Service Authorization

1.   Current Service Plan
2.   Current Health and Safety Plan/Signature page
3.   Current Psychological Evaluation
4.   Current Skill Assessment and Summary
5.   Current Behavioral Approaches, Behavior Programs, Point Systems
6.   Guardian/conservator paperwork
7.   Medical history
8.   Current list of medication, including purpose and side effects
9.   Standing Orders from Physician
10. Psychotropic information if applicable
11. Current Seizure Plan (must be signed by physician or RN)
12. Other pertinent information*

* If you have any questions please call Deen Ajibola (Executive Director) at 763-315-2837 or James Hammill (Director of Program Services) at 763-218-2961 or Bill Jacobs (Program Director) at 612-670-1160.

Policy:
Applications for services from Amas Incorporated are considered without regard to race, creed, national origin, religion, physical handicap, sexual orientation, marital status, or status regarding public assistance. Reasonable accommodations shall be made as required by the Americans with Disabilities Act. Applicants must be at least 18 years of age, have a primary diagnosis of mental retardation or related condition, and be willing and able to participate in the services or supports requested. The decision to accept a person for services will be based solely on the support needs of the applicant and the resources available to meet the individual's needs.

Procedures:
1. The individual's Case Manager shall complete and submit an application for admission to the Program Director. The application shall include a risk management plan and signed, appropriate Consent to Release Information forms.

2. If it appears that Amas Incorporated programs can meet the individual's service needs, a meeting will be scheduled with the applicant, legal representative, case manager, and other significant individuals. At this meeting the following issues will be discussed.

> The applicant's desired outcomes and expectations for services and supports;
> The case manager's expectations for services;
> Areas of specific support required that meets applicant's medical, behavioral, or social needs
> Any revisions to the risk management plan which may be required
> Supports or assistance required during the transition to services
> Issues related to transportation
> Areas of concern or request for additional information which may be required to determine if the applicant wishes to continue the application for services and if Amas Incorporated Programs will be able to meet the individual's expectation and service needs.

3. If the applicant wishes to proceed with the application for services, Amas Incorporated will make a determination whether or not to accept the applicant within 3 days of receipt of all requested information and will notify the applicant, the legal representative, and case manger of the decision. If the applicant is accepted for services, a start date will be determined. If no service openings are available, the applicant's name will be placed on a waiting list and s/he will be informed of any opening as it occurs. If the applicant is not accepted for services, the reasons for the determination well as any additional options will be communicated to the applicant, the legal representative and the case manager.

4. Prior to authorizing services, the individual's Case Manager will provide Amas Incorporated with the following information for the consumer's data file:

i. Identifying information including date of birth, legal representative, history, medical, and names and telephone numbers of contacts;

ii. Individual’s medical and health information, including medications and individual medication administration and monitoring information;

iii. The Individual’s Service Plan; and

iv. A record of other license holders serving the individual including a contact person and telephone numbers, services being provided, services that require coordination between two license holders, and name of agency responsible for coordination.