Informed Choice

Effective Date: March 1, 2004		Review Date: March 1, 2004
Background	Informed choice is a voluntary decision made by a person or their legal representative after becoming familiarized with alternatives to: • Select from a number of feasible alternatives • Select an alternative that may be developed in the future • Refuse any or all alternatives
Services	If it is determined at the screening that the person is in need of the level of care provided by an Intermediate Care Facility for Persons with Mental Retardation or Related Conditions (ICF/MR), then the person and or the legal representative, if any, will be asked to make an informed choice of which services they would like to receive. This means the person and/or the legal representative are informed by the case manager/service coordinator and understand any feasible alternatives available under the waiver or in an ICF/MR and given choice among those alternatives. The case manager/service coordinator should insure that the person and their legal representative are not influenced or led to believe that there is only one option available. Where more than one provider of a feasible service is available the person or their legal representative, if any, must be allowed to select the provider of service if the selected provider has the capacity to meet the person's needs.
Waiting Lists	A person may indicate their choice of the MR/RC Waiver services even if the county does not currently have an available allocation. Counties must have procedures and criteria for determining priorities for the allocation of waivered services and the person will be placed on a waiting list. The procedures and criteria include county management of waivered services costs so that the county is not required to provide services at a cost that would cause them to exceed the average reimbursement level available. The case manager/service coordinator should inform the person and/or their legal representative, if any, of a waiting list.
Service Alternatives	During the screening process, the case manager/service coordinator assists in determining eligibility, but the choice and type of services is a decision made by the person and their legal representative, if any, regardless of recommendations made by the other team members. There may also be options available other than waivered or ICF/MR services. Discussion of feasible service alternatives should occur at the annual team meetings. For a service to be a feasible alternative: • Person must be eligible to receive the service • Service must be appropriate to meet the person's needs as identified in the Individual Service Plan • Service must be within established funding limits
Documentation	The person and/or their legal representative must also indicate their informed choice by signing the document under the statement: “I have received information regarding service alternatives, understand feasible service options, and have made an informed choice of my preferences.” If a person is unable to make an informed choice for the purpose of completing the screening document, the case manager/service coordinator must establish a guardianship for the person prior to completing the screening. The screening cannot occur even if a petition has been filed for establishment of a guardian. Any meeting that is held prior to the date of appointment of a guardian is an informational meeting only and is not the full team screening. If there is an emergency, it may be possible to appoint a special guardian. Click here for more information on Guardianship Responsibilities.