change in need is a change that impacts the currently authorized services and/or

funding Mark YES if a change in need was documented. Mark NA if there was no change in need.

55 Pa. Code Chapter 51 Bulletin 00-10-06, Supports

Coordination Services ISP Manual

29. If YES, identify the change in need The reviewer documents the change in need identified. 55 Pa. Code Chapter 51 Bulletin 00-10-06, Supports


30. The individual’s ISP is updated timely when a change in need is identified.

The reviewer determines if the ISP was updated timely when a change in need was identified based on a review of service notes, Individual Monitoring Tools and the ISP.

PATH: HCSIS > Plan > History > Critical Revision.




# Question Guidance Source Documents The SC has seven (7) calendar days from identification of a change in need to update

the ISP. The Reviewer reviews the ISP history screen to assure a draft Critical Revision ISP

was created within seven (7) days. Mark YES if the ISP was updated timely. Mark NO if the ISP was not updated within seven (7) days and identify the

current needs that were not included in the ISP. Mark NA if there was no change in need.

QUALITY MANAGEMENT – There are systemic efforts to continuously improve quality.The SC works with the individual to address IM4Q considerations.31. There is an IM4Q consideration for the

individual. The reviewer determines if the individual has an IM4Q consideration. (PATH: HCSIS > M4Q > IM4Q > Considerations).

Mark YES if there is an IM4Q consideration. Mark NA if there is not an IM4Q consideration.


IM4Q Considerations Manual

32. The SC documents follow-up of an IM4Q consideration.

The reviewer determines if the SC documented the IM4Q consideration follow-up based on the review of service notes, individual monitoring tools and the IM4Q section in HCSIS.

(PATH: HCSIS > M4Q > IM4Q > Considerations) Mark YES if the IM4Q consideration follow-up is documented. Mark NO if the IM4Q consideration follow-up is not documented and identify the

consideration follow-up that was not documented. Mark NA if there is not an IM4Q consideration.



33. SC follows the process to inform the individual, family members and the provider of all IM4Q considerations.

The reviewer determines if the SC informed the individual, family members and the provider of all IM4Q considerations based on the review of service notes and the IM4Q section in HCSIS.

(PATH: HCSIS > M4Q > IM4Q > Considerations) Mark YES if the SC documented sharing IM4Q consideration. Mark NO if the SC did not document sharing of the IM4Q consideration. Mark NA if there is not an IM4Q consideration.



PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The system of support is straightforward.The SC accurately documents information in the individuals’ records. 34. The Service Notes meet quality

standards. The reviewer determines if the service notes meet quality standards. The reviewer reviews the SNs for the review period.



# Question Guidance Source Documents (PATH: HCSIS > SC > Service Notes > Search).

o Quality Standards (as per the trainings):- Person centered- Clear and concise- Objective- Include Who, What, When and Where- Detailed- Describe actions taken and actions needed

Mark YES if the services notes meet quality standards. Mark NO if the services notes do not meet quality standards.

Coordination Services ODP Trainings “Service Notes Basics

2013 – Part 1” & “Service Notes – Part 2 (2014)”.

The SC is responsive to the individuals’ needs and identified issues.35. There were identified issues

documented. The reviewer determines if there are any issues identified based on service notes

and Individual Monitoring Tools. o Issues are defined as:

- Any situation that warrants corrective action and timely response by an individual providing supports

- Circumstances that negatively impact an individual’s providing supports- An individual is not receiving the appropriate quality, type, duration and

frequency of services as identified in the ISP- An individual is dissatisfied with the manner in which the services or

supports are delivered

Mark YES if identified issues were documented. Mark NA if there were no issues.


36. The SC documents follow-up on issues identified.

The reviewer determines if the SC followed-up on issues based on a review of service notes, Individual Monitoring Tools and the ISP.

Documentation within service notes, monitorings or ISP should indicate follow-up action. Mark YES if there is documentation of the follow-up actions. Mark NO if there is not documentation of the follow-up actions. Mark NA if there were no issues.


37. There are unresolved issues where the SCO/SC notified the Provider but no action was taken by the Provider.

The reviewer determines if there are any issues that were unresolved by the provider during the review period based on a review of service notes and Individual Monitoring Tools. Mark YES if there are unresolved issues and note the issues. Mark NA if there are no unresolved issues.



# Question Guidance Source Documents

38. If there were issues that were unresolved by the provider, there is documentation that the SCO/SC notified the AE of the unresolved issue.

The reviewer determines if the record contains notification to the AE of identified issues that were unresolved by the provider.

The reviewer also accepts emails and letters as verification at the onsite visit. Mark YES if there were unresolved issues and there is documentation of AE

notification. Mark NO if there were unresolved issues and there is no documentation of AE

notification. Mark NA if there are no unresolved issues.


The SC identifies and addresses risk for the individual.39. The SC documents a risk assessment. The reviewer determines if the SC documented a risk assessment based on a review

of service notes, incident reports, Individual Monitoring Tools and the ISP. ISP PATH: HCSIS > Plan > Health & Safety > Focus Area > General Health Safety Risks,

Fire Safety, Traffic, Cooking/Appliance Use, Outdoor Appliances, Water Safety, Safety Precautions, Knowledge of Self-Identifying Info, Stranger Awareness, Sensory Concerns, Meals/Eating.

Mark YES if the ISP includes evidence of a risk assessment. Mark NO if the ISP does not include evidence of a risk assessment

**Identify the risks that have not been documented.

ISP Manual

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual’s assessed needs are addressed in the ISP through waiver-funded services or other funding sources or natural supports.The SC identifies and addresses risk for the individual.40. The SC incorporates risk mitigation

strategies into the ISP. The reviewer determines if the SC incorporated risk mitigation strategies based on a

review of the ISP. PATH: HCSIS > Plan > Health & Safety > Focus Area > General Health Safety Risks,

ISP Manual


# Question Guidance Source DocumentsFire Safety, Traffic, Cooking/Appliance Use, Outdoor Appliances, Water Safety, Safety Precautions, Knowledge of Self-Identifying Info, Stranger Awareness, Sensory Concerns, Meals/Eating. Mark YES if the ISP includes risk mitigation strategies. Mark NO if the there are risks identified but the ISP does not include risk

mitigation strategies. Mark NA if there were no risks that required mitigation.

**Identify the risks that did not have risk mitigation documented.

The SC assures a person-centered ISP is completed.41. The SC updates and submits the

annual ISP within 365 days of the prior annual ISP.

The reviewer determines if the annual review ISP was updated and submitted within 365 days of the prior annual ISP based on a review of the ISP.

The reviewer ensures the Annual Review Update ISP was submitted for approval (Pending Approval) within 365 days of the previous Annual Review Update ISP.

PATH: HCSIS > Plan > History > Summary > Annual Review Update > Pending Approval Mark YES if the annual ISP was updated within 365 days. Mark NO if the annual ISP was not updated within 365 days.

ISP Manual

42. The SC submits the annual review ISP for approval and authorization at least 30 days prior to the Annual Review Update Date (ARUD).

The reviewer determines if the SC submitted the annual review ISP at least 30 days prior to the Annual Review Update Date based on a review of the ISP.

PATH: HCSIS > Plan > History. The reviewer looks at the date of the “Pending Approval” ARU to determine the 30

days. If there is more than one ARU in the FY, the reviewer uses the ARU closer to the

ARUD Mark YES if the annual ISP was submitted timely. Mark NO if the annual ISP was not submitted timely and identify the number of

days outside of the 30 days required.

ISP Manual

43. If NO, how late: The reviewer calculates the number of days the Annual Review Update ISP was late based on the Annual Review Update Date.

The reviewer chooses the appropriate time frame from the drop down. Mark N/A if the ISP is an Initial ISP or if it was not late.

** Identify in comment reason for N/A.

ISP Manual

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual is supported to achieve personal goals.


# Question Guidance Source DocumentsThe SC develops an ISP that is person-centered and addresses all assessed needs.44. The SC develops a person-centered ISP

to address all assessed needs. The reviewer determines if the SC incorporated all assessed needs in the ISP based

on a review of service notes, the SIS assessment and the ISP. The reviewer determines if the SC incorporated all services and support to mitigate

identified risks are incorporated into the ISP. SIS PATH: HCSIS> Individual > Evaluation > Assessment Switchboard

Mark YES if the ISP includes evidence that all assessed needs have been reviewed and/or addressed.

Mark NO if there are identified assessed needs that are not included in the ISP.**Identify the assessed needs that have not been documented.

ISP Manual

45. The SC documents service frequency for all services in the ISP.

The reviewer determines if the SC documented service frequency based on a review of the ISP.

PATH: HCSIS > Plan > Serv & Supp > Outcome Act > Frequency and Duration section. Mark YES if the ISP includes service frequencies. Mark NO if the ISP does not include service frequencies.

**Identify the services that have no frequency documented.

ISP Manual ODP Training “The Outcome Section of

the ISP Part 2: Outcome Actions”

46. A person-centered ISP is developed that supports the outcomes (personal goals) throughout the entire plan.

The reviewer determines if the SC developed an ISP that supports the outcomes throughout the ISP based on a review of the ISP. Mark YES if the outcomes are supported by the information in the ISP. Mark NO if the outcomes are not supported by the information in the ISP.

**Identify the outcomes that are not supported.

ISP Manual

47. The individual is under 25 years of age. The reviewer reviews demographics to the determine individual’s age. PATH: HCSIS > Individual > Demographics > Demo. The reviewer indicates age in the comment filed.

Mark YES if individual is under 25 years old. Mark NA if the individual is 25 years or older.

Bulletin 00-16-02, OVR Referral Process for Employment-Related Services

48. The individual has an authorization for Prevocational Services

The reviewer determines if the individual is under 25 years old and has been authorized for Prevocational Services.

The reviewer is responsible to determine when the INITIAL authorization occurred. The reviewer indicates in the comment field the date of the initial authorization and

if it occurred prior to August 28, 2015 Mark YES if there is an authorization for prevocational services. Mark NA if the individual is 25 years or older or if there is no authorization for

prevocational services.




49. The SC develops an ISP that reflects the person’s interests and goals related to employment.

The reviewer determines if the SCs developed an ISP that reflects interest and goals related to employment.

The reviewer answers based on review of ARU meeting service notes and the entire ISP. Mark YES if the ISP and ARU meeting service note reflects that the SC developed

an ISP that reflects interest and goals related to employment. Mark NO if the ISP and ARU meeting service note do not reflect that the SC

developed an ISP that reflects interest and goals related to employment. Mark NA if the individual does not have any interests or goals related to

employment based on the record review.



PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual receives all approved services in the ISP.The SC monitors service delivery.50. The SC conducts all monitoring at the

required frequency. The reviewer determines if the SC conducted monitorings at the required frequency

based on a review of the Individual Monitoring Tools. (PATH: HCSIS > SC > Indiv Monitoring). If the individual has approved non-statutory frequency, identify them in the

comments section by MCI#. Mark YES if the SC conducted all monitorings at the required frequency. Mark NO if the SC did not conduct all monitorings at the required frequency.


Coordination Services Bulletin 00-16-01, Targeted Services

Management for Individuals with an Intellectual Disability


# Question Guidance Source Documents Mark NA if the individual is newly enrolled and no monitoring was due at time of

the review.

*3 months is calculated as calendar months, and not interpreted as per quarter. The 3 months are a rolling 3 months [i.e. Feb, Mar, April; Mar, Apr, May; etc.]

For Consolidated Waiver – Frequency is 3 face-to-face monitorings every 3 months*. For PFDS, an individual living with a family member - Frequency of contact is at least

1 time every 3 months* and face-to-face at least every 6 months. For PFDS, an individual living on their own or any other setting – Frequency is face-

to-face contact every 3 months* and contact every month TSM and Base MA eligible is 1 time outside of the ISP meeting Base non-MA eligible is 1 time a year

2017 waiver renewal Consolidated face-to-face every 60

days PFDS face-to-face every 3 months

(regardless of living situation)

51. The SC conducts all monitoring at the required location.

The reviewer determines if the SC conducted monitorings at the required location based on a review of the Individual Monitoring Tools.

(PATH: HCSIS > SC > Indiv Monitoring). If the individual has approved non-statutory frequency, identify them in the

comments section by MCI#. Mark YES if the SC conducted all monitorings at the required location. Mark NO if the SC did not conduct all monitorings at the required location. Mark NA if the individual is newly enrolled and no monitoring was due at time of

the review.


Coordination Services

2017 waiver renewal Consolidated Waiver – during a 6

month timeframe – 1 face-to-face in home, 1 face-to-face at day service and 1 time any location agreeable to the



*3 months is calculated as calendar months, and not interpreted as per quarter. The 3 months are a rolling 3 months [i.e. Feb, Mar, April; Mar, Apr, May; etc.]

For Consolidated Waiver – Location is 1 in the residence, 1 at the day program and 1 where the individual chooses.

For PFDS, an individual living with a family member - Location is in the home at least 1 time per calendar year.

For PFDS, an individual living on their own or any other setting – Location is in the home at least 1 time every 6 months.

TSM and Base – no location requirements

individual PFDS Waiver – 1 face-to-face in home

every 6 months, 1 face-to-face at day service and 1 time any location agreeable to the individual

52. The SC monitoring documentation meets quality standards.

The reviewer determines if the SC entered monitoring tools during the review period that meet quality standards based on a review of the Individual Monitoring Tools.

o Quality Standards (as per the trainings):- Person centered- Checks whether services are meeting needs as per the ISP- If the person has access to services- If services are being delivered according to the ISP- Describe actions needed

Mark YES if all the monitoring tools meet quality standards. Mark NO if all the monitoring tools don’t meet quality standards.


Coordination Services ODP Trainings “Introduction to

Individual Support Plan (ISP) Monitoring” & “ISP Monitoring 2014”.

53. The individual received services in type, scope, amount, duration and frequency as defined in the ISP.

The reviewer determines if the individual’s approved services and supports are received in the type, scope, amount, duration and frequency as defined in the ISP based on a review of the service notes and Individual Monitoring Tools.

ISP should be used to determine what services need to be monitored. Mark YES if the individual received all approved services and supports as per the

ISP. Mark NO if the individual did not receive all approved services and supports as

per the ISP.



54. If service is not being provided as authorized, the SC documents

The reviewer determines if the SC documented evidence of justification when services are not being received based on a review of the service notes, Individual



# Question Guidance Source Documentsjustification of service not being provided.

Monitoring Tools and the ISP. Mark YES if services are not being provided and there is documented

justification. Mark NO if services are not being provided and there is no documented

justification. Mark NA if all services are being provided as authorized.


HEALTH & WELFARE – The individual’s health, safety and rights are protected.The SC monitors health, safety and welfare.55. The individual’s identified health care

needs are being addressed. The reviewer determines if the individual’s health care needs are being addressed

based on a review of service notes and Individual Monitoring Tools. This includes both ongoing routine health care needs and unexpected situations that

require follow-up. Mark YES if the individual’s health care needs are being addressed. Mark NO if the individual’s health care needs are not being addressed. Mark NA if there are no health care needs.


Everyday Lives: Values in Action pg. 17, Promote Health, Wellness and Safety

56. If the individual’s identified health care needs were not met, the SCO took appropriate follow-up action.

The reviewer determines if health care needs were not met and if the SC followed-up appropriately based on a review of service notes, Individual Monitoring Tools and the ISP. Mark YES if there are unmet health care needs and the SC documented follow-

up. Mark NO if there are unmet health care needs and the SC did not document

follow-up. Mark NA if there are no unmet health care needs.



PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual receives all approved services in the ISP.The SC monitors the individual’s health and welfare.57. The SC identifies an imminent risk to

the health and welfare of the individual during a monitoring.

The reviewer determines if the SC identified an imminent risk to the individual during any monitoring based on a review of service notes and Individual Monitoring Tools.

Imminent Risk is an immediate risk of abuse, neglect, exploitation or death as identified in the Annex A of the Incident Management bulletin. Mark YES if there is imminent risk and indicate risk. Mark NA if there is no documented imminent risk.


Bulletin 6000-04-01, Incident Management

58. If there was imminent risk to the The reviewer determines if the SCO notified the AE and/or RPM of the imminent risk Bulletin 00-10-06, Supports


# Question Guidance Source Documentshealth and welfare of the individual, the SCO/SC maintains records that they notified the AE and Regional Program Manager (RPM) as required.

based on a review of service notes and Individual Monitoring Tools. The On Site Team accepts any proof of notification during the onsite visit if it is not

in the record. Mark YES if there was imminent risk and there is documentation of AE and RPM

notification. Mark NO if there are issues and there is no documentation of AE and RPM

notification. Mark NA if there is no documented imminent risk.

Coordination Services Bulletin 6000-04-01, Incident

Management

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual has an active life in the community.The SC offers and monitors an active life in the community for the individual.59. The SC includes evidence in the record

that they facilitated conversations with the individual about receiving on-going opportunities and support necessary to participate in community activities of the person’s choice.

The reviewer determines if the SC is facilitating conversations to ensure the individual is getting support for community activities based on a review of service notes, Individual Monitoring Tools and the ISP. Mark YES if the SC is documenting the facilitation of discussions. Mark NO if the SC does not document the facilitation of discussions.

Exploratory

60. The SC reflects in the ISP that the individual is afforded the same degree of community access and choice as an individual who is similarly situated in the community who does not have a disability and who does not receive an HCBS.

The reviewer determines if the SC included information about the individual being afforded the same degree of community access and choice based on a review of the ISP. Mark YES if the SC included information on community access and choice in the

ISP. Mark NO if the SC did not include information on community access and choice

in the ISP.

Exploratory

61. The SC uses the individual monitoring tool to record if the individual, who is receiving community participation supports, is engaged in community activities aligned with their preferences at the rate identified in their ISP and in accordance with the waiver.

The reviewer determines if the SC used the individual monitoring tool to record information about engaging in community activities that align with the individual’s preference based on a review of service notes, Individual Monitoring Tools and the ISP. Mark YES if the SC used the monitoring tool to record information about

Community Participation Supports. Mark NO if the SC did not use the monitoring tool to record information about

Community Participation Supports Mark NA if the individual does not receive Community Participation Supports.

Exploratory

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual is supported to communicate.


# Question Guidance Source DocumentsThe SC assesses and addresses communication needs for the individual.62. There is a communication need for this

individual The reviewer determines if the individual has a communication need based on

services notes, Individual Monitoring Tool and the ISP. Mark YES if there is a communication need. Mark NA if there is not a communication need.

Bulletin 00-08-18, Communication Supports and Services

Everyday Lives: Values in Action pg. 16, Assure Effective Communication

63. The individual’s primary mode of communication is assessed and the assessment includes specifics on the communication need.

The reviewer determines if the individual’s primary mode of communication is assessed, including communication specifics, such as communication supports and services, including services and technologies authorized and funded by ODP or outside ODP.

The reviewer determines if the primary mode of communication is assessed based on service notes, Individual Monitoring Tool and the ISP. Mark YES if the primary mode of communication and communication specifics, if

appropriate, are entered into HCSIS. Mark NO if the primary mode of communication and communication specifics, if

appropriate, are not entered into HCSIS.

Bulletin 00-08-18, Communication Supports and Services


64. The SC explores with the individual options for communication assistance when appropriate and supports the individual to choose.

The reviewer determines if the SC explores with the individual options for communication assistance when appropriate and supports the individual to choose based on a review of service notes, Individual Monitoring Tools and the ISP. Mark YES if the SC explores with the individual options for communication

assistance when appropriate and supports the individual to choose. Mark NO if the SC did not explore with the individual options for communication

assistance when appropriate and support the individual to choose. Mark NA if communication assistance is not needed.

Bulletin 00-08-18, Communication Supports and Services,


65. If there is an individual who is identified as deaf or hard of hearing, the SC appropriately identifies the individual as a Harry M class member.

• The reviewer determines if Demographics > Demo Harry M indicator is marked.• Harry M class members consist of:

- Individuals who are deaf or hard of hearing- Are enrolled in the Consolidated Waiver- An individual is identified as “deaf” when there is a hearing impairment and:

Is unable to understand/communicate verbal expressions commensurate with the intellectual disability level even with the use of hearing aids, OR

Whose primary language is one of the following: o American Sign Language (ASL) o Sign language from other countries (such as Spanish) o Signed Exact English o A mixture of ASL and Signed Exact English, or o Visual-Gestural Communication

Bulletin 00-14-04, Accessibility of Intellectual Disability Services for Individuals Who Are Deaf


# Question Guidance Source Documents Mark YES if the Harry M indicator is correctly checked. Mark NO if the Harry M indicator is not checked and should be. Mark NA if the individual is not identified as deaf or hard of hearing.

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual‘s family receives the supports needed.The SC provides information to address family support needs.66. There is evidence that the SC offers

information to the family. The reviewer determines if the SC offered the family information about services and

resources (i.e. trainings, community resources, support groups, etc.) based on a review of service notes, Individual Monitoring Tools and the ISP. Mark YES if there is evidence that the SC provided information to the family in

the record. Mark NO if there is no evidence that the SC provided information to the family in

the record. Mark NA if there is no family involvement.


Support Families throughout the Lifespan

HEALTH & WELFARE – The individual’s health, safety and rights are protected.The SC ensures that the individual is aware of how to identify and report Abuse, Neglect and Exploitation.67. The individual receives information on

how to identify and report abuse, neglect, and exploitation.

The reviewer determines if the SC provided the individual with information about Abuse, Neglect, and Exploitation (ANE) based on a review of service notes.

The ANE information must be provided at any meeting other than the annual ISP meeting. Mark YES if there is a service note that details the SC providing the ANE

information at a meeting other than the annual ISP meeting. Mark NO if there is not a service note that details the SC providing the ANE

information or the information was shared during the annual ISP meeting.

ODP Informational Packet 053-12

68. The SC identifies any current medical contacts such as doctors, dentists, psychiatrists, allied health professionals, specialists, etc. seen in the past 12 months.

The reviewer determines if required health care practitioners are identified based on a review of service notes, Individual Monitoring Tool and the ISP. Mark YES if the SC identified all health care practitioners seen in the last 12

months in HCSIS. Mark NO if the SC did not identify all health care practitioners seen in the last 12

months in HCSIS.

ISP Manual Everyday Lives: Values in Action pg. 17,

Promote Health, Wellness and Safety

The SC ensures reportable incidents are reviewed and corrective action is completed.69. If the record describes a reportable

incident, including critical incidents, there is an incident report entered in EIM.

The reviewer determines if there was a reportable incident based on a review of the services notes and Individual Monitoring Tools.

The reviewer determines that if there is an incident in the record that there is an incident recorded in EIM.

PATH: HCSIS > M4Q > EIM > Search > Individualo Critical incidents are defined as incidents in the IM Bulletin as those requiring

55 Pa. Code Chapter 51 55 Pa Code Chapter 6000 subchapter Q

– Incident Management ODP Informational Packet 072-13


# Question Guidance Source Documentsan investigation at any level.- Abuse- Neglect- Misuse of funds- Rights Violation- Death

Mark YES if the SC documented a reportable incident and there is an incident report in EIM.

Mark NO if the SC documented a reportable indent but no there is incident report in EIM.

Mark NA if the SC did not document a reportable incident in the service notes or Individual Monitoring Tool.

**If a critical incident is found that doesn’t have an incident report in EIM – the unreported critical incident protocol should be followed.

70. If the record describes a reportable incident and there is no report entered in EIM, the SCO/SC notified the provider of the need to enter the report in EIM.

The reviewer determines if the SCO/SC notified the provider of the need to enter a reportable incident if there is an unreported reportable incident in the record.

The reviewer determines if the SCO/SC notified the provider based on a review of service notes and Individual Monitoring Tools. Mark YES if there is a reportable incident with no incident in EIM and the SCO/SC

notified the provider of the need to enter the incident. Mark NO if there is a reportable incident with no incident in EIM and the SCO/SC

did not notify the provider of the need to enter the incident. Mark NA if there is no reportable incident.



71. If there is a reported incident in EIM, the SC documents review of the initial incident report (including medication error and restraints incidents) for evidence that the individual’s health, safety and rights were safeguarded

The reviewer determines if the SC documented review of the initial incident including the individual’s health, safety and rights were safeguarded based on a review of service notes and Individual Monitoring Tools. Mark YES if proper actions have been taken. Mark NO if proper actions have not been taken. Mark NA if there were no reportable incidents in the past 12 months.



72. If there is a critical incident in EIM, the SC reviews the incident and documents in HCSIS.

The reviewer determines if the SC documented review of the incident in a service note or Individual Monitoring Tool.

PATH: HCSIS > M4Q > EIM > Search > Individualo Critical incidents are defined as incidents in the IM Bulletin as those requiring

an investigation at any level.- Abuse- Neglect- Misuse of funds




# Question Guidance Source Documents- Rights Violation- Death

Mark YES if the SC reviewed the incident and documented review. Mark NO if the SC did not document a review of the incident. Mark NA if there is no reportable incident.

73. If the reported incidents in EIM for the individual identified corrective action, the SC monitors the corrective action implementation.

The reviewer determines if the SC monitored the corrective action listed in the incident based on a review of the services notes and Individual Monitoring Tools.

EIM > Incident > Preventative Corrective Action (only required if the incident is confirmed – critical categories only)

EIM > Incident > Additional Corrective Action Mark YES if the SC monitored the incident corrective action. Mark NO if the SC did not monitor the incident corrective action. Mark NA if there are no reported incidents.



74. If the reported incidents in EIM for the individual identified corrective action and the provider did not complete the corrective action, the SC follows-up with the Provider and AE.

The reviewer determines if the SC monitored the corrective action listed in the incident based on a review of the services notes and Individual Monitoring Tools.

The reviewer determines if the SCO/SC followed-up with the Provider and AE when the corrective action was not completed. Mark YES if the SC notified the Provider and AE of incident corrective action what

was not completed. Mark NO if the SC did not notify the Provider and AE of incident corrective action

what was not completed. Mark NA if there are no reported incidents.



HEALTH & WELFARE – Individuals with complex physical and behavioral needs receive appropriate supports.The SC provides Due Process Rights information to the individual.75. For individuals who have experienced

a crisis period, there was additional monitoring during that crisis period in order to resolve the crisis.

The reviewer determines if there are any crisis periods and if the SC increased monitoring during the crisis based on a review of service notes and Individual Monitoring Tools.

NOTE – Service note documentation of increased monitoring is sufficient, increased monitoring tools are not required.

The reviewer will have a conversation with SCO representatives about their protocols in regards to increased monitoring for individuals Mark YES if there are crisis periods and the SC increased their monitoring. Mark NO if there are crisis periods and the SC did not increase their monitoring. Mark NA if there are no crisis periods.


Support People with Complex Needs


# Question Guidance Source Documents76. The individual has complex needs. The reviewer determines if the individual has complex needs.

Complex needs are multiple (2 or more) needs across personal, physical, mental, social and financial well-being that require significant attention or resources or are currently unmet.

o Examples:- Medical complexity - Socioeconomic factors - Mental illness - Behaviors and traits

Mark YES if the individual has complex needs. Mark NO if the individual does not have complex needs.



77. If the individual has complex needs, the SC ensures there is a plan in place and implemented to address those needs.

The reviewer determines if a plan is in place and implemented to address identified complex needs based on a review of service notes, Individual Monitoring Tools and ISP. Mark YES if a plan is in place and implemented to address complex needs. Mark NO if a plan is not in place and implemented to address complex needs. Mark NA if the individual does not have complex needs.



78. If there is a complex need identified for the individual, the SC addresses issues identified via monitoring related to support for the person.

The reviewer determines if there are any complex needs and identified issues based on a review of service notes, Individual Monitoring Tools and ISP.

The reviewer determines if the complex need/issues have been addressed based on a review of service notes, Individual Monitoring Tools and ISP. Mark YES if there are complex needs and related issues that the SC has

addressed. Mark NO if there are complex needs and related issues that the SC has not

addressed. Mark NA if the individual does not have complex needs.



HEALTH & WELFARE – The individual has wellness opportunities.The SC ensures wellness resources are available.79. Where wellness needs have been The reviewer determines if there are any wellness needs and if the SC worked with Exploratory


# Question Guidance Source Documentsidentified for the person, the SC worked with the team to ensure resources are available for the individual.

the team based on a review of service notes, Individual Monitoring Tools and ISP. Mark YES if there are wellness needs that have been discussed with the team. Mark NO if there are wellness needs and there have not been team discussions. Mark NA if there are no wellness needs.


HEALTH & WELFARE –The individual’s restrictive intervention followed proper procedure.The SC ensures that restrictive procedures are followed-up.80. For incidents reported by the SCO in

which unauthorized restrictive interventions or restraints were used, the Human Rights Committee was notified.

The reviewer determines if the SCO reported an unauthorized restrictive intervention or restraints.

The reviewer reviews the record to ensure the HRC was notified. The reviewer also accepts emails and letters as verification of notification at the

onsite visit. Mark YES if there was an unauthorized restrictive intervention and the HRC was

notified. Mark NO if there was an unauthorized restrictive intervention and there is no

documentation of the HRC notification. Mark NA if there were no unauthorized restrictive interventions or restraints.

Exploratory

RECORD REVIEW - ONSITE

# Question Guidance Source DocumentsADMINISTRATIVE AUTHORITY - The individual receives information about fair hearing and appeal rights.The SC provides Due Process Rights information to the individual.81. The SC provides due process rights

information at the annual ISP meeting. The reviewer determines if the SC provided the due process rights at the annual ISP

meeting based on the ISP Signature Page. PATH: ISP Signature Page, page 2, Question 14.

Mark YES if the ISP Signature Page is checked “Yes”. Mark NO if the ISP Signature Page is not checked or “No” is checked. Mark NA if the individual is in Base/TSM.


Coordination Services Bulletin 00-08-05, Due Process and Fair

Hearing Procedures for Individuals with Mental Retardation


# Question Guidance Source Documents82. Choice of providers was offered to the

individual/family. The reviewer determines if the SC offered individual choice by reviewing the ISP

Signature Page. PATH: ISP Signature Page, page 2, Question 4.

Mark YES if the ISP Signature Page is checked “Yes”. Mark NO if the ISP Signature Page is not checked or “No” is checked.

ISP Manual

83. Choice of services was offered to the individual/family.

The reviewer determines if the SC offered individual choice by reviewing the ISP Signature Page.

PATH: ISP Signature Page, page 2, Question 5. Mark YES if the ISP Signature Page is checked “Yes”. Mark NO if the ISP Signature Page is not checked or “No” is checked.

ISP Manual

84. SC provides the individual information on participant directed service options annually.

The reviewer determines if the SC offered individual choice annually by reviewing the ISP Signature Page.


ISP Manual

85. At the annual ISP meeting, the SC provides education and information to the individual about employment services (i.e. competitive, integrated employment, OVR services and benefits counseling).

The reviewer determines if the SC offered individual information about employment services by reviewing the ISP Signature Page.




PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – The individual is supported in developing the ISP, including involvement of people chosen by the individual.The SC works with the individual in the planning and development of supports and services.86. The individual attends the Annual

Review Update ISP meeting. The reviewer determines if the individual attended the ISP meeting based on the ISP

Signature Page. PATH: ISP Signature Page, page 1, top of page

Mark Yes if the individual attended. Mark No if the individual did not attend.

Consolidated and PFDS waivers ISP Manual

87. If the individual did not attend the ARU ISP meeting, the SC reviews the results of the meeting with the individual and provides documentation of the review.

The reviewer determines if the SC reviewed the results of the ISP meeting with any individuals who did not attend based on the ISP Signature Page.

PATH: ISP Signature Page, page 1, bottom of page (signature and date) & page 2, Question 1. Mark YES if the ISP Signature Page is signed by the individual.



# Question Guidance Source Documents Mark NO if the ISP Signature Page is not signed by the individual. Mark NA if the individual was present at the ISP meeting.

88. The SC includes required team members in the Annual Review Update ISP meeting.

The reviewer determines if the SC included the required team members in the ISP meeting based on the ISP, ISP Signature Page and the ISP invitation letter.

The reviewer uses the ISP Service Details for the ARU ISP (PATH: Plan > History > Summary> Annual Update Review > Approved > Service Details > Print Selected Sections) and records all required team members. This information is shared for the onsite confirmation (copy of service details or list should be taken onsite).

PATH: ISP Signature Page, page 1. Team members who attended the ISP meeting sign the signature page. If a waiver provider chose not to be present, the reason for their absence is

documented on the ISP Signature Page Mark YES if the ISP Signature Page is signed by all waiver providers. Mark NO if the ISP Signature Page is not signed by all waiver providers and the SC

did not document the reason for the absence. Mark NA if there are no required team members.


89. The SC includes people chosen by the individual in ISP development and the ISP meeting.

The reviewer determines if the SC included people chosen by the individual in the ISP meeting based on service notes and the ISP Signature Page.

The reviewer shares information gathered from the service notes and ISP Signature Page is reviewed onsite.

PATH: ISP Signature Page, page 1, signature and date. Mark YES if the SC included people chosen by the individual. Mark NO if the SC did not include people chosen by the individual or did not

document a discussion. Mark NA if the individual did not want to invite anyone.

Exploratory

PERSON-CENTERED PLANNING, SERVICE DELIVERY & OUTCOMES – Individuals are afforded employment first.The SC offers employment first.90. The SC ensures that a new

prevocational support for an individual who is under 25 years of age is permitted only after a referral is made to the OVR and determination from OVR that the individual is ineligible or closes the case.

The reviewer determines if the file contains one of the following documents: o a determination from OVR that the individual is ineligible or o indication that OVR closed the case

Mark YES if there is evidence of OVR determination in file. Mark NO if there is no OVR determination from OVR in file. Mark NA if the individual is 25 years or older.



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