Public Comments
TO:
Steven Cook, Director
FROM:
Alison Becker, Bureau Director
Bureau of Developmental Disabilities Services
RE:
Summary of Comments from Public Hearing on Proposed LSA
#02-210 Concerning Individualized Support Plans
DATE:
November 27, 2002
This memorandum contains a summary of the public comments that were submitted at the public hearings on proposed rule LSA #02-210. In addition, the responses of the Bureau of Developmental Disabilities Services (BDDS) to those public comments are included.
We recommend that you adopt as a final rule, with the modifications specified below.
Public Comments and Agency Responses
LSA #02-210
Comments that resulted in a change in the rule are marked with an asterisk (*)
Comment # 1: A comment was received indicating that the rule should be recalled and rewritten because the rule does not accurately reflect person centered planning.
Response: The rule will not be recalled.
Comment # 2: A comment was received asking if providers can be given an advance copy of the ISP form, even if the form is still in draft form. A comment was received indicating that the ISP should be more computer friendly. There need to be enough room to write all the information that is required.
Response: There will be training on the rule and ISPs. Copies of the form will be provided at that time.
Comment # 3: A comment was received indicating that parents need more information before they can do a support plan. Parents often agree to support plans before they know what is available.
Response: This comment is beyond the scope of the rule.
* Comment # 4: A comment was received indicating that qualifications for facilitators need to be included in the rule. A facilitator should have received training before being allowed to facilitate. Leaders in the field recommend that all individuals who facilitate a PCP should receive training from a reputable entity or individual, observe a facilitation, and participate in a circle before facilitating a PCP. A comment was made that 460 IAC 7-4-1 should read as follows: "The support team shall be led by a trained facilitator chosen by the individual to gather and complete the profile information portion of the PCP. The support team shall be led by the TCM, or QMRP if an ICF/MR, or BDDS service coordinator if neither or the previous apply to complete the ISP document." Leaving facilitation to anyone chosen by the individual does not make sense given the responsibility placed upon the facilitation.
Response: Changes are being made to 460 IAC 7-4-1 to require a facilitator to be a trained facilitator and to specify the required training.
Comment # 5: A comment was received indicating that in regard to 460 IAC 7-4 and 460 IAC 7-5 that a statement be included regarding service providers who are accredited by JCAHO who are providing behavioral supports to follow the JACHO and DMHA guidelines for their services.
Response: All providers will be held to the rule. No change will be made.
* Comment # 6: Comments were received indicating that the rule does not seem to identify one person as ultimately responsible for pulling together the ISP and making sure that everything is included. A comment was received indicating that in 460 IAC 7-4-3, it should be clarified whether or not the individuals are required or are at the discretion of the individual. A further comment was received indicating that the wording in 460 IAC 7-4-3 is confusing, are these required members of the support team really at the discretion of the individual? The beginning is ambiguous. A comment was also made that it should be clarified who ISP participants should be. A comment was received indicating that the word "assuring" in 460 IAC 7-4-3 has resulted in role confusion and a lack of clarity.
Response: IAC 7-4-3(b) will be change to clarify who is responsible for convening the support team, the development of the ISP, the dissemination of the ISP and the maintenance of original documents. Further issues relating to role confusion and a lack of clarity will be dealt with during training.
* Comment # 7: A comment was received indicating that clarification would be helpful as to who is to maintain the master copy of the ISP. A further comment was received regarding who is to forward the ISP to each participant.
Response: Agreed. 460 IAC 7-4-3(b) will be changed to specify the provider responsible for maintaining the ISP and forwarding the ISP to each participant.
Comment # 8: A comment was received that under 460 IAC 7-4-1 it is not specified what kind of PCP.
Response: Person centered planning needs to be flexible to meet the needs of the individual. No change will be made.
* Comment # 9: A comment was made wondering if all levels of providers should have access to the ISP and should all members of the team have access to everything.
Response: All providers should have access to information. As indicated above, 460 IAC 7-4-3(b) will be changed to indicate the provider responsible for disseminating the ISP.
Comment #10: A comment was received regarding 7-5-8, understand why it is there but noting that a provider cannot be responsible for the actions of a landlord. If a landlord will not fix something, can an ICLB be used to pay to fix it?
Response: ICLB parameters are beyond the scope of this rule.
* Comment #11: A comment was received suggesting that a social security number and other medical insurance information be added to 460 IAC 7-5-2.
Response: Social security number and other medical insurance information will be added to 460 IAC 7-5-2.
Comment # 12: A comment was received suggesting that Medicaid number, insurance information and health care representative be added to 460 IAC 7-5-4.
Response: This information is already contained in other sections. Insurance information is being added to 460 IAC 7-5-2, see No. 11, above. No change will be made to 460 IAC 7-5-4.
Comment #13: Comments were received regarding the listing of issues that need to be addressed in 460 IAC 7-5-8. Listing more examples of health issues will help trigger thoughtfulness of IST. The date of the annual physical should be noted. A psychiatrist, dental care/dentist, special dietary needs, behavioral support plan, PT, OT, Speech, Rec. Therapy, adaptive equipment, specialized medical care and annual physicals should be added. Chronic conditions such as diabetes, thyroid, dysphasia, cellulites, arthritis, heart conditions, cholesterol, obesity, reproductive, asthma, cancer, degenerative condition and high blood pressure may need to be listed. A home safety checklist from Florida was submitted as an example of things to look for in assessing the appropriateness of the physical environment.
Response: Some of these issues are explicitly listed. 460 IAC 7-5-8(a)(2)(N) requires that other chronic or healthcare issues be discussed. No changes will be made. Environmental requirements will vary based on the needs of the individual; this is a decision for the IST to make. No changes will be made.
Comment #14: A comment was received questioning the time between an application and the implementation of the ISP.
Response: The time between an application and the implementation of the ISP is beyond the scope of this rule.
Comment #15: A comment was received questioning the application process for the support services waiver.
Response: The application process for the support services waiver is beyond the scope of this rule.
Comment #16: A comment was received questioning who was responsible for the accounting of financial information of individuals.
Response: 460 IAC 6 sets out who the provider responsible for the accounting of financial information of individuals. No change will be made to this rule.
Comment #17: A comment was received noting that the ISP is a component of the PCP and the formatting of 460 IAC 7-3-12 needs to clearly delineate the ISP as a component of the PCP.
Response: The ISP is to be a component of the PCP. No change will be made.
Comment #18: A comment was received indicating that guidance/clarification was needed about what to do when an individual avoids programming and does not show up for scheduled appointment.
Response: This is an issue that a support team may need to consider when developing a plan. No change will be made.
Comment # 19: A comment was hoping that individuals do not need to have group home style evacuation routes posted.
Response: The safety measures that need to be taken for any particular individual should be decided upon by the individual's IST. No change will be made.
Comment #20: A comment was made expressing concern that the rule applies to individuals in group homes and indicating that the rule needs to match the ICF/MR regulations more closely. Examples were given of items that are to be discussed by teams even though the ICF/MR guidelines provide a standard such as life safety codes.
Response: ICF/MR guidelines go beyond the scope of this rule. If an individual resides in a group home that needs to be taken into consideration when developing the individual's ISP. No change will be made.
* Comment #21: A comment was made indicating that the definition of outcome should be defined as follows: "Outcome is a statement of the individual's desires for the near future, which is based upon the individual's preferences, desires, and needs identified in the PCP process. An outcome is a common vision of what the support team is working together to accomplish."
Response: 460 IAC 7-3-11 will be changed to better reflect what is meant by outcome.
Comment #22: A comment was made suggesting that the following be added to the 460 IAC 7-3-12 "discovers what is working for and not working for the individual and what the individual likes and dislikes, and …"
Response: No change will be made.
* Comment #23: A comment was made that the terminology ISP should be incorporated into the definition and (4) added as follows: "(4) empowers the individual and the individual's family to create a life plan and corresponding Individualized Support Plan [ISP] for the individual that …"
Response: Agree. Changes will be made to 460 IAC 7-3-12(4).
Comment #24: A comment was received indicating that 460 IAC 7-4-4 should be amended to require that a PCP profile sheet be attached.
Response: There already is a requirement for a profile sheet. No change will be made.
Comment #25: A comment was received indicating that in 460 IAC 7-5-5, the words "during the PCP process" should be substituted for the words "during the development of the ISP" in (b)(2), (b)(3) and (b)(4)(B).
Response: These tasks need to be done during the development of the PCP. No change will be made.
Comment #26: A comment was received asking if "minimum frequency of contact the case manger was to have with individual" meant any type of contact.
Response: 460 IAC 6 provides standards for case managers. No change will be made.
