Provider Choices

Provider Choices and Transferring Funds Procedure

Imagine! will recruit, develop and make available to individuals a pool of qualified providers. Individuals will be given the opportunity to choose the provider that best meets their needs. The following are general guidelines which should be considered when choosing a provider. Imagine! has a complete policy which is available through the case management department.

At each annual individualized plan (IP) meeting, or more often if needed, the planning team will consider how satisfied individuals, families and guardians are with service provider(s) and services provided.

Individuals who access services through Imagine! will be afforded the opportunity to choose the provider(s) that they feel best meets their needs. Imagine! is committed to respecting individual choice and facilitating reasonable and feasible changes, when possible, and when it is in the best interests of the person receiving services.

When someone is dissatisfied with the services they are currently receiving, the Interdisciplinary Team (IDT), facilitated by the Case Manager, is responsible for making all reasonable attempts to resolve the issues between the service recipient and the current service provider. It is the responsibility of the person receiving services, the guardian or an individual designated as an authorized representative for the person receiving services to make the Case Manager for the individual aware that there is dissatisfaction with the current services being provided. The Case Manager will convene an IDT meeting to discuss the issues and to put in place a plan to address those issues. The IDT will set a timeframe within which the issues must be successfully resolved. If resolution does not occur the individual, guardian or authorized representative for the individual will provide at least 30 days notice, in writing, to the current service provider that they intend to transfer their services and funding to another provider. The request for and notice of transfer may come only from a consumer, a guardian or authorized representative, or the IDT. It may not come from a service provider agency or direct care provider.

If the individual/guardian/authorized representative does not have a specific alternative provider in mind the case manager will request that IMAGINE! start the Request for Proposal (RFP) process. If the individual/guardian/authorized representative has a specific provider in mind and the provider is willing to accept that individual, the Case Manager will facilitate the transfer and request that the individual/guardian/authorized representative complete and sign the Verification of Consumer/Guardian Choice Options When Engaging Service Providers form.

Service providers do not need to accept for services every person who expresses an interest in receiving services from them. In some cases Imagine! may ask for further discussion with the provider when access to services has been denied. Service providers will not recruit people currently receiving services from other organizations, but may supply general information about services at the request of the individual/guardian/authorized representative.

When someone wants to change service providers, but does not have any specific issues with the current provider that need resolution, Imagine! can help to facilitate the change in a manner that is not detrimental to the individual, either provider, or other service recipients of the providers involved. The change should occur as soon as reasonably possible, but no later than 6 months after the request.

Choices that jeopardize services for other individuals will be negotiated to achieve the best outcome for all involved.

Provider changes that are requested due to gross incompatibility, as determined by the IDT, or verified issues of MANE will be facilitated as quickly as possible.