Individualized Service Plans (ISPs) Explained

What is an Individualized Service Plan (ISP)?

An Individualized Service Plan (ISP) is a written personal life plan. It is designed to be ever-changing, understandable and usable in helping each individual achieve their personalized valued outcomes. This plan is required by Medicaid to describe the billing of Home and Community Based Services (HCBS) Waiver services.

The plan summarizes a person’s wants and needs, and his/her unique network of supports and services. This network is referred to as the individual’s “circle of support”. Individualized service planning places the focus of all planning activities on the needs and desires of the person with developmental disabilities or intellectual disabilities. These activities bring together the most important people in his or her life to help meet the person’s goals. Individualized service planning is often referred to as Person-centered Planning.

How is an ISP created?

The ISP is a written plan that is developed through a collaborative planning process. Collaborative planning produces a richness of personal information that can be used to help plan and choose preferred personal outcomes. The ISP is an agreement between the service coordinator and the person with disabilities regarding needs and wants. The service coordinator will assist in the pursuit of valued outcomes and the services and supports needed to live a successful life. The ISP is written by the service coordinator.

Who receives an ISP?

All individuals enrolled in Medicaid Service Coordination (MSC) and/or the HCBS Waiver must have an Individualized Service Plan (ISP). This would include all individuals who reside in an Individualized Residential Alternative (IRA).

Who participates in the ISP Process?

Family members, friends, agency staff and others who spend time with the person, along with the service coordinator. These become the person’s “circle of support.” Members of this circle choose specific tasks, follow up on details, and report the results of their efforts, at a minimum in semi-annual meetings.

What About People Who Reside in an Intermediate Care Facility (ICF)?

If your loved one lives in an Intermediate Care Facility, their plan is a Comprehensive Functional Assessment (CFA). Contact your social worker to learn more.

Russell Gerry

Chief Compliance Officer

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