Reimbursable Support Coordination Services include the following based on the assessed need of the individual and as specified in the approved Individual Service Plan: 1. Facilitate the Service Planning Process and Individual Service Plan Development a. Utilizing person-centered planning in all areas to include pre-meetings with individual, their selected support network, and service providers for development of the annual Individual Service Plan (ISP) to respond to the assessed needs of the individual. 2. Coordinate Waiver Services a. Assisting the individual with choice of service provider agencies to deliver the services and supports and achieve goal(s) identified by the individual in the ISP. This includes arranging and attending meetings, as necessary, to coordinate with other providers and/or community organizations. b. Consistently inquiring about satisfaction with service providers and offering choice of other service providers upon request. 3. Coordinate Non-Waiver Services, Community Engagement and Resource Development c. Participating in activities and gather information that help link eligible individuals with medical, social, and/or educational providers or other programs and services that can provide needed services to address identified needs and to achieve goal(s) specified in the ISP. 4. Evaluate the Quality and Outcome of Services and Identifying Unmet Needs a. Contacting individuals and any authorized representative as needed to address any identified health and safety risks and progress toward personal goal(s). b. Referring for additional or different services, request for clinical validation of a change in need, and follow-up activities. c. Monitoring of the health and welfare of the individual, through direct observation, review of documents, and follow up to ensure that service plans have the intended effect and that approaches to address challenging behaviors, medical and health needs, and skill acquisition are coordinated in their approach and anticipated outcome
