§ 441.560 Service budget requirements.

(a) For the self-directed model with a service budget, a service budget must be developed and approved by the State based on the assessment of functional need and person-centered service plan and must include all of the following requirements: (1) The specific dollar amount an individual may use for Community First Choice services and supports. (2) The procedures for informing an individual of the amount of the service budget before the person-centered service plan is finalized. (3) The procedures for how an individual may adjust the budget including the following: (i) The procedures for an individual to freely adjust amounts allocated to specific services and supports within the approved service budget. (ii) The circumstances, if any, that may require prior approval by the State before a budget adjustment is made. (4) The circumstances, if any, that may require a change in the person-centered service plan. (5) The procedures that govern the determination of transition costs and other permissible services and supports as defined at § 441.520(b). (6) The procedures for an individual to request a fair hearing under Subpart E of this title if an individual's request for a budget adjustment is denied or the amount of the budget is reduced. (b) The budget methodology set forth by the State to determine an individual's service budget amount must: (1) Be objective and evidence-based utilizing valid, reliable cost data. (2) Be applied consistently to individuals. (3) Be included in the State plan. (4) Include a calculation of the expected cost of Community First Choice services and supports, if those services and supports are not self-directed. (5) Have a process in place that describes the following: (i) Any limits the State places on Community First Choice services and supports, and the basis for the limits. (ii) Any adjustments that are allowed and the basis for the adjustments. (c) The State must have procedures in place that will provide safeguards to individuals when the budgeted service amount is insufficient to meet the individual's needs. (d) The State must have a method of notifying individuals of the amount of any limit that applies to an individual's Community First Choice services and supports. Notice must be communicated in an accessible format, communicated in plain language, and needed auxiliary aids and services should be provided. (e) The budget may not restrict access to other medically necessary care and services furnished under the State plan and approved by the State but which are not included in the budget. (f) The State must have a procedure to adjust a budget when a reassessment indicates a change in an individual's medical condition, functional status, or living situation.