Sec. 10.09.90.12. Covered Services — Plan of Care

A. The POC shall contain, at minimum:

(1) A description of the participant’s strengths and needs;

(2) The diagnosis or diagnoses established as evidence of the participant’s eligibility for services under this chapter;

(3) The goals of care coordination services to address the behavioral health, medical, social, educational, and other services needed by the participant, with expected target completion dates;

(4) A crisis plan including the proposed strategies and interventions for preventing and responding to crises and the youth and family’s definitions of what constitutes a crisis;

(5) Designation of the care coordinator with primary responsibility for implementation of the POC;

(6) Signatures of the care coordinator and other CFT members, if appropriate;

(7) Signatures of the participant and family indicating that the participant and family have:

(a) Participated in the development of the POC; and

(b) Had choice in the selection of services, providers, and interventions when possible, in the care coordination process of building the POC; and

(8) For 1915(i) participants, specified for each recommended service, the following information as appropriate or as required by the Department:

(a) Description of the service;

(b) Service start date;

(c) Estimated duration;

(d) Frequency and units of service as measured in 15 minute increments to be delivered;

(e) The specific need or goal that the service is related to; and

(f) The provider name and contact information.

B. If not included in the POC, an ongoing record of contacts made on the participant’s behalf, which includes all of the following, shall be included in the participant’s chart:

(1) Date, start and end time, and subject of contact;

(2) Individual contacted;

(3) Electronic or scanned signature of care coordinator making the contact;

(4) Nature, content, and unit or units of service provided;

(5) Place of service;

(6) Whether strategies and tasks specified in the POC have been achieved;

(7) The timeline for obtaining needed services;

(8) The timeline for reevaluation of the plan;

(9) The need for and occurrences of coordination with child- and family-serving agencies and providers;

(10) The names and contact information for the participant’s primary care provider, dentist, and other health care providers;

(11) The medications that the participant is currently taking and the dosage and frequency of the medications; and

(12) Monthly summary notes, which reflect progress made towards the identified needs and outcome measures.