Restricted Services Policy
A small number of service codes in DSPD’s total scope of services have restrictions that affect how they can and cannot be used in the Person Centered Support Plan (PCSP). In general, the “restrictions” mean approval must be given to the support coordinator by the Request for Services (RFS) committee regarding the service’s purpose and use prior to being implemented in the PCSP. For example, if the person has never received RHS before and they need a residential placement, the support coordinator is not authorized to load the service in the plan before they have submitted a Request for Services (or an Emergency Request), the committee has reviewed the rate, units and other pertinent information associated with the request (e.g., criteria and documentation), and the committee has approved it.
In order to ensure the policy is applied consistently, USTEPS will store the service codes, durations, and rates that apply to the restricted codes the RFS committee has authorized for the person. The PCSP validator will check for restricted services on the budget and compare them to the restricted services the person is authorized to have. If a discrepancy regarding the duration or rate of a restricted service exists between the PCSP budget and what is authorized for the person, then the validator will prevent the plan from activating. The validator will check for both the presence of the restricted service and its absence in the PCSP Budget.
List of Restricted Services:
The following services are restricted and require pre-authorization by the RFS committee before they can be loaded on the PCSP budget for the first time or have a change in their rate.
(Day Supports) DSG and DSI
(Residential) RHS, PPS, and HHS
(UTA Transportation) UTA-M, UTA-T, UTD, UTF and UTP.
(Employment Preparation Service) EPR
If the support coordinator is unable to activate the PCSP because a Restricted Service loaded on the Restricted Services screen does not exist in the PCSP Budget for a reason outside of their control (e.g. the provider's contract expired and they have not submitted the new contract for final processing), the support coordinator can contact DSPD's Support Services Coordinator to temporarily remove it from the Restricted Services screen while the plan is activated. Then, after the plan has been activated, the Support Services Coordinator will restore the Restricted Service in preparation for the time when whatever caused the problem is resolved.If the support coordinator wants to change the prescription of a restricted service that results in either a change in its rate and/or an increase in its total dollars and the service has already been authorized by the RFS committee, they must submit a new Request for Services and receive approval to implement the change before doing so in the plan. However, if the service is RHS and the support coordinator only wants to change its absentee factor such that its total dollars remain the same, then they can submit the updated rate worksheet directly to the Support Services Coordinator for implementation without issuing a Request for Services and receiving approval from the committee (see the Needs Based Change Policy).