DAL 14-01: Individualized Service Plan (ISP) with an EHP addendum to meet the requirements for the EHP functional assessment

October 29, 2014

DAL: DAL 14-01

SUBJECT: Individualized Service Plan (ISP) with an EHP addendum to meet the requirements for the EHP functional assessment

Dear Administrator:

The purpose of this letter is to inform you that Enriched Housing Programs (EHP) may elect to use the Individualized Service Plan (ISP) with an EHP addendum to satisfy the requirements for both the EHP case management evaluation and the functional assessment. EHPs are required to complete both upon admission, annually thereafter and whenever there is a significant change in the resident's condition.

Upon admission, Operators will complete the ALR Resident Evaluation Forms DOH-4297 Part A and Part B. Information documented on DOH-4297 Part B will be used in conjunction with the Medical Evaluation (DOH-3122 or DSS-3122) to develop the resident's initial ISP. Annually thereafter, or whenever there is a significant change in the resident's condition, the EHP will:

  • Obtain an updated medical evaluation;
  • Review and update the resident's ISP and EHP addendum; and
  • Write a case management note clarifying any changes to the ISP or EHP addendum

Since the ISP with the EHP addendum more accurately reflects the resident's current status, the ALR Resident Evaluation Form DOH-4297 Part B would not be required. An example of an ISP with an EHP addendum is attached for your reference. If the EHP does not elect to utilize the ISP and EHP addendum, they would continue to complete the medical evaluation (DOH-3122 or

DSS-3122), the EHP case management evaluation and the EHP functional assessment upon admission, annually and whenever there is a significant change in the resident's condition.

If you have any questions regarding this correspondence, please contact the Division of ACF/Assisted Living Surveillance at (518) 408-1133 for further clarification.

Sincerely,

Valerie A. Deetz, Director
Division of ACF and Assisted Living Surveillance & the Community Transitions Program

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