PROPOSED RULEMAKING
DEPARTMENT OF
PUBLIC WELFARE
[ 55 PA. CODE CHS. 2380, 2390, 6400 AND 6500 ]
Individual Support Plan for Individuals with Mental Retardation
[38 Pa.B. 1937]
[Saturday, April 26, 2008]The Department of Public Welfare (Department) under the authority of the Public Welfare Code (62 P. S. §§ 901--922 and 1001--1087) intends to amend the regulations set forth in Annex A.
Purpose of Regulation
The purpose of this proposed regulatory amendment is to update and clarify regulations regarding the comprehensive plan to provide services for individuals with mental retardation. The process of developing and implementing a plan to provide these services has changed. The proposed amendment is needed to clarify the individual plan development process and the provider's role in developing and implementing the individual plan.
Background
Current regulations specify that a provider shall develop and implement an Individual Program Plan (IPP) or Individual Written Program Plan (IWPP). The IPP and IWPP were the sole documents to be used by providers to organize and manage services provided for individuals served by the Office of Developmental Programs (ODP), formerly the Office of Mental Retardation (OMR). Each provider created an IPP or IWPP for every individual served. An individual could easily have several plans: one for his residential program; one for the vocational program; and one for day services. In some cases, individuals and their families would attend multiple meetings to update plans for each provider, and the plans would conflict with each other.
As part of the regulatory development process, an individual and family-focused work group was convened. The group offered suggestions for the language to be used in the regulatory revisions some of which are incorporated into the proposed amendments. The group also requested ODP add regulatory language specifying when individuals and families receive information prior to the plan development meeting and requested the 3 month review summary within 30 days of completion of review. ODP agreed the addition would be beneficial, and added this language to the proposed amendments. These time frames were acceptable to the workgroup, which was composed of an individual receiving services, families, providers, provider associations and administrative entity representatives.
In 2002, OMR (now ODP) implemented the Individual Support Plan (ISP) to resolve these problems by replacing multiple plans with one comprehensive plan. The ISP is the single document used to coordinate all supports and services for an individual, to eliminate the need for each provider to have its own plan. The individual and his family or friends, as applicable, meet with all providers at the same time to develop and plan how to meet the needs and wants of the individual. This creates consistency and ensures that everyone is working together to meet the individual's needs and personal goals.
The creation and coordination of the ISP is conducted by the supports coordinator. Supports coordination assists waiver participants with locating, coordinating and monitoring needed services and supports. With the improvements in planning for the individual needs and wants moving from a provider-directed IPP or IWPP to a supports coordinator-facilitated ISP, the current regulations need to conform to these improvements. The proposed amendments are consistent with the current process for developing or implementing the ISP. The proposed regulations do, however, change the acronyms ''IPP'' or ''IWPP'' to the more generic ''IP,'' and change existing regulatory language to reflect the preferred process for developing an IP. This regulatory change provides for consistent and uniform language throughout the relevant regulations. It also allows for changes to occur, if necessary, in the type of format used to document and coordinate all supports and services provided to an individual in the future.
Requirements
§§ 2380.3, 2390.5, 6400.4 and 6500.4 regarding definitions
These sections are being amended to define the IP and supports coordinator.
§§ 2380.33, 2390.33 and 6400.44 regarding program specialist
These sections state the responsibilities of a program specialist. The proposed change to these sections reflects that a program specialist is required to provide the completed assessment prior to planning meetings. The other proposed change is the addition of information on how a provider is required to coordinate and develop an IP for individuals who do not have an assigned supports coordinator.
§§ 2380.35 and 6400.45 regarding staffing
These sections describe the conditions under which a person may be unsupervised. This section requires that staffing ratios specified in the IP must be implemented as written.
§ 6500.44 regarding supervision
This section describes the conditions under which a person may be left unsupervised. This section requires that staffing ratios specified in the IP must be implemented as written.
§ 2380.101 regarding program activities and services
This section states that the program activities shall be provided as specified in the IP. The change in this section is that the general term ''services'' was added to the section heading and subsection (c).
§ 2390.91 regarding activities and services
This section states that the activities for an individual shall include work experience and other developmentally-oriented work training and shall be provided as specified in the IP. The change in this section is that the general term ''services'' was added to the section heading and the text of the regulation. The term ''work training activities'' was changed to ''work training endeavors.''
§§ 2380.103(1), 2390.95(1), 6400.122(1) and 6500.112(1) regarding development of the individual plan
These sections define the development of the IP. Specific changes to these sections include a new section for an individual who does not have an assigned supports coordinator. It indicates what procedures are to be followed by the program specialist or family living specialist when there is no supports coordinator.
§§ 2380.104, 6400.123 and 6500.113 regarding review of the IP
These sections define the review and revision process for the IP. The most prominent enhancement to these sections is that the time frame for quarterly reviews is now three calendar months in all three chapters.
§ 2390.97 regarding review of the IP
This section defines the review process for IPs. It provides that the time frame for review is at least every 3-calendar months.
§§ 2380.105, 6400.124 and 6500.114 regarding participation in the development of the IP
These sections outline who must participate in the development of the IP. The amendment describes the duties of the program specialist or family living specialist.
§ 2390.96 regarding content of the IP
This section states the content requirements for the IP. The change adds provisions for individuals without an assigned supports coordinator and outlines procedures that are to be followed regarding the development and content of the individual's plan.
§§ 2380.106, 6400.125 and 6500.115 regarding content of IP
These sections define the content required for the IP. The proposed amendment specifies that a program specialist or family living specialist shall review certain areas of the IP and document any missing or incomplete items. The program specialist shall also prepare the IP for individuals without a supports coordinator.
§§ 2380.107, 6400.126 and 6500.116 regarding implementation of the IP
These sections require that the IP shall be implemented as written.
§§ 2380.108, 2390.98, 6400.127 and 6500.117 regarding copies of the IP
These sections outline the requirements regarding copies of the IP. The changes require the program specialist or family living specialist to send a written summary of each three month review to all interested parties. The program specialist or family living specialist shall also keep documentation for those persons who have opted not to receive a written copy of the reviews.
§§ 6400.163 and 6500.133 regarding use of prescription medications
These sections relate to prescription medications. The acronym IPP is replaced with ''IP.''
Affected Individuals and Organizations
Currently, the majority of individuals receiving services through ODP are required to have an ISP. It is the only form approved for documenting services and facilitating payment through ODP under Chapters 2380, 2390, 6400 and 6500. The ISP eliminates the need for each provider to have its own plan. The benefits to individuals and families include having only one plan meeting to attend in which all providers are required to be present. Previously, some individuals and families were being asked to attend meetings separately with the various providers which created an unnecessary hardship.
As part of the regulatory development process, the individual and family-focused workgroup requested that ODP add certain regulatory language to specify that individuals and families receive assessment information prior to the plan development meeting. Providers will be required to distribute copies of their assessment information and 3-month review summary to individuals and families within 30 days of the meeting. The provider shall also forward the assessment data that will be used during the plan meeting to planning team members no later than 30 days before the meeting.
Accomplishments and Benefits
The proposed amendments codify the current process for developing and implementing the ISP. The proposed regulations do, however, revise the acronyms ''IPP'' or ''IWPP'' to the more generic ''IP'' and change the existing regulatory language to reflect the preferred process for developing an IP. This regulatory revision provides for consistent and uniform language throughout Chapters 2380, 2390, 6400 and 6500. It also allows for changes to occur in the type of format used to document and coordinate all supports and services for an individual if necessary in the future. The regulatory revisions are necessary to ensure that ODP has the necessary authority to enforce the new requirements and protect the health and welfare of individuals receiving services.
Fiscal Impact
There is no cost associated with clarifying and updating plan regulations for the Commonwealth, local government or individuals receiving services. The regulation work group identified one additional cost to providers related to copies of reviews and assessment information that are required to be sent to them on a quarterly basis. This information previously was only sent to the Supports Coordinator and the individual. It will now be sent to the individual's family, if appropriate, as well. However, a provision allows families to opt not to receive this information. Electronic distribution of materials to families is permitted if the family has a means to receive and read information in electronic form. Mailing and copying costs should be minimal for providers. Additionally, because the regulations clarify that only the form approved by the Department will be accepted as the IP, providers who create both a regulatory IPP and the Department-requested ISP can cease this practice. Regulations will allow for the single IP document which will eliminate the cost of staff time in creating a second document.
Paperwork Requirements
Providers will need to provide copies of their assessment information and three month review summary to individuals and families. The amount of paperwork will depend on the page count of each provider's assessment information and the three month review summary. The proposed regulations permit electronic distribution. The proposed regulations add a 30-day time frame for providers to send review summary information to individuals and families. The proposed amendments also state that the provider must forward assessment data to be used during the plan meeting to planning team members no later than 30 days before the meeting. No new forms are required by the amended regulations.
Effective Date
This regulatory amendments will be effective upon final publication in the Pennsylvania Bulletin.
Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding the proposed rulemaking to the Department at the following address: Wendy Dixon, Human Services Program Specialist, Office of Developmental Programs, Department of Public Welfare, P. O. Box 2675, Harrisburg, PA 17105-2675, ra-odpregscomment@state.pa.us, within 30 calendar days after the date of publication of this proposed rulemaking in the Pennsylvania Bulletin. Reference Regulation No. 14-512 when submitting comments.
Persons with a disability who require an auxiliary aid or service may submit comments by using the AT&T Relay Service at (800) 654-5984 (TTY users) or (800) 654-5988 (voice users).
Regulatory Review Act
Under section 5(a) of the Regulatory Review Act (act) (71 P. S. § 745.5(a)), on April 16, 2008, the Department submitted a copy of this proposed rulemaking to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare. In addition to submitting the proposed rulemaking, the Department has provided the IRRC and the Committees with a copy of a Regulatory Analysis Form prepared by the Department. A copy of this form is available to the public upon request.
Under section 5(g) of the act, if the IRRC has any comments, recommendations or objections to any portion of the proposed regulation, it may notify the Department and the Committees within 30 days after the close of the public comment period. The notification shall specify the regulatory review criteria that have not been met. The act specifies detailed procedures for review by the Department, the General Assembly and the Governor, of any comments, recommendations or objections raised, prior to final publication of the regulations.
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-512. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 55. PUBLIC WELFARE
PART IV. ADULT SERVICES MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICE
CHAPTER 2380. ADULT TRAINING FACILITIES
GENERAL PROVISIONS § 2380.3. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * [IPP--Individual Program Plan.]
IP--Individual plan--The form provided by the Department which identifies services and supports needed and used by an individual.
* * * * * Supports coordinator--The individual responsible for case management functions.
STAFFING § 2380.33. Program specialist.
* * * * * (b) [A program specialist shall be responsible for the program at the facility, including the following:
(1) Coordination or completion of assessments.
(2) Coordination or development and review of IPPs.
(3) Coordination of training and development for individuals.
(4) Development of planned program activities.
(5) Participation in interdisciplinary team meetings.
(6) Ensurance of the implementation of IPPs and program activities.]
The program specialist shall be responsible for the following:
(1) Coordinating and developing training for individuals.
(2) Coordinating and completing assessments.
(3) Participating in the development of the IP.
(4) Attending the IP development meetings.
(5) Providing the completed assessment and other relevant information for the development of the IP prior to the planning meetings to the supports coordinator, individual, and, if appropriate, to the individual's parent, guardian or advocate. The program specialist shall send this information within 30 days following the receipt of notification of the planning meeting.
(6) Reviewing the IP for content accuracy.
(i) Content discrepancies shall be communicated to the supports coordinator in writing.
(ii) Written documentation of content discrepancy communications shall be maintained in the individual's record.
(7) Ensuring the implementation of IP outcomes.
(8) Coordinating the training of direct support professionals in the content of relevant IPs.
(9) Monitoring services provided for the individual.
(10) Ensuring monthly documentation of the individual's participation and progress for IP outcomes.
(11) Providing quarterly documentation of the individual's participation and progress for the IP outcomes to the supports coordinator, individual, and, if appropriate, the individual's parent, guardian or advocate.
(12) Informing the individual and, if appropriate, the individual's parent, guardian or advocate of the option not to receive a copy of the assessments or quarterly documentation.
(13) Maintaining documentation of an individual's or the individual's parent, guardian or advocate's request denying a copy of assessment or quarterly documentation.
(14) Documenting and reporting changes in the individual's needs, interests and personal goals to the supports coordinator, and, if appropriate, the individual's parent, guardian or advocate.
(c) If the individual does not have an assigned supports coordinator, the program specialist shall coordinate the development of the IP.
(d) If the individual does not have an assigned supports coordinator, the program specialist shall prepare the IP using the Department approved format.
(e) If the individual does not have an assigned supports coordinator, the program specialist shall provide the individual, and, if appropriate, the individual's parent, guardian or advocate with a copy of the IP and attendance sheet.
(1) The individual or individual's parent, guardian or advocate may decline in writing to receive copies of the IP or attendance sheet.
(2) The program specialist shall maintain a copy of the written request.
[(c)] (f) * * *
* * * * * § 2380.35. Staffing.
* * * * * (d) An individual may be left unsupervised for specified periods of time if the absence of direct supervision is consistent with the individual's assessment and is part of an individual's [IPP] IP aimed at achieving a higher level of independence.
(e) Direct staff support as specified in the IP shall be implemented as written.
(f) Staffing ratios specified in the IP shall be implemented as written.
[(e)] (g) An individual may not be left unsupervised solely for the convenience of the facility or staff persons.
PROGRAM § 2380.101. Program activities and services.
* * * * * (c) Program activities and services shall be provided as specified in each [IPP] IP.
* * * * * § 2380.103. Development of [IPP] the IP.
[(a) An IPP shall be developed for each individual based upon the individual assessment, within 30 individual attendance days after the individual's admission date.] For individuals without a supports coordinator the following apply:
(1) The program specialist shall prepare an IP for each individual based upon the individual's assessment information.
(2) The program specialist shall complete the IP within 30 days after the individual's admission date.
[(b) The IPP] (3) The IP shall be developed by the [interdisciplinary] individual's planning team.
[(c)] (4) Members of the [interdisciplinary] individual's planning team at a minimum shall include the individual, the program specialist, [the individual's parent, guardian or advocate, if appropriate,] direct service staff persons who work with the individual, [staff persons from the funding agency,] and if applicable and appropriate, the individual's parent, guardian or advocate, staff persons from the individual's residential program[, if applicable,] and other specialists, such as medical, nursing, behavior management, speech, occupational or physical therapy specialists [if appropriate for the individual's special needs].
(5) The program specialist shall send invitations to each planning team member for each IP development meeting.
(6) The program specialist shall maintain a copy of the invitation and attendance sheet with the IP in the individual's file.
[(d)] (7) At least three members of the [interdisciplinary] individual's planning team, in addition to the individual if the individual chooses to attend, shall be present at the [interdisciplinary] individual's planning team meeting at which the [IPP] IP is developed.
[(e)] (8) Members of the [interdisciplinary] individual's planning team who attend the meeting to develop the [IPP] IP shall sign and date the [IPP] IP attendance sheet to indicate participation.
(9) The IP shall be reviewed and updated by the planning team annually, or more frequently if the individual's needs change.
(10) The program specialist shall send a copy of the attendance sheet and the IP to each member of the planning team unless the member does not want a copy.
(11) If a member of the individual's planning team denies a copy of the IP or attendance sheet, the program specialist shall maintain a copy of the written denial in the individual's record.
§ 2380.104. Review[, update, and rewrite] of [IPP] the IP.
[(a) A review of each individual's progress on the IPP, and a revision of the IPP if necessary, shall be completed or coordinated by the program specialist at least every 65 individual attendance days.
(b) The IPP shall be revised in accordance with subsection (a) if there has been no progress on a goal, if a goal is no longer appropriate or if a goal needs to be added.
(c) The IPP shall be reviewed and rewritten by the interdisciplinary team at least annually.
(d) At least three members of the interdisciplinary team, in addition to the individual if the individual chooses to attend, shall be present at the annual interdisciplinary team meeting at which the IPP is reviewed and rewritten.
(e) Members of the interdisciplinary team who attend the meeting to rewrite the IPP shall sign and date the new IPP.
(f) The IPP shall be discussed with, dated by and signed by the individual, the individual's parent, guardian or advocate if appropriate, and the program specialist after each 65-day review and annual rewrite of the IPP.]
(a) A review of each individual's progress on the IP shall be completed by the program specialist and the individual, and, if appropriate, the individual's parent, guardian or advocate, every 3 months, or more frequently if the individual's needs change.
(b) A revision of the IP, if necessary, shall be communicated to the supports coordinator, individual, and, if appropriate, the individual's parent, guardian or advocate.
(c) The IP shall be revised if one of the following apply:
(1) There has been no progress on an outcome.
(2) An outcome is no longer appropriate.
(3) An outcome is added.
§ 2380.105. Participation in the development of the [IPP] IP.
[The individual's parent, guardian or advocate, if appropriate, and the funding agency shall be invited, in writing, to participate in the initial development and annual rewrite of the IPP. A copy of the written invitations shall be kept.]
(a) The program specialist shall provide assessment information for the development and revision of an IP.
(b) The program specialist shall participate in the development and revision of the IP.
§ 2380.106. Content of [IPP] the IP.
[Each IPP shall include:
(1) The goals for the individual in specific areas of growth and development.
(2) An evaluation of the individual's skill level for each goal.
(3) Monthly documentation of the individual's progress on each goal.
(4) Specific activities and services that meet the needs of the individual.
(5) A program and schedule for allowing the individual to be without direct staff supervision for specific periods of time, aimed at achieving a greater level of independence, if the individual's assessment states the individual may be without direct supervision.
(6) A planned program to address the social, emotional and environmental needs of the individual, if a medication is prescribed to treat maladaptive behavior.]
(a) For individuals with a supports coordinator, the program specialist shall review the IP for the following:
(1) Outcomes addressing the individual's needs.
(2) Specific activities and services that reflect the individual's needs, interests and personal goals.
(3) Time frames for expected completion of outcomes.
(4) An evaluation of the individual's skill level for each outcome.
(5) A program and schedule outlining specified periods of time for the individual to be without direct supervision, aimed at achieving a greater level of independence, if the absence of direct supervision is consistent with the individual's assessment.
(6) Method of evaluation used to determine the progress towards each outcome.
(7) A program to address the social, emotional and environmental needs of the individual, if medication has been prescribed to treat maladaptive behavior.
(8) A program to address the reduction of a restrictive procedure, if restrictive procedures are used in response to a maladaptive behavior.
(b) The program specialist shall document missing or incomplete items from the IP.
(c) The program specialist shall report missing or incomplete items from the IP in writing to the supports coordinator.
(d) For individuals without a supports coordinator, the program specialist shall prepare the IP including the items in subsection (a)(1)--(8).
§ 2380.107. Implementation of [IPP] the IP.
[Each IPP] Each IP shall be implemented as written.
§ 2380.108. Copies of [IPP] the IP.
(a) A [written] copy of [IPPs] the IP and [adjustments] revisions made during reviews shall be kept in the individual's record.
(b) [The individual, the individual's parent, guardian or advocate, if appropriate, the residential service provider, if applicable, and the funding agency shall be provided with a copy of all IPPs. Documentation of transmittal of each IPP shall be kept.]
The program specialist shall send the written summary of each 3-month review to the supports coordinator, individual, and, if appropriate, the individual's parent, guardian or advocate within 30 days after the completion of the review.
(c) If the individual, or the individual's parent, guardian or advocate, denies a copy of a written summary, the program specialist shall maintain the signed written denial.
MEDICATIONS § 2380.123. Use of prescription medications.
* * * * * (b) If a medication is prescribed to treat maladaptive behavior, there shall be a [planned] program [as part of the IPP] to address the social, emotional and environmental needs of the individual related to the maladaptive behavior as part of the IP.
RECORDS § 2380.173. Content of records.
Each individual's record [shall] must include:
* * * * * (5) [IPPs] IP.
* * * * *
CHAPTER 2390. VOCATIONAL FACILITIES
GENERAL PROVISIONS § 2390.5. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * IP--Individual plan--The form provided by the Department which identifies services and supports needed and used by an individual.
[Individual written program plan--A plan that is developed for a client on the basis of assessment data that specifies specific objectives and program services for the clients.]
* * * * * Supports coordinator--The individual responsible for case management functions.
* * * * *
STAFFING § 2390.33. Program specialist.
* * * * * (b) [A program specialist shall be responsible for the program at the facility, including the following:
(1) Development and implementation of individual written program plans.
(2) Coordination of training and development for clients.]
The program specialist shall be responsible for the following:
(1) Coordinating and developing training for clients.
(2) Coordinating and completing assessments.
(3) Participating in the development of the IP.
(4) Attending the IP development meetings.
(5) Providing the completed assessment and other relevant information for the development of the IP prior to the planning meetings to the supports coordinator, client and, if appropriate, to the client's parent, guardian or advocate. The program specialist shall send this information within 30 days following the receipt of notification of the planning meeting.
(6) Reviewing the IP for content accuracy.
(i) Content discrepancies shall be communicated to the supports coordinator in writing.
(ii) Written documentation of content discrepancy communications shall be maintained in the client's record.
(7) Ensuring the implementation of IP outcomes.
(8) Coordinating the training of direct support professionals in the content of relevant IPs.
(9) Monitoring services provided for the client.
(10) Ensuring monthly documentation of the client's participation and progress for IP outcomes.
(11) Providing quarterly documentation of the client's participation and progress for IP outcomes to the supports coordinator, client, and, if appropriate, the client's parent, guardian or advocate.
(12) Informing the client and, if appropriate, the client's parent, guardian or advocate of the option not to receive a copy of the assessments or quarterly documentation.
(13) Maintaining documentation of a client's or the client's parent, guardian or advocate's request denying a copy of assessment or quarterly documentation.
(14) Documenting and reporting changes in the client's needs, interests and personal goals to the supports coordinator and, if appropriate, the client's parent, guardian or advocate.
(c) If the client does not have an assigned supports coordinator, the program specialist shall coordinate the development of the IP.
(d) If the client does not have an assigned supports coordinator, the program specialist shall prepare the IP using the Department approved format.
(e) If the client does not have an assigned supports coordinator, the program specialist shall provide the client and, if appropriate, the client's parent, guardian or advocate with a copy of the IP and attendance sheet.
(1) The client or client's parent, guardian or advocate may decline in writing to receive copies of the IP or attendance sheet.
(2) The program specialist shall maintain a copy of the written request.
[(c)] (f) * * *
* * * * *
PROGRAM § 2390.91. Activities and services.
Activities and services for a client [shall] must include work experience and other developmentally oriented, work training [activities] endeavors designed to promote movement into a higher level vocational program or into competitive employment. Activities and services shall be provided as specified in the [individual written program plan] IP.
§ 2390.95. Development of the [individual written program plan] IP.
[(a) An individual written program plan shall be developed for a client within 30 client attendance days of the client's admission date.
(b) The plan shall be developed by the interdisciplinary team. The members of the interdisciplinary team shall sign and date the plan.]
For client's without a supports coordinator, the following apply:
(1) The program specialist shall prepare an IP for each client based on the client's assessment information.
(2) The program specialist shall complete the IP within 60 days after the client's admission date.
(3) The IP shall be developed by the client's planning team.
(4) Members of the client's planning team at a minimum shall include the client, the program specialist, the direct service staff who work with the client, and if applicable and appropriate, the client's parent, guardian or advocate, the staff person from the individual's residential program, and other specialists, such as medical, nursing, behavior management, speech, occupational or physical therapists, if appropriate, for the individual's needs.
(5) The program specialist shall send invitations to each planning team member for each IP development meeting.
(6) At least three members of the planning team, in addition to the client if the client chooses to attend, shall be present at the planning team meeting at which the IP is developed.
(7) Members of the planning team shall sign and date the attendance sheet to indicate participation in the IP development meeting.
(8) The program specialist shall retain a copy of the invitation and attendance sheet in the client's file.
(9) A copy of the attendance sheet shall be sent to each member of the planning team.
(10) The program specialist shall send a copy of the attendance sheet and the IP to each member for the client's planning team unless the member does not want a copy.
(11) If a member of the client's planning team denies a copy of the IP or attendance sheet, the program specialist shall maintain a copy of the written denial in the client's record.
§ 2390.96. Content of [individual written program plan] the IP.
[The plan shall include the following information:
(1) Specific short term objectives including measurable steps for completion.
(2) Evaluation of client's current skill level in the area of the objective.
(3) Time frames for expected completion of objectives.
(4) Method of evaluation used to determine mastery of objective.
(5) Service areas to which the client will be assigned.
(6) Staff responsible for the outcome of the individual written program plan.
(7) Assessment of the client's placement potential.]
(a) For clients with a supports coordinator, the program specialist shall review the IP for the following items:
(1) Outcomes addressing the client's needs.
(2) Specific activities and services that reflect the client's needs and interests.
(3) Time frames for expected completion of outcomes.
(4) An evaluation of the client's skill level for each outcome.
(5) A program and schedule outlining specified periods of time for the individual to be without direct supervision, aimed at achieving a greater level of independence, if the absence of direct supervision is consistent with the individual's assessment.
(6) Method of evaluation used to determine the progress towards each outcome.
(7) Services areas to which the client will be assigned.
(8) Assessment of the client's potential to achieve competitive employment placement potential.
(b) The program specialist shall document missing or incomplete items from the IP.
(c) The program specialist shall report missing or incomplete items from the IP in writing to the supports coordinator.
(d) For clients without a supports coordinator, the program specialist shall prepare the IP including items listed in subsection (a)(1)--(8).
§ 2390.97. Review[, update and rewrite] of [individual written program plan] the IP.
(a) [The plan for clients, except those clients in a training program, shall be reviewed and updated by the program specialist at least every 65 client attendance days.
(b) The plan for clients in a training program shall be reviewed and updated by the program specialist at least every 20 client attendance days.
(c) The plan shall be discussed with the client and signed by the program specialist and the client and dated after each review.
(d) The plan shall be reviewed and rewritten by the interdisciplinary team at least annually. The members of the interdisciplinary team shall sign and date the revised plan.]
A review of each client's progress on the IP, except those clients in a training program, shall be completed by the program specialist and the client, and, if appropriate, the client's parent, guardian or advocate every 3 months, or more frequently if the client's needs change.
(b) A progress review of the IP for clients in a training program shall be completed by a program specialist and the client and, if appropriate, the client's parent, guardian or advocate every 20 days, or more frequently if the individual's needs change.
(c) A revision of the IP, if necessary, shall be communicated to the supports coordinator, client, and, if appropriate, the client's parent, guardian or advocate.
(d) The IP shall be revised if any of the following occur:
(1) There has been no progress on an outcome.
(2) An outcome is no longer appropriate.
(3) An outcome is added.
§ 2390.98. Copies of [individual written program plan] the IP.
(a) A [written] copy of the [plan and adjustments] IP and revisions made during reviews shall be kept in the client's file.
(b) [The client, or parent or guardian when appropriate, shall be invited, in writing, to participate in the initial development and reviews of the program plan. A copy of the written invitations shall be kept in the client's file.
(c) A client, parent or guardian shall be provided with a copy of a plan.]
The program specialist shall send the written summary of each 3-month review to the supports coordinator, the client and, if appropriate, the client's parent, guardian or advocate within 30 days after the completion of the review.
(c) If the client, or the client's parent, guardian or advocate, denies a copy of the written summary, the program specialist shall maintain the signed written denial.
CLIENT RECORDS § 2390.124. Content of records.
A client's record [shall] must include the following information:
* * * * * (8) [Copies of individual written program plans or work performance reviews.
(9) A copy of a written invitation to participate in individual written program plan reviews.]
Copies of IPs and revisions made during reviews.
(9) Copies of work performance reviews.
* * * * *
PART VIII. MENTAL RETARDATION MANUAL
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
Article I. LICENSING/APPROVAL
CHAPTER 6400. COMMUNITY HOMES FOR INDIVIDUALS WITH MENTAL RETARDATION
GENERAL PROVISIONS § 6400.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * [IPP--Individual program plan.]
IP--Individual plan--The form provided by the Department which identifies services and supports needed and used by an individual.
* * * * * Supports coordinator--The individual responsible for case management functions.
STAFF § 6400.44. Program specialist.
* * * * * (b) [A program specialist shall be responsible for the program at the home, including the following:
(1) The individual's daily activities.
(2) Coordination or completion of assessments.
(3) Coordination or development and review of individual program plans.
(4) Coordination of training and development for individuals.
(5) Development of planned program activities.
(6) Participation in planning team meetings.
(7) Ensurance of the implementation of individual program plans and program activities.]
The program specialist shall be responsible for the following:
(1) Supervising the individual's daily activities.
(2) Coordinating and completing assessments.
(3) Participating in the development of the IP.
(4) Attending the IP development meetings.
(5) Providing completed assessment and other relevant information for the development of the IP prior to the planning meetings to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate. The program specialist shall send this information within 30 days following the receipt of notification of the planning meeting.
(6) Reviewing the IP for content accuracy.
(i) Content discrepancies shall be communicated in writing to the supports coordinator.
(ii) Written documentation of content discrepancy communications shall be maintained in the individual's record.
(7) Ensuring the implementation of IP outcomes.
(8) Coordinating the training of direct support professionals in the content of relevant IPs.
(9) Monitoring services provided for the individual.
(10) Ensuring monthly documentation of the individual's participation and progress for IP outcomes.
(11) Providing quarterly documentation of the individual's participation and progress for IP outcomes to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate.
(12) Informing the individual and, if appropriate, the individual's parent, guardian or advocate of the option not to receive a copy of the assessments or quarterly documentation.
(13) Maintaining documentation of an individual's or the individual's parent, guardian or advocate's request denying a copy of the assessment or quarterly documentation.
(14) Documenting and reporting changes in the individual's needs, interests or personal goals to the supports coordinator and, if appropriate, the individual's parent, guardian or advocate.
(c) If the individual does not have an assigned supports coordinator, the program specialist shall coordinate the development of the IP.
(d) If the individual does not have an assigned supports coordinator, the program specialist shall prepare the IP using the Department approved format.
(e) If the individual does not have an assigned supports coordinator, the program specialist shall provide the individual and, if appropriate, the individual's parent, guardian or advocate with a copy of the IP and attendance sheet.
(1) The individual or the individual's parent, guardian or advocate may decline in writing to receive copies of the IP or attendance sheet.
(2) The program specialist shall maintain a copy of the written request.
[(c)] (f) * * *
* * * * * § 6400.45. Staffing.
* * * * * (c) An individual may be left unsupervised for [specific] specified periods of time if the absence of direct supervision is consistent with the individual's assessment and is part of the [IPP] IP aimed at achieving a higher level of independence.
(d) Direct staff support as specified in the IP shall be implemented as written.
(e) Staffing ratios specified in the IP shall be implemented as written.
[(d)] (f) An individual may not be left unsupervised solely for the convenience of the home or the staff.
PROGRAM § 6400.122. Development of the [IPP] IP.
[(a) An IPP shall be developed for each individual, based on the individual assessment, within 60 calendar days of the individual's admission date.] For individuals without a supports coordinator, the following apply:
(1) The program specialist shall prepare an IP for each individual based upon the individual's assessment information.
(2) The program specialist shall complete the IP within 60 days after the individual's admission date.
[(b) The IPP] (3) The IP shall be developed by [an interdisciplinary] the individual's planning team.
[(c)] (4) Members of the [interdisciplinary] individual's planning team at a minimum shall include the individual, [the individual's direct care staff,] the program specialist, [the individual's parent, quardian or advocate, if appropriate,] direct staff persons who work with the individual, and if applicable and appropriate, the individual's parent, guardian or advocate, [the county case manager if the individual is funded through the county mental retardation program,] the program specialist for the individual's day program, and other specialists, such as medical, nursing, behavior management, speech, occupational, or physical therapy specialists [if appropriate for the individual's special needs].
(5) The program specialist shall send invitations to each planning team member for each IP development meeting.
(6) The program specialist shall maintain a copy of the invitation and attendance sheet with the IP in the individual's file.
[(d)] (7) At least three members of the [interdisciplinary] individual's planning team, in addition to the individual if the individual chooses to attend, shall be present at the [interdisciplinary] individual's planning team meeting at which the [IPP] IP is developed.
[(e)] (8) Members of the [interdisciplinary] individual's planning team who attend the meeting to develop the [IPP] IP shall sign and date the [IPP] IP attendance sheet to indicate participation.
(9) The IP shall be reviewed and updated by the planning team annually, or more frequently if the individual's needs change.
(10) The program specialist shall send a copy of the attendance sheet and the IP to each member of the planning team unless the member does not want a copy.
(11) If a member of the individual's planning team denies a copy of the IP or attendance sheet, the program specialist shall maintain a copy of the written denial in the individual's record.
§ 6400.123. Review[, revision and rewrite] of the [IPP] IP.
(a) [A review of each individual's progress on the IPP and a revision of the IPP, if necessary, shall be completed or coordinated by the program specialist at least every 3 months.
(b) The IPP shall be revised in accordance with subsection (a) if there has been no progress on a goal, if a goal is no longer appropriate or if a goal needs to be added.
(c) The IPP shall be reviewed and rewritten by the interdisciplinary team at least annually.
(d) At least three members of the interdisciplinary team, in addition to the individual if the individual chooses to attend, shall be present at the annual interdisciplinary team meeting at which the IPP is reviewed and rewritten.
(e) Members of the interdisciplinary team who attend the meeting to rewrite the annual IPP shall sign and date the new IPP.
(f) The IPP shall be discussed with, dated by and signed by the individual, the individual's parent, guardian or advocate if appropriate and the program specialist after each 3-month review and annual rewrite of the IPP.]
A review of each individual's progress on the IP shall be completed by the program specialist, and the individual and, if appropriate, the individual's parent, guardian or advocate, every 3 months, or more frequently if the individual's needs change.
(b) A revision of the IP, if necessary, shall be communicated to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate.
(c) The IP shall be revised if any of the following occur:
(1) There has been no progress on an outcome.
(2) An outcome is no longer appropriate.
(3) An outcome needs to be added.
§ 6400.124. Participation in the development of the [IPP] IP.
[The individual's parent, guardian or advocate if appropriate and the county case manager if the individual is funded through the county mental retardation program shall be invited, in writing, to participate in the initial development and the annual rewrite of the IPP. A copy of the written invitations shall be kept.]
(a) The program specialist shall provide assessment information for the development and revision of the IP.
(b) The program specialist shall participate in the development and revision of the IP.
§ 6400.125. Content of the [IPP] IP.
[An IPP shall include:
(1) The goals for the individual in specific areas of growth and development.
(2) An evaluation of the individual's skill level for each goal.
(3) Monthly documentation of the individual's progress on each goal.
(4) A plan for the individual to participate in community life.
(5) Specific activities and services that meet the needs of the individual.
(6) A program and schedule for allowing the individual to be without direct staff supervision for specific periods of time, aimed at achieving a greater level of independence, if the individual's assessment states the individual may be without direct supervision.
(7) A planned program to address the social, emotional and environmental needs of the individual, if a medication is prescribed to treat maladaptive behavior.]
(a) For individuals with a supports coordinator, the program specialist shall review the IP for the following:
(1) Outcomes addressing the individual's needs.
(2) Specific activities and services that reflect the individual's needs, interests and personal goals.
(3) Time frames for expected completion of outcomes.
(4) An evaluation of the individual's skill level for each outcome.
(5) A program and schedule outlining specified periods of time for the individual to be without direct supervision, aimed at achieving a greater level of independence, if the absence of direct supervision is consistent with the individual's assessment.
(6) Method of evaluation used to determine the progress towards each outcome.
(7) A program to address the social, emotional and environmental needs of the individual, if medication is prescribed to treat maladaptive behavior.
(8) A program to address the reduction of a restrictive procedure, if restrictive procedures are used in response to a maladaptive behavior.
(b) The program specialist shall document missing or incomplete items from the IP.
(c) The program specialist shall report missing or incomplete items from the IP in writing to the supports coordinator.
(d) For individuals without a supports coordinator, the program specialist shall prepare the IP including the items in subsection (a)(1)--(8).
§ 6400.126. Implementation of the [IPP] IP.
[An IPP] Each IP shall be implemented as written.
§ 6400.127. Copies of the [IPP] IP.
(a) A copy of [IPPs] the IP and [adjustments] revisions made during reviews shall be kept in the individual's record.
(b) The program specialist shall send a written summary of each 3-month review to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate, within 30 days after the completion of the review.
(c) If the individual, or the individual's parent, guardian or advocate, denies a copy of a written summary, the program specialist shall maintain the signed written denial.
(d) * * *
MEDICATIONS § 6400.163. Use of prescription medications.
* * * * * (b) If a medication is prescribed to treat maladaptive behavior, there shall be a [planned] program [as part of the IPP] to address the social, emotional and environmental needs of the individual related to the maladaptive behavior as part of the IP.
* * * * *
INDIVIDUAL RECORDS § 6400.213. Content of records.
Each individual's record [shall] must include:
* * * * * (7) [ IPPs] IP.
* * * * *
CHAPTER 6500. FAMILY LIVING HOMES
GENERAL PROVISIONS § 6500.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * [IPP--Individual program plan.]
IP--Individual plan--The form provided by the Department which identifies services and supports needed and used by an individual.
* * * * * Supports coordinator--The individual responsible for case management functions.
STAFFING § 6500.43. Family living specialist.
* * * * * [(d) A family living specialist shall be responsible for the program at the home, including the following:
(1) Supervision and evaluation of services provided for the individual.
(2) Coordination of support services for the family.
(3) Completion or coordination of individual assessments.
(4) Development, review, update and revision of IPPs.
(5) Ensurance of the implementation of IPPs.]
(d) The family living specialist shall be responsible for the following:
(1) Coordinating and completing individual assessments.
(2) Coordinating the training for family members.
(3) Participating in the development of the IP.
(4) Attending the IP development meetings.
(5) Providing completed assessment and other relevant information for the development of the IP prior to the planning meetings to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate. The family living specialist shall send this information within 30 days following the receipt of notification of the planning meeting.
(6) Reviewing the IP for content accuracy.
(i) Content discrepancies shall be communicated in writing to the supports coordinator.
(ii) Written documentation of content discrepancy communications shall be maintained in the individual's record.
(7) Ensuring the implementation of IP outcomes.
(8) Monitoring services provided for the individual.
(9) Orienting the family on the content of the IP.
(10) Ensuring monthly documentation of the individual's participation progress for IP outcomes.
(11) Providing quarterly documentation of the individual's participation and progress for IP outcomes to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate.
(12) Informing the individual and, if appropriate, the individual's parent, guardian or advocate of the option not to receive a copy of the assessment or quarterly documentation.
(13) Maintaining documentation of an individual's or the individual's parent, guardian or advocate's request denying a copy of assessment or the quarterly assessment.
(14) Documenting and reporting changes in the individual's needs, interests or personal goals to the supports coordinator and, if appropriate, the individual's parent, guardian or advocate.
(15) Meeting with the individual at his home once a month or more frequently as indicated by the individual's IP.
(e) If the individual does not have an assigned supports coordinator, the family living specialist shall coordinate the development of the IP.
(f) If the individual does not have an assigned supports coordinator, the family living specialist shall provide the individual and, if appropriate, the individual's parent, guardian or advocate with a copy of the IP and attendance sheet.
(1) The individual or the individual's parent, guardian or advocate may decline in writing to receive copies of the IP or attendance sheet.
(2) The program specialist shall maintain a copy the written request.
[(e)] (g) * * *
* * * * * § 6500.44. Supervision.
(a) An individual may not be left unsupervised with a person who is not 18 years of age or older, unless the absence of direct supervision is consistent with the individual's assessment and is part of the [IPP] IP aimed at achieving semi-independence.
* * * * *
PROGRAM § 6500.112. Development of the [IPP] IP.
[(a) An IPP shall be developed for each individual, based in the individual's assessment, within 3 months after the individual lives in the home.
(b) The IPP shall be developed by the family living specialist in conjunction with the individual and the family.
(c) The family living specialist and the family members who assisted in developing the IPP shall sign and date the IPP.]
For individuals without a supports coordinator, the following apply:
(1) The family living specialist shall prepare an IP for each individual based upon the individual's assessment information.
(2) The family living specialist shall complete the IP within 90 days after the individual lives in the home.
(3) The IP shall be developed by the individual's planning team.
(4) Members of the individual's planning team at a minimum shall include the individual, the family and, if applicable and appropriate, the individual's parent, guardian or advocate, the program specialist for the individual's day service, and other specialists, such as medical, nursing, behavior management, speech, occupational or physical therapy specialists.
(5) The family living specialist shall send invitations to each planning team member for each IP development meeting.
(6) The family living specialist shall maintain a copy of the invitation and attendance sheet with the IP in the individual's file.
(7) Members of the individual's planning team who attend the meeting to develop the IP shall sign and date the IP attendance sheet to indicate participation.
(8) The IP shall be reviewed and updated by the planning team annually, or more frequently if the individual's needs change.
(9) The family living specialist shall send a copy of the attendance sheet and the IP to each member of the planning team unless the member does not want a copy.
(10) If a member of the individual's planning team denies a copy of the IP or attendance sheet, the program specialist shall maintain a copy of the written denial in the individual's record.
§ 6500.113. Review[, revision and rewrite] of the [IPP] IP.
(a) [The IPP shall be reviewed and revised if necessary, by the family living specialist in conjunction with the individual and the family at least every 3 months.
(b) The IPP shall be revised in accordance with subsection (a) if there has been no progress on a goal, if a goal is no longer appropriate or if a goal needs to be added.
(c) The IPP shall be reviewed and rewritten by the family living specialist in conjunction with the individual and the family at least every 12 months.
(d) The IPP shall be discussed with, dated by and signed by the individual, the individual's parent, guardian or advocate if appropriate, the family living specialist and the family members who assisted in revising or rewriting the IPP after each 3 month review and annual rewrite of the IPP.]
A review of each individual's progress on the IP shall be completed by the family living specialist in conjunction with the individual, the family and, if appropriate, the individual's parent, guardian or advocate every 3 months, or more frequently if the individual's needs change.
(b) A revision of the IP, if necessary, shall be communicated to the supports coordinator, family, individual and, if appropriate, the individual's parent, guardian or advocate.
(c) The IP shall be revised if any of the following occur:
(1) There has been no progress on an outcome.
(2) An outcome is no longer appropriate.
(3) An outcome needs to be added.
§ 6500.114. Participation in the development of the [IPP] IP.
[The individual's parent, guardian or advocate if appropriate and the county case manager if the individual is funded through the county mental retardation program shall be invited, in writing, to participate in the initial development and the annual rewrite of the IPP. A copy of the written invitations shall be kept.]
(a) The family living specialist shall provide assessment information for the development and revision of the IP.
(b) The family living specialist shall participate in the development and revision of the IP.
§ 6500.115. Content of the [IPP] IP.
[Each IPP shall include:
(1) Goals for the individual in specific areas of growth and development.
(2) An evaluation of the individual's skill level for each goal.
(3) Monthly documentation of the individual's progress on each goal.
(4) A plan for the individual to participate in community and family life.
(5) Specific activities and services that meet the needs of the individual.
(6) A program and schedule for allowing the individual to be without direct supervision for specific periods of time, aimed at achieving a greater level of independence, if the individual's assessment states the individual may be without direct supervision.
(7) A planned program to address the social, emotional and environmental needs of the individual, if a medication is prescribed to treat maladaptive behavior.]
(a) For individuals with a supports coordinator, the family living specialist shall review the IP for the following items.
(1) Outcomes addressing the individual's needs.
(2) Specific activities and services that reflect the individual's needs, interests and personal goals.
(3) Time frames for expected completion of outcomes.
(4) An evaluation of the individual's skill level for each outcome.
(5) A program for the individual to participate in community life activities reflecting the individual's interests.
(6) A program and schedule outlining specified periods of time for the individual to be without direct supervision, aimed at achieving a greater level of independence, if the absence of direct supervision is consistent with the individual's assessment.
(7) A program to address the social and emotional needs of the individual, if medication is prescribed to treat maladaptive behavior.
(8) A program to address the reduction of a restrictive procedure, if restrictive procedures are used in response to maladaptive behavior.
(b) The family living specialist shall document missing or incomplete items from the IP.
(c) The family living specialist shall report missing or incomplete items from the IP in writing to the supports coordinator.
(d) For individuals without a supports coordinator, the family living specialist shall prepare the IP including the items in subsection (a)(1)--(8).
§ 6500.116. Implementation of the [IPP] IP.
The [IPP] IP shall be implemented as written.
§ 6500.117. Copies of the [IPP] IP.
(a) A copy of all [IPPs] IPs and revisions shall be kept in the individual's record.
(b) [The individual, the individual's parent, guardian or advocate, if appropriate, and the county case manager if the individual is funded through the county mental retardation program, and the individual's day service facility shall be provided a copy of all IPPs. Documentation of transmittal of each IPP shall be kept.]
The family living specialist will send a written summary of each 3-month review to the supports coordinator, individual and, if appropriate, the individual's parent, guardian or advocate within 30 days after the completion of the review.
(c) If the individual or the individual's parent, guardian or advocate denies a copy of a written summary, the family living specialist shall maintain the signed written denial.
MEDICATIONS § 6500.133. Use of prescription medications.
* * * * * (b) If a medication is prescribed to treat maladaptive behavior, there shall be a [planned] program [as part of the IPP] to address the social, emotional and environmental needs of the individual related to the maladaptive behavior as part of the IP.
* * * * *
INDIVIDUAL RECORDS § 6500.182. Individual records.
* * * * * (c) Each individual's record [shall] must include:
* * * * * (6) [IPPs] IP.
* * * * *
[Pa.B. Doc. No. 08-788. Filed for public inspection April 25, 2008, 9:00 a.m.]
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