approved self-directed services plan and budget

(5) For purpose of this section, the term “approved self-directed services plan and budget” means, with respect to a participant, the establishment of a plan and budget for the provision of self-directed personal assistance services, consistent with the following requirements: (A) Self-direction The participant (or in the case of a participant who is a minor child, the participant’s parent or guardian, or in the case of an incapacitated adult, another individual recognized by State law to act on behalf of the participant) exercises choice and control over the budget, planning, and purchase of self-directed personal assistance services, including the amount, duration, scope, provider, and location of service provision. (B) Assessment of needs There is an assessment of the needs, strengths, and preferences of the participants for such services. (C) Service plan A plan for such services (and supports for such services) for the participant has been developed and approved by the State based on such assessment through a person-centered process that— (i) builds upon the participant’s capacity to engage in activities that promote community life and that respects the participant’s preferences, choices, and abilities; and (ii) involves families, friends, and professionals in the planning or delivery of services or supports as desired or required by the participant. (D) Service budget A budget for such services and supports for the participant has been developed and approved by the State based on such assessment and plan and on a methodology that uses valid, reliable cost data, is open to public inspection, and includes a calculation of the expected cost of such services if those services were not self-directed. The budget may not restrict access to other medically necessary care and services furnished under the plan and approved by the State but not included in the budget. (E) Application of quality assurance and risk management There are appropriate quality assurance and risk management techniques used in establishing and implementing such plan and budget that recognize the roles and responsibilities in obtaining services in a self-directed manner and assure the appropriateness of such plan and budget based upon the participant’s resources and capabilities.

Source

42 USC § 1396n(j)(5)


Scoping language

For purpose of this section
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