10102 — Purchase of Service Funding Authorizations

Link to TCADD Policy

SCOPE:

This procedure applies to all employees of Tri-Counties Regional Center. This procedure sets forth:

1. An authorization for funds format;
2. Monitoring for quality of case management documentation;
3. An orderly review process for ensuring continuity of services;
4. Appraisal of each purchase in accord with the following concerns:
   1. The service is relevant to the person’s desired outcomes as identified through the Individual/Family Services Planning process. It reflects the most inclusive and cost-effective service;
   2. All alternative resources have been explored, exhausted and documented; and,
   3. The request for funds is in accordance with current Tri-Counties Regional Center service policies;
5. Fair selection of provider of service from pool of qualified vendors.

PROCEDURE:

1. Services may be authorized for purchase only if the following criteria are met:
   1. The recipient of service is currently eligible for services with an active status at TCRC in Early Start (Status I), Provisional Eligibility (Status U) or Lanterman Services (Status 2).   
   2. The need for the purchased service is clearly documented within the person’s Individualized Family Service Plan or Standardized Individual Program Plan (S-IPP) and supported by information in the database and interdisciplinary notes.
   3. The service is not available through generic or other resources.
   4. The service must be in accordance with the Service Policies established by Tri-Counties Association for the Developmentally Disabled, Inc. Board of Directors.
   5. The service must be purchased from an authorized vendor or fiscal management service.
   6. The service must be authorized by Chapter 1, Title 17, of the California Administrative Code.
   7. For continuation of a purchased service, there must be evidence that progress has been made in achieving desired personal outcomes and the individual must be satisfied with the service and the service provider.
   8. The service does not duplicate service(s) already being provided to the individual.

2. Service Coordinator Responsibilities:
3. An authorization for funds is a result of the Individualized Family Service Plan or Individual Program Plan process in which:

2. Individual’s need(s) and desired outcomes were identified;
3. All possible resources were identified and explored; and,
4. Services and supports were agreed upon.
5. The case record must have adequate and current documentation of assessment, when needed, and ongoing case management process including, at a minimum:

2. Appropriate evaluations, e.g. nutritional evaluation, nursing, behavioral;
3. Psycho-social Assessment;
4. CDER;
5. Annual or semi-annual face-to-face contact;
6. Individualized Family Service Plan or Individual Program Plan;
7. Progress reports as required from service provider(s); and,
8. SANDIS Title 19 Notes.
9. The Individualized Family Service Plan or Individual Program Plan must be reflective of the individual’s desired outcomes and specify the purchase of supports/services required to meet these outcomes.

2. The service requiring regional center funds must be related to at least one desired outcome as identified in the person’s Individualized Family Service Plan or Individual Program Plan.
3. Documentation must include evidence that regional center funds are not being used to supplant the budget of any generic agency mandated to provide such services or to provide service available through private insurance, community organizations/agencies/programs.

2. A denial from a generic or third-party source for services for which the individual is eligible must be in the case record.
3. Such documentation should be in written format from such source but may be recorded in an interdisciplinary note by the service coordinator, indicating the source, name of person denying the purchase, and reason for the denial; if appropriate.
4. The service coordinator has reviewed with the manager unusual or special situations that may require an exception to service policy.
5. All sections of the SANDIS Authorization are completed correctly.

2. Service code and subcode must be identified.
3. Admission Agreement and Rate Page forms are completed for community care licensed homes.
4. The length of time a service may be authorized is dependent upon individual need and the nature of the service to be provided.

2. An on-going service (without a termination date) may be completed for licensed and certified homes, Primary supports, such as adult day activities, supported work and supported living may also be authorized on-going as well, allowing for adequate monitoring and review.
3. A maximum of one year for other support services may be considered by the Planning Team.
4. Short-term authorization periods may meet time limited service needs of an individual, e.g. respite and behavior intervention.
5. Authorization may be for one time only; e.g. an assessment, evaluation or emergency respite.
6. The appropriate specialist should be consulted, if needed, and must complete a SANDIS Title 19 Note documenting the consultation.
7. The SANDIS Authorization is completed and then submitted along with the IPP Amendment for the manager approval.  This should be completed at least two weeks prior to the proposed start of the service.

2. Any lead time shorter than two weeks must be explained to the manager and is allowed only in those situations which are considered urgent.
3. A request for funds as an exception to the service policies must be accompanied by information about the need for the service, resources explored and other services the individual is receiving.
4. It is the expectation that there must be no retroactive funding. Any retroactive funding requests (any funding request 60 days or more past the starting date of service) are to be processed as follows:
5. Reviewed by the manager and then the Assistant Director of Services & Supports or designee with an explanation.

3. Administrative Review of Request for Funds:
4. The manager reviews the SANDIS Authorization and other supportive documentation in the case record, as appropriate, to determine whether there is:

3. Consistency with Tri-Counties Regional Center Service Policies;
4. An appropriate Individualized Family Service Plan or Individual Program Plan, with specific outcomes related to individual need and preferences and time-framed plans to achieve these outcomes;
5. Accuracy of service codes and sub codes correct number of units and appropriate service dates
6. Evidence that the requested service is related to at least one desired outcome;
7. Evidence that regional center funds are not being used to supplant the budget of any generic agency mandated to provide such services;
   1. Documentation of a denial of service from a generic or third-party source must be in the case record. Such documentation may be in a T19 Note or by copy of the denial.
8. Documentation of appropriate consultation from clinical specialists, where indicated;
9. For continuation of a purchased service, documentation of individual progress in achieving desired outcomes and satisfaction with supports and/or services and with the service provider.
10. After review, the manager:

3. Approves appropriate SANDIS Authorization as well as any exceptional level of IPP Amendment and forwards to the Director of Service & Supports or designee.
4. Manager forwards SANDIS authorization on for 2^nd level approval by Department Director or designee.
5. The appropriate Department Director, or designee, reviews each request and:

3. Approves the SANDIS Authorization; or,
4. Consults the submitting manager for further information; or,
5. Denies the request and defers the SANDIS Authorization to the submitting manager with explanation.
6. The manager reviews the request with the service coordinator, making recommendations/changes as necessary.

4. Emergency Requests for Funds:

4. When a service must begin prior to two weeks or prior to the usual starting timeline for a service, the emergency procedure can be utilized. Generally, emergencies are those involving serious health, behavioral or respite needs.
5. The service coordinator is responsible for obtaining consultation from the appropriate specialist, as needed.
6. If the manager is unavailable for consultation and review, the request may go directly to the appropriate Department Assistant Director or covering Services and Supports Manager.

5. Termination of a Purchase of Service Authorization:

5. The service coordinator, immediately upon determination that a service is no longer needed or being used, shall submit and complete an IPP amendment
6. When necessary, the service provider should be notified verbally of the termination. When the regional center proposes to terminate the person’s services with less than a 30-day notice, other than for immediate health and safety, individual request, or unanticipated change in residence, the service provider must be paid for those days of services during that 30-day period for which the individual would have been authorized to receive services as identified in the Individualized Family Service Plan or Individual Program Plan. Funding is not provided under the other following circumstances:

5. There is agreement between the regional center, service provider, and individual for an earlier termination date. In this instance, funding is provided through the date the person ends services.
6. The individual’s vacated place in the service has been filled by another person. In this instance, funding for the individual who is no longer receiving services will cease on the date the substitute person begins attending.
7. Notification of the individual/family of a unilateral decision by the regional center to terminate a purchased service, must be carried out in accordance with the provision of law.

Revision Date: 12/2025