Instructions for Reassessing Individual Support Needs

Reassessments differ from assessments in that a reassessment typically occurs on an interim basis (i.e., between the annual assessment and semi-annual updates) and is typically looking at a specific part of the individual’s plan, rather than all aspects. Reassessments occur for a variety of reasons (safety, protection, change in support need, change in desired outcomes, administrative adjustments and temporary situations requiring temporary program changes) and may be requested by any of the people involved, including the guardian, the individual who does not have a guardian, the provider of support, the support broker, or concerned others. The support broker has the responsibility for organizing the reassessment.

Implementing the results of the reassessment may result in:

  • An increase in service.
  • A decrease in service.
  • The addition of a service.
  • The termination of a service.
  • A substitution of a service.
  • A change in model of support.
  • A change in environment.
  • Or a short-term version of any of these.

The re-assessment should (with the exception of emergency/crisis), include:

  • The individual;
  • The guardian (if applicable);
  • The support team members involved in the particular issue to be addressed;
  • Any other people that the individual wants included and can provide written informed consent for inclusions; and,
  • Other specialists, if needed.

For all reassessments, the Reassessment of Individual Support Needs form must be completed.

The support broker must determine if the change of service plan will result in a reduction, termination or formal suspension of a service. For each changed service:

  1. Determine if the service a Medicaid funded service.
  2. Determine the actual level of care for each service (defined by a SPC code) that is funded in the service plan.
  3. Determine if any service will be terminated. A termination of services occurs if one service, defined by SPC category, terminates, even if replaced by a difference SPC-defined service. (For example if supported employment (SPC 615) will be terminated, even if it will be replaced by sheltered workshop employment (SPC 108/706), SPC 615 is terminated. However, moving from one adult family home to another adult family home, (SPC 202.01/.02), is neither a reduction or a termination of service.) Ending any of the following programs even if another program is being substituted would likely result in a termination of services and require notice or agreement:
    SPC 102
    Adult Day Care
    SPC 103
    Respite Care
    SPC 104
    Supportive Home Care
    SPC 107
    Specialized Transportation
    SPC 108
    Centered-Based Work Services
    SPC 110
    Daily Living Skills Training
    SPC 110
    Mobility Training
    SPC 112
    Sound Response
    SPC 113
    Consumer Education and Training
    SPC 202
    Adult Family Home
    SPC 203
    Foster Home
    SPC 501
    Crisis Response
    SPC 506
    Community-Based Residential Facility
    SPC 507
    Communication Development Program
    SPC 507
    Counseling/Therapeutic Resources TIES
    SPC 609
    Consumer-Directed Supports
    SPC 610
    Housing Counseling
    SPC 615
    Supported Employment
    SPC 615
    Supported Self Employment
    SPC 615
    Time Bank
    SPC 619
    Financial Management Services
    SPC 701
    Training and Development
    SPC 706
    Day Center Services – Non-Medical
    SPC 710
    Community Skilled Nursing Services
  4. While we strive for providing increased in quality of life, individual choice and community inclusion, a perceived reduction in any of these factors would not necessarily result in a reduction of services qualifying the person for prior notice and a hearing required by Medicaid rules. For example, the addition of a roommate or relocation to a different neighborhood where on-call staff can be more easily accessed does not usually cause a reduction of services. A reduction of services will occur for any SPC-defined service if the person will receive quantifiably less of an active service (for example, if the person receives 3 hours per day of personal care services instead of 4). If the provision of the support service is passive in nature, the addition of consumers to be served by the same support person at any given time may not be a reduction of services. [1]
If implementation of the re-assessment recommendations, (regardless of who requested the re-assessment) will result in a reduction, termination or formal suspension of service(s), certain procedures need to be followed:
The broker must complete the Reassessment of Individual Support Needs form a minimum of 30 days prior to the proposed implementation date for the service reduction. The form should be e-mailed to the SDS coordinator.
Within 5 working days the county will mail the waiver participant and guardian a letter informing them of the forthcoming proposed service reduction, their right to appeal this decision and the process to follow for appeals.
  • This notice will occur a minimum of 10 days before implementation of any service reduction or termination.
  • If the individual/guardian objects to the reductions or termination and asks for an administrative hearing, the Support Broker must be prepared to attend the hearing and provide written and verbal testimony, if called upon.
  • If the individual/guardian objects to the reduction or termination and asks for an administrative hearing within 10 days of receiving notice, the Support Broker must suspend all actions leading toward the reduction of supports until such time that the hearing decision is made.
If implementation of the re-assessment recommendations, (regardless of who requested the re-assessment) will result in an increase in service(s) and if the increase in services requires additional funding, certain procedures need to be followed:
The support broker must submit the reassessment form to the SDS Coordinator and request to attend at Friday SDS review meeting. Managers may opt to approve or deny requests under $1,000 based solely on the written reassessment.
If the request is approved on a short-term or one-time payment, the support broker will be issued an Exceptional Expense Request (EER) approval form, authorizing payment.
If approved and the approval results in a permanent change in the individual’s on going rate, a new ISP, IFP and voucher must be completed.
If implementation of the re-assessment recommendations will result in a change in services that does not constitute a reduction or increase in services, certain procedures need to be followed:
If there will be a new provider for the same service and hours, the current provider must be given 90 days notice; a new ISP, IFP and voucher must be completed.
If there is mutual agreement, notice can be shortened to 30 days.
If the current provider is compromising the individual’s safety, immediate notice may be given.
If there is a change of address and telephone number as a result, e-mail the SDS Coordinator a System Change Form and a new ISP, IFP and voucher must be completed.

[1] An active support service is defined in situations where staff is engaged in daily living skills training, personal cares or other actions that require regular focused attention and engagement. A passive support service is defined in situations where staff are present to provide general supervision for safety and protection, or in such activities as food preparation, house cleaning and recreational services where the services can be provided to more than one person without effecting the quantity or quality of services to any individual consumer. A reduction in an active support service would likely be a reduction in service while a reduction of a passive support service would likely not be. However, each change in a service plan for an individual is situation–dependent and must be reviewed in depth to ascertain the actual effect of the change on the person. Given a particular case, even a reduction of a passive support service may constitute a reduction of services triggering the right to prior notice and appeal.