Number of people served Enter the total number of people served in the setting or settings that are included in this self-assessment. Name and Role of Stakeholder Group For purposes of this self-assessment, is defined as consumer, “Role” family member, agency staff, case managers, and community advocates. Each provider is required to conduct self-assessment activities with a stakeholder group that includes consumers, family agency staff, case managers, and an advocate from an advocacy organization not directly affiliated with the provider agency. In this section, enter the first and last names, and role (e.g., consumer, family member, or advocate) of each stakeholder involved in your process. Methodology for Completing Self-Assessment In this section, please describe your agency’s approach to completing the self-assessment process. For example, how did you determine the persons selected to represent the required roles of the stakeholder group? Did you convene meetings or conference calls? Was each member of the stakeholder group provided with a copy of the tool? Who was responsible for which aspects of the before submission? Section B Section B Questions Instructions Question 1 A response here means this statement is true for your setting. “YES” Question 2 A response here means this statement is true for your setting. “YES” Question 3 If your evidence supporting compliance with the HCBS Setting Rule must demonstrate how such a “YES”, situation is not in violation of the Rule. For example, were the settings grouped together at the request of individuals served, were individuals able to choose to participate in services at this setting from other options made available to them, does participation in services at this setting prohibit individuals from being integrated in their community?
Number of people served Enter the total number of people served in the setting or settings that are included in this self-assessment. Name and Role of Stakeholder Group For purposes of this self-assessment, “Role” is defined as consumer, family member, agency staff, case managers, and community advocates. Each provider is required to conduct self-assessment activities with a stakeholder group that includes consumers, family agency staff, case managers, and an advocate from an advocacy organization not directly affiliated with the provider agency. In this section, enter the first and last names, and role (e.g., consumer, family member, or advocate) of each stakeholder involved in your process. Methodology for Completing Self-Assessment In this section, please describe your agency’s approach to completing the self-assessment process. For example, how did you determine the persons selected to represent the required roles of the stakeholder group? Did you convene meetings or conference calls? Was each member of the stakeholder group provided with a copy of the tool? Who was responsible for which aspects of the before submission? Section B Section B Questions Instructions Question 1 A “YES” response here means this statement is true for your setting. Question 2 A “YES” response here means this statement is true for your setting. Question 3 If “YES”, your evidence supporting compliance with the HCBS Setting Rule must demonstrate how such a situation is not in violation of the Rule. For example, were the settings grouped together at the request of individuals served, were individuals able to choose to participate in services at this setting from other options made available to them, does participation in services at this setting prohibit individuals from being integrated in their community?
StatewideTransitionPlanFinal3171512revised33115gp.docx