441—83.87 (249A) Service plan. A service plan shall be prepared and utilized for each HCBS BI waiver consumer. The service plan shall be developed by an interdisciplinary team, which includes the consumer, and, if appropriate, the legal representative, consumer’s family, case manager, providers, and others directly involved. The service plan shall be stored by the case manager for a minimum of three years. The service plan staffing shall be conducted before the current service plan expires.
	 83.87(1) Information in plan. The plan shall be in accordance with 441—subrule 24.4(3) and shall additionally include the following information to assist in evaluating the program:
	  a.   	 A listing of all services received by a consumer at the time of waiver program enrollment.
	  b.   	 For supported community living:
	 (1) 	 The consumer’s living environment at the time of waiver enrollment.
	 (2) 	 The number of hours per day of on-site staff supervision needed by the consumer.
	 (3) 	 The number of other waiver consumers who will live with the consumer in the living unit.
	  c.   	 An identification and justification of any restriction of a consumer’s rights including, but not limited to:
	 (1) 	 Maintenance of personal funds.
	 (2) 	 Self-administration of medications.
	  d.   	 The names of all providers responsible for providing all services.
	  e.   	 All service funding sources.
	  f.   	 The amount of the service to be received by the consumer.
	  g.   	 Whether the consumer has elected the consumer choices option and, if so:
	 (1) 	 The independent support broker selected by the consumer; and
	 (2) 	 The financial management service selected by the consumer.
	  h.   	 A plan for emergencies and identification of the supports available to the consumer in an emergency.
	 83.87(2) Use of nonwaiver services. Service plans must be developed to reflect use of all appropriate nonwaiver Medicaid services and so as not to replace or duplicate those services.
Service plans for consumers aged 20 or under which include supported community living services beyond intermittent must be approved (signed and dated) by the designee of the bureau of long-term care, or when a county voluntarily chooses to participate, by the county board of supervisors’ designee or the bureau’s designee. The Medicaid case manager shall attach a written request for a variance from the limitation on supported community living to intermittent.
	 83.87(3) Annual assessment. The IME medical services unit shall assess the consumer annually and certify the consumer’s need for long-term care services. The IME medical services unit shall be responsible for determining the level of care based on the completed Brain Injury Waiver Functional Assessment, Form 470-3283, and supporting documentation as needed.
	 83.87(4) Service file. The Medicaid case manager must ensure that the consumer service file contains the consumer’s service plan.
	  a.   to  d.   Rescinded IAB 8/7/02, effective 10/1/02.