Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 3 - INDIVIDUAL SERVICE PLANNING FOR BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Section R9-21-307 - The Individual Service Plan

Current through Register Vol. 30, No. 28, July 12, 2024
A. General provisions.
1. An individual service plan (ISP) shall be
				developed by the clinical team and each client.
2. The ISP shall include the most appropriate
				and least restrictive services, consistent with the client's needs and
				preferences, as identified in the assessment conducted according to
				R9-21-305, and
				without regard to the availability of services or resources.
3. The ISP shall identify those services
				which maximize the client's strengths, independence, and integration into the
				community.
4. Generic services
				available to the general public should be utilized, to the maximum extent
				possible, when adequate to meet the client's needs and if access can be
				arranged by the case manager or client.
5. If all needed services are not available,
				a plan for alternative services shall detail those services which are, to the
				maximum extent possible, adequate, appropriate, consistent with the client's
				needs, and least restrictive of the client's freedom.
6. The clinical team shall solicit and
				actively encourage the participation of the client and guardian.
7. The clinical team shall inform the client
				of the right to have a designated representative throughout the ISP process and
				to invite family members or other persons who could contribute to the
				development of the ISP. The case manager shall seek to obtain a representative
				for clients who need special assistance or otherwise have limited capacity to
				articulate their own preferences and to protect their own interests in the ISP
				process and shall advise the relevant human rights committee that the client
				has been determined to need special assistance.
8. The ISP shall contain goals and objectives
				which are measurable and which facilitate meaningful evaluation of the progress
				toward attaining those goals and objectives.
9. The ISP shall incorporate a specific
				description of the client objectives, services, and interventions for each
				mental health agency which will provide services to the client. Each existing
				service provider will bring to the ISP meeting a detailed written description
				of the objectives and services currently in effect for the client.
10. For residents of an inpatient facility,
				the facility's treatment and discharge plan shall be developed according to
				R9-21-312
				and shall be incorporated in the ISP.
11. Prior to the planned discharge of a new
				client from an inpatient facility, the clinical team shall develop an ISP which
				describes the community services, including alternative housing and residential
				supports, that will be provided when the client leaves the facility.
12. The ISP shall be written in language
				which can be easily understood by a lay person.
13. In developing the ISP, the case manager
				shall facilitate resolution of differences among service providers and, if
				resolution is not achieved, shall refer the matter to the regional authority,
				which shall resolve the matter in accordance with the Administration's policy.