Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Individualized Backup Plans


A key component of person-centered service planning is a risk assessment process to identify issues or situations that can jeopardize health and welfare and to develop an individualized backup plan that specifies actions to prevent them or address them if they occur. For example, a backup plan should designate individuals to be called--and in which order--if workers do not arrive when scheduled. Backup plans should also address methods for handling any critical incidents that may occur, such as a serious injury, abuse, neglect, or exploitation.

Every participant receiving home and community services--whether through the traditional agency-delivered service system or a participant direction program--should be educated about the availability of backup resources and have a backup plan individually tailored to their needs and preferences.

Appendix D-1(e) of the HCBS waiver application (version 3.5) requires states to specify how potential risks to participants will be assessed during the development of the service plan and how strategies to mitigate risk will be incorporated into the service plan, subject to participants’ needs and preferences. In addition, states must describe how the service plan development process will address the need for backup plans and the arrangements that are used for backup must be included. These requirements apply to both traditional and participant direction programs.

Section 1915(j) regulations also emphasize the importance of developing backup plans. Identifying actual and potential risks--and determining how they will be handled--should be accomplished through discussion and negotiation among persons involved in the service planning process.

If the backup plan includes calling individuals who are willing and able to work at short notice, such as neighbors, all of their payroll paperwork must be on file in advance. Similarly, if it includes calling a traditional service agency, the agency should be informed that they are listed on a participant’s backup plan and should be provided with information about the participant’s needs.

Typically, backup plans include the names and contact information of individuals or entities to be called in a specific order; for example, family and friends may be called first, and a counselor or case manager called only if family and friends are unable to provide backup. Some states have developed an Emergency Backup Person Designation Form to identify individuals as emergency backup personnel; individuals designated are required to sign the form demonstrating their willingness to serve in this capacity. The effectiveness of backup plans should be tested periodically and changes made as needed.

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