§ 441.555 Support system. For each service delivery model available, States must provide, or arrange for the provision of, a support system that meets all of the following conditions: ( a ) Appropriately assesses and counsels an individual before enrollment.
( b ) Provides appropriate information, counseling, training, and assistance to ensure that an individual is able to manage the services and budgets if applicable. ( 1 ) This information must be communicated to the individual in a manner and language understandable by the individual. To ensure that the information is communicated in an accessible manner, information should be communicated in plain language and needed auxiliary aids and services should be provided.
( 2 ) The support activities must include at least the following: ( i ) Person-centered planning and how it is applied.
( ii ) Range and scope of individual choices and options.
( iii ) Process for changing the person-centered service plan and, if applicable, service budget.
( iv ) Grievance process.
( v ) Information on the risks and responsibilities of self-direction.
( vi ) The ability to freely choose from available home and community-based attendant providers, available service delivery models and if applicable, financial management entities.
( vii ) Individual rights, including appeal rights.
( viii ) Reassessment and review schedules.
( ix ) Defining goals, needs, and preferences of Community First Choice services and supports.
( x ) Identifying and accessing services, supports, and resources.
( xi ) Development of risk management agreements. ( A ) The State must specify in the State Plan amendment any tools or instruments used to mitigate identified risks.
( B ) States utilizing criminal or background checks as part of their risk management agreement will bear the costs of such activities.
( xii ) Development of a personalized backup plan.
( xiii ) Recognizing and reporting critical events.
( xiv ) Information about an advocate or advocacy systems available in the State and how an individual can access the advocate or advocacy systems.
( c ) Establishes conflict of interest standards for the assessments of functional need and the person-centered service plan development process that apply to all individuals and entities, public or private. At a minimum, these standards must ensure that the individuals or entities conducting the assessment of functional need and person-centered service plan development process are not: ( 1 ) Related by blood or marriage to the individual, or to any paid caregiver of the individual.
( 2 ) Financially responsible for the individual.
( 3 ) Empowered to make financial or health-related decisions on behalf of the individual.
( 4 ) Individuals who would benefit financially from the provision of assessed needs and services.
( 5 ) Providers of State plan HCBS for the individual, or those who have an interest in or are employed by a provider of State plan HCBS for the individual, except when the State demonstrates that the only willing and qualified entity/entities to perform assessments of functional need and develop person-centered service plans in a geographic area also provides HCBS, and the State devises conflict of interest protections including separation of assessment/planning and HCBS provider functions within provider entities, which are described in the State plan, and individuals are provided with a clear and accessible alternative dispute resolution process.
( d ) Ensures the responsibilities for assessment of functional need and person-centered service plan development are identified.
( e ) Implement and maintain a grievance process, in accordance with § 441.301(c)(7), except that the references to section 1915(c) of the Act are instead references to section 1915(k) of the Act.
[77 FR 26898, May 7, 2012, as amended at 89 FR 40870, May 10, 2024]