New Mexico Department of Health
Our mission is to promote health and wellness, improve health outcomes, and assure safety net services for all people in New Mexico.

Service Planning & Budgets

Service Planning and budget development start with person-centered thinking, planning and practice. The Service Support Plan (SSP) is the document that results from the planning process. The SSP/budget, once approved by the participant will be submitted by the consultant to the Third-Party Assessor (TPA) for review.


Person-Centered

The following person-centered thinking, processes, and practices are central to the development process.

Thinking

Person-Centered thinking values and supports individuals with intellectual and developmental disabilities to make informed choices and exercise the same basic, civil and human rights as other citizens, including dignity of risk.

Planning

Person-Centered Planning (PCP) is an ongoing process that identifies what is important to and what is important for a person. The individual with Intellectual and/or Developmental Disability (IDD) is at the center of the process and is encourage to direct the process as much as possible. No matter what the nature or severity of a person’s disability, there are many ways to identify a person’s strengths, abilities, preferences, needs, and goals. PCP supports people with IDD to exercise the same basic legal, civil and human rights as well as other citizens.

Practice

Person-centered practice is aligning service and resources to support individuals to achieve individual goals and outcomes that are important to and for them.


Service and Support Plan

The Service and Support Plan (SSP) development process starts with person-centered planning. This process obtains information about the participant’s strengths, capacities, preferences desired outcomes and risk factors. In person-centered planning, the SSP must revolve around the individual participant and reflect his or her chosen lifestyle, culture, functional, and social needs for successful community living. The consultant will use information obtained from the TPA (in-home assessment and CIA) to incorporate into the discussion and planning process. The goal of the planning process is for the participant to achieve a meaningful life in the community, as defined by the participant. The participant is the leader in the development of the SSP. The participant will take the lead or be encouraged and supported to take the lead to the best of their abilities to direct development of the SSP. The participant may involve, if he/she so desires, family members or other individuals, including service workers or providers, in the planning process.

Personal Plan Facilitation Services

Personal plan facilitation supports planning activities that will result in a holistic person-centered plan that may be used by the participant to develop his/her service support plan (SSP) as well as identify other sources of support outside the SSP process. Essential Life Planning (ELP), Circle of Friends, Making Action Plans (MAPS), Planning Alternative Tomorrows with Hope (PATH), Personal Future Planning (PFP), Lifestyle Planning and Personal Profile may be used by the facilitator to produce the plan.  This service provides an opportunity for the individual to explore and articulate the vision he/she has for his/her life. This service is provided by trained staff using personal plan facilitation tools. This service is available to participants one (1) time per budget year, and will be used to plan for the current (already in place) and subsequent SSP and budget. For more information, please read the Mi Via Waiver.

Please see the Mi Via Self-Directed Waiver Service Standards – Appendix A: Service Description and Provider Qualifications for information on personal plan facilitation services.

Components

The Mi Via SSP template is organized by the four (4) categories of services, and includes questions in each section that help identify the participant’s strengths, goals, natural and informal supports, concerns and challenges, and how the participant will know whether the plan he/she has developed is working well.

Each section of the SSP must be completed by the participant, even if he/she does not plan to request services or goods from that section. This is because the SSP is a comprehensive planning tool and all areas need to be considered carefully.

Please see the Mi Via Self-Directed Waiver Service Standards – Appendix B: Service and Support Plan Template for more information on the SSP template.

Other Supports

Please visit the Services & Supports section of our website to learn more about Living Supports, Community Membership Supports, Health and Wellness Supports and more.

Other Sections

The SSP also includes a section for Environmental Modification services which are physical adaptations that provide medical or remedial benefits to the individual’s physical environment that address the qualifying diagnosis.  Please see the Mi Via Self-Directed Waiver Service Standards for more details.

24-Hour Emergency Back-up Plan

This section lists who the participant will contact in an emergency or if regularly scheduled employees or service providers are unable to report to work. The Emergency Back-Up Plan is mandatory and must be completed in the SSP.  Please see the Mi Via Self-Directed Waiver Service Standards for more details.

Consultant/Support Guide Services

The last section of the SSP addresses how much help the participant or his/her employer of record may need from their Consultant/Support Guide or others to be successful with self-direction and with being a successful employer.  Please visit the Consultant Services section of our website to learn more.

Completing and Submitting

The SSP can be written out by hand, or the consultant can use the Mi Via Self-Directed Waiver Service Standards – Appendix B: Service and Support Plan Template form to fill it out electronically. However, in order for the SSP to be submitted to the TPA, all sections completed with detailed descriptive information must be entered into theMi Via on-line system SSP by the consultant.


Developing a Budget

Once the SSP has been completed and the participant has identified the supports he/she would like to obtain through the Mi Via program, the consultant and participant work together to develop the SSP/budget request.  The budget is developed one (1) goal at a time. Each goal includes is clear and complete explanation of the requested services(s) or good(s), how they are related to the participant’s qualifying condition and why they are appropriate for the participant. Each goal includes full details about each of the requested services(s) or good(s), including: amount, frequency and duration, type of provider, cost or estimated cost, rate of pay etc.

Budget Submission

Once the budget request is complete and approved by the participant, the consultant will submit it to the TPA for consideration using the Mi Via Plan of Care Online system.

For more information on the SSP components and budget development process please see the Mi Via Self-Directed Waiver Service Standards document.

Individual Budgetary Allotment

The Individual Budgetary Allotment (IBA) is the maximum amount of funding for each participant that is determined by the individual’s assessed Level of Care (LOC) and age. This amount of funding will allow the participant to develop a plan to meet functional, medical and habilitative assessed need(s) to enable the participant to remain in his or her community.


AGES IBA AMOUNT NOTES
0-17 $23,443.00  
18-20 $54,589.00 68,589 if using In Home Living Services
21+ $72,710.00  

Third Party Assessor

The Third-Party Assessor (TPA) is under contract with the Human Services Department Medical Assistance Division (HSD/MAD). The TPA performs utilization management duties such as reviewing, approving, or denying participant’s Service Support Plans/budgets (SSP). Participants work with their consultants to develop their SSP/budget, which is submitted through the Mi Via Plan of Care Online-system for the TPA review and approval.  The TPA also provides services related to medical eligibility (Level of Care) determination and re-determinations.

Authorized Annual Budget

The Authorized Annual Budget (AAB) is the amount of the annual budget approved for a participant by the TPA. Participants work with their consultant to develop an annual budget request which is submitted to the TPA for review and approval. The total amount approved by the TPA is the AAB.


The Financial Management Agency

The Financial Management Agency (FMA) is under contract with the Human Services Department Medical Assistance Division (HSD/MAD). The FMA helps implement the approved budget by paying the participant’s employees and vendors and tracking expenditures.

Mi Via Plan of Care Online System

The Mi Via Plan of Care online system (FOCoSonline) is used by the Mi Via FMA for receiving and processing payments. The Mi Via plan of care on-line system is also used by participants to view the plan and monitor their budgets, and review and approve their employee’s timesheet. Working with the participant, the consultant uses the Mi Via Plan of Care online system to submit developed SSP/budget requests.