An individual assessment process forms the basis for developing an Individual Plan (Plan).
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(1) Psychological, medical, social, and functional assessments are completed prior to the development of an initial Plan.
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(2) The medical, social, and functional assessments are reviewed and updated at least annually.
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(3) Consistent with the service recipient-directed focus of an In-Home Supports Waiver, the Developmental Disabilities Services Division (DDSD) case manager completes a needs assessment at least annually with the service recipient to form the basis for developing the Plan of Care.
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(4) Consistent with a service recipient-centered focus, the DDSD case manager ensures completion of a review and update at least annually of necessary assessments to support the need for services, as well as assessment of the skills, supports, and needs of the service recipient through the Community Waiver and Homeward Bound Waiver.
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(A) Assessments address the service recipient's needs and choices for supports and services related to:
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(i) personal relationships;
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(ii) home;
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(iii) employment, education, or both;
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(iv) transportation;
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(v) health and safety;
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(vi) leisure;
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(vii) social skills; and
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(viii) communication.
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(B) The DDSD case manager ensures early intervention and prevention by the Personal Support Team when changes occur. Events such as the loss of a loved one, change in roommates, staff, schedules, health changes, or loss of a job prompt a re-assessment of needs, services, and supports.