10802-Director 2nd Level Funding Requests

TCRC Procedure │ Service Coordination │ Procedure # 10802

SCOPE:

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

1. A format to put forward a service request;
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:
   1. The service is relevant to the person’s desired outcomes as identified through the person-centered planning team process.
   2. It reflects the most inclusive and cost-effective service;
   3. All alternative resources have been explored, exhausted and documented; and,
   4. 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.
6. Tri-Counties Regional Center cannot grant exceptions to State law or regulations.

 PROCEDURE:

1. Services may be authorized for purchase only if the following criteria are met:
   1. The recipient of service is currently receiving services from the Regional Center and is active (Status U, 1 or 2).
      1. In an extraordinary situation, a presumption of eligibility may be made by the Executive Director, or appropriate Department Director.
   2. The need for the purchased service must be clearly documented within the person’s Individualized Family Service Plan (IFSP) or Standardized Individual Program Plan (S-IPP) and be supported by the information in the record.
   3. The service is not available through generic or other resources.
   4. The service constitutes an exception to the Service Policies and Guidelines established by Tri-Counties Association for the Developmentally Disabled, Inc. Board of Directors.  Tri-Counties Regional Center cannot grant exceptions to State law or regulation.
   5. The service must be purchased from an authorized vendor.
   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.
2. Service Coordinator Responsibilities:
   1. A request for funds is a result of the Individualized Family Service Plan (IFSP)or Standardized Individual Program Plan (S-IPP) process in which:
      1. Individual’s need(s) and desired outcomes were identified;
      2. All possible resources were identified and explored; and,
      3. Services and supports were agreed upon.
   2. The case record must have adequate and current documentation of assessment and ongoing case management process including, at a minimum:
      1. Appropriate evaluations, e.g. nutritional evaluation, nursing, behavioral;
      2. Psycho-social Assessment;
      3. CDER or Early Start Report;
      4. Annual face-to-face contact;
      5. Individualized Family Service Plan or Standardized Individual Program Plan;
      6. Progress reports as required from service provider(s); and,
      7. Sandis/Title 19 Notes.
   3. The Individualized Family Service Plan or Standardized Individual Program Plan must be reflective of the person’s desired outcomes and specify the purchase of supports/services required to meet these outcomes.
      1. The service requiring Regional Center funds must be related to at least one desired outcome as identified in the person’s IFSP or S-IPP.  
   4. 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.
      1. A denial from a generic or third-party source for services for which the individual is eligible should be in the case record, if possible.
      2. Such documentation should be in written format from such source but may be recorded in SANDIS/Title 19 note by the service coordinator, indicating the source, name of person denying the purchase, and reason for the denial.
   5. The service coordinator has reviewed with the manager unusual or special situations that may require an exception to service policy.
   6. All sections of the authorization are completed correctly.
      1. Service code and sub-code must be identified.
      2. Admission Agreement and Rate Page forms are included for community care licensed homes.
   7. The length of time a service may be authorized is dependent upon the individual’s need and the nature of the service to be provided, not to exceed one year.
      1. For residential services that are an exception to policy, i.e. the first time that a child is placed out-of-home or when an adult is placed in a facility with more than 6 beds, an additional level of approval needs to be completed at initial placement only. 
      2. Supported Living Services costs over the maximum a community care facility would cost may be considered for a maximum of one year by the Planning Team.
      3. Primary supports, such as adult day activities, supported work and supported living may be authorized for a period of three (3) to six (6) months initially, allowing for adequate monitoring and review.  Once a baseline is established the authorization may go for one year.
      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.
   8. The appropriate specialist should be consulted, if needed, and must complete a note documenting the consultation.
   9. When the authorization is complete, the service coordinator forwards the S-IPP amendment to the manager at least 15 days prior to the proposed start of the service.  Click here for form  
      1. Any lead time shorter than 15 days must be explained to the manager and is allowed only in those situations which are considered urgent.
   10. 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:
       1. Reviewed by the manager and then the Director of Services & Supports or designee with an explanation.
       2. Accompanied by the corresponding S-IPP Amendment –
3. Administrative Review of Request for Funds:
   1. The manager reviews the S-IPP Amendment and other supportive documentation in the case record, as appropriate, to determine:
      1. If it constitutes an exception to Tri-Counties Regional Center Service Policies;
      2. Is there an appropriate Individualized Family Service Plan or Standardized Individual Program Plan, with specific outcomes related to individual needs and preferences and time-framed plans to achieve these outcomes;
      3. The accuracy of service codes and sub-codes;
      4. Evidence that the requested service is related to at least one desired outcome;
      5. 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 should be in the case record, if available.
      6. Documentation of appropriate consultation from clinical specialists, where indicated; and,
      7. For continuation of a purchased service, documentation of progress in achieving desired outcomes and satisfaction with supports and/or services and with the service provider.
   2. After review, the manager approves the appropriate authorization as well as the S-IPP Amendment, the documents are then forwarded to the Director or Assistant Director of Services & Supports, or designee.
   3. The Assistant Director or designee, reviews appropriately forwarded authorizations and Exception Requests and:
      1. Provides signature on the S-IPP Amendment and approves the corresponding authorization; or,
      2. Consults the submitting service coordinator and/or manager for further information; or,
      3. Denies the request and returns the amendment to the manager / service coordinator with rationale.
   4. For those requests receiving approval, Support Staff sort and route copies for processing.
      1. The original S-IPP Amendment is sent to the individual/family for signature. 
      2. A copy of the S-IPP Amendment is placed in the case record for future review/authorization.

Revision Date: 02/2026