CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS (parts 430 to 456) > PART 441—SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES > SUBPART J—Optional Self-Directed Personal Assistance Services Program (§441.450 to §441.484) > 441.468—Service plan elements.

441.468—Service plan elements.

(a) The service plan must include at least the following:
(1) The scope, amount, frequency, and duration of each service.
(2) The type of provider to furnish each service.
(3) Location of the service provision.
(4) The identification of risks that may pose harm to the participant along with a written individualized backup plan for mitigating those risks.
(b) A State must develop a service plan for each program participant using a person-centered and directed planning process to ensure the following:
(1) The identification of each program participant's preferences, choices, and abilities, and strategies to address those preferences, choices, and abilities.
(2) The option for the program participant, or participant's representative, if applicable, to exercise choice and control over services and supports discussed in the plan.
(3) Assessment of, and planning for avoiding, risks that may pose harm to a participant.
(c) All of the State's applicable policies and procedures associated with service plan development must be carried out and include, but are not limited to, the following:
(1) Allow the participant, or participant's representative, if applicable, the opportunity to engage in, and direct, the process to the extent desired.
(2) Allow the participant, or participant's representative, if applicable, the opportunity to involve family, friends, and professionals (as desired or required) in the development and implementation of the service plan.
(3) Ensure the planning process is timely.
(4) Ensure the participant's needs are assessed and that the services meet the participant's needs.
(5) Ensure the responsibilities for service plan development are identified.
(6) Ensure the qualifications of the individuals who are responsible for service plan development reflect the nature of the program's target population(s).
(7) Ensure the State reviews the service plan annually, or whenever necessary due to a change in the participant's needs or health status.
(8) Ensure that a participant may request revisions to a service plan, based on a change in needs or health status.
(d) When an entity that is permitted to provide other State plan services is responsible for service plan development, the State must describe the safeguards that are in place to ensure that the service provider's role in the planning process is fully disclosed to the participant, or participant's representative, if applicable, and controls are in place to avoid any possible conflict of interest.
(e) An approved self-directed service plan conveys authority to the participant, or participant's representative, if applicable, to perform, at a minimum, the following tasks:
(1) Recruit and hire workers to provide self-directed services, including specifying worker qualifications.
(2) Fire workers.
(3) Supervise workers in the provision of self-directed services.
(4) Manage workers in the provision of self-directed services, which includes the following functions:
(i) Determining worker duties.
(ii) Scheduling workers.
(iii) Training workers in assigned tasks.
(iv) Evaluating workers performance.
(5) Determine the amount paid for a service, support, or item.
(6) Review and approve provider invoices.