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Procedure No. I.C.2.PR.008 Issue Date:  January 11, 2002 
Subject:  Individual Support Agreement
  Fiscal Management 
Effective Date:  Upon release
Revised:  July 7, 2003 
Section:  Services and Supports:
  Individual Support 
A. Purpose
To ensure a standardized process for fiscal management of Individual Support Agreements (ISAs).

B. Applicability
This procedure shall apply to DMR staff and Qualified Family and Individual Consultation and Support Providers with fiscal management responsibility for Individual Support Agreements, agencies contracted to provide fiscal intermediary services, and those individuals responsible for self-directing their own services.

C. Definitions
Case Manager: A DMR employee who is assigned primary responsibility for individuals who are eligible for DMR services. The case manager serves as primary contact with the individual or family/guardian on the person’s behalf. The Case Manager is responsible to ensure the development of an Individual Plan that meets DMR requirements, and monitor the delivery and quality of all services and supports as identified in the Individual Plan. This person may also function as a support broker. (See support broker definition)

Fiscal Intermediary An organization that has a contract with the Department of Mental Retardation for the purpose of managing funds and making payroll and non-labor related payments for people with approved individual budgets.

HCBS Waiver – The Home and Community Based Services Waiver administered by DMR “waives” certain restrictions of Medicaid regulations and allows a flexible approach to providing services within the community.  These services assist a person to live in the community, who would otherwise be eligible for placement in an ICF/MR.

Individual Support Agreement (ISA) An agreement that outlines the responsibilities for self-direction of services for the individual, family member, or sponsoring person of the individual budget.

Individual Family Support Budget The budget format for individuals who choose qualified vendors and waiver services at DMR established rates.

Level of Need Assessment: the department’s method for determining an individual’s level of support need for the purposes of allocating DMR funded resources in an equitable manner. The Level of Need Assessment is completed at the time of the referral to the PRAT. When an individual is accepted into funded support services he or she is notified of that funding range for the purposes of developing an Individual Plan and associated Individual Budget.
Planning and Resource Allocation Team (PRAT) – A Regional Team chaired by the Planning and Quality Coordinator, and comprised of representatives from Resource Management, Case Management Supervision, Business Office, Family Support, and Regional Administration. This team manages the process whereby DMR identifies available resources, identifies individual consumer needs, assigns Priority, implements Planning and Resource Allocation policies and procedures, makes recommendations regarding applicants for the HCBS waiver, processes allocation of resources, and referrals to available out of home residential group living settings and Provider Agency based day services.

Qualified Family and Individual Consultation and Support Provider: Individuals or vendors qualified by DMR, who deliver supports to individuals and families such as the provision of information, advocacy training and support, assistance with meeting employer tasks, assistance with managing and monitoring the individual budget, assistance with developing and sustaining a personal emergency backup plan, and assistance with coordinating training for directly hired support staff.

Support Broker: Refers to DMR Case Management staff designated as Support Brokers or a Qualified Family and Individual Consultation and Support Provider.

Spending Plan: The financial management database, which compares regional appropriations to actual and projected expenditures. It is used to reserve funds for contractual obligations and measure the availability of funds for new obligations for each residential and day account including Community Training Home (CTH), Residential School, Community Living Arrangement (CLA), Supported Living (SLV), Individual Supports, Employment Opportunities, and other day services

D. Implementation
There are seven processes involved in the various stages of ISA Management:
  • Monthly fiscal reviews
  • Quarterly fiscal reviews
  • Adjustment to existing ISAs
  • Amendments to existing ISAs
  • Suspension of funding
  • Termination
  • Transfer of Individual Budget to another region
  • Annual Individual Budget Reconciliation
  • Change of Fiscal Intermediary
  1. Monthly Fiscal Reports:
    Each region will establish a regional contact person to whom the fiscal intermediaries will send the monthly individual budget expenditure reports for all ISA budgets. Each region will establish an internal system for distribution and review of monthly reports. Unless otherwise requested, these reports will also be sent to the individual or sponsoring family member by the FI. The reports are due the 25th day of each month.

  2. Quarterly Fiscal Reviews:
    Each region will establish a contact person to whom the fiscal intermediaries in each region will send individual budget quarterly expenditure repots for ISA and IFS budgets.  These reports are due the 25th day of the start of the new quarter.  Individuals who do not use FIs must also meet these requirements.  Each region will establish an internal system for distribution and review of quarterly reports, and send a copy of these reports to the Central Office Operations Center within two weeks of receiving the reports from the fiscal intermediary.  The purpose of the quarterly fiscal review is to identify under or over expenditures that warrant further review and possible revisions to the Individual Plan and individual budget.  The FI will also send a quarterly report to the individual or sponsoring family member.

  3. Amendments to existing ISAs (Increase or decrease in the funding amount) need for a change in the type of or the amount of particular support or service. Request for additional services and supports are made through PRAT. If PRAT authorizes an increase in services and an increase in the allocation above what was originally approved, a revision to the individual Plan and an amendment to the individual budget (IFS Budget or ISA Budget) are required. Amendments follow Procedure No. I.C.2.PR.007, Individual Support Budget Authorization Process.

    One-time amendments in the fourth quarter. When a payment for a one-time amendment is made in the fourth quarter of a budget, the payment for goods and services can be used for the intended purposes in the first quarter of the new budget year. Examples of this include: summer camp when payment is due in advance, home modifications, purchase and installation of adaptive equipment, and a series of clinical visits that extend beyond the end of the budget period.
     
  4. Adjustment to existing ISAs (No change in the funding amount) The individual/family and support broker may discuss the need for a change in the type or amount of a particular support or service. When this change is within existing line items or results in a new line item, without a change in the authorized allocation, a revision to the individual plan and individual budget is required to effect the change.

    The support broker will document the change and effective date on an ISA Amendment/ Adjustment form. For adjustments within existing line items, the broker completes the form with the line items that are changing. For adjustments that result in new line items, the Amendment Adjustment form is completed for all budgeted line items. All adjustments require approval from the Self Determination Director, Resource Administrator, or regional designee prior to implementation.  Copies of the ISA Amendment/Adjustment form are distributed to the individual, family, and fiscal intermediary.  A copy of the ISA Amendment/Adjustment form is sent with the Quarterly report to the central office Operations Center. For one-time adjustments less than five hundred dollars, the regional Self-Determination Director, Resource Administrator, or designee may verbally notify the FI.  These one-time adjustments will be documented by the FI on the next monthly and quarterly expenditure reports.

  5. Program Fund Payment Adjustments Payment adjustments for an individual can be made when it is determined by the broker and or regional designee when a significant amount of cash has accumulated in the individuals program funds. If the situation is expected to be ongoing through the current budget period, the broker or regional designee can initiate a payment change. The region will adjust payments to the FI by withholding or reducing the amount of the next prospective quarterly payment for a particular individual.

  6. Termination of ISA's and IFS Budgets An individual/family may decide to terminate the ISA or IFS budget and chose an alternative support service.  The broker or regional designee will discuss with the individual/family all the available options and resources available, update the individual plan, and begin the process of referral to those options.  Once the new option has been identified and secured, the broker or regional designee will fill out the form for termination of the individual budget.  The form should be sent within 10 business days to the CO Operations Center, the FI, the SD Director, Resource Administrator, or regional designee, and the regional fiscal office representative.

  7. Transfer of an Individual Budget from one region to another. Transfer of an Individual Budget is initiated by using the DMR Regional Transfer form. The transfer form is completed by the Resource Administrator and distributed to the fiscal office, Operations Center at CO, and the regional designee in the receiving region.

  8. Annual Individual Budget Reconciliation
    The region will recover all unspent funds for each budget through a payment adjustment. The FI will prepare an end of budget period expenditure report for all budgets that end on each of the four fiscal quarters (September 30, December 31, April 31, June 30).  The FI will have 90 days from the end date of the budget to prepare and submit a final expenditure report.  These reports will list the names of each individual, the authorized budgeted amount, program funds received from DMR, the amount expended, and any cash surpluses.  The region will complete all payment adjustments for each individual within 120 days of the budget period end date by adjusting a prospective quarterly payment during the next budget period

  9. Change of Fiscal Intermediaries
    Individuals who self direct their services with an ISA can change Fiscal Intermediaries. The case manager completes the FI choice form and forwards the form to the Self Determination Director, Resource Administrator, or regional designee. Change of Fiscal Intermediaries occurs with the next quarterly prospective payment or when the budget is renewed. Copies of the form are distributed to the New FI, Former FI, Fiscal Office Representative, and the Operations Center at CO.
E. References
  • Amendment Adjustment Form
  • Budget Termination Form
  • FI Choice Form
  • ISA Cost Standards
  • Individual Family Support Manual
  • Individual Support Agreement (ISA)
  • Individual Support Agreement Authorization Process I.C.2.PR.007
  • Transfer of Funds Form
F. Attachments
     None