Services designed to assist individuals in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings.

Habilitation provided in day programs includes support and functional training in use of community services, basic life skills, appropriate behaviors for the workplace and appropriate social behaviors.

Habilitation services do not include special education and related services (as defined in Section 4(a)(4) of the 1975 Amendments to the Education of the Handicapped Act (20 U.S.C. 1401(16), (17)) which otherwise are available to the individual through a State or local educational agency and vocational rehabilitation services which otherwise are available to the individual through a program funded under Section 110 of the Rehabilitation Act of 1973 (29 U.S.C. 730). 

The Plan of Care, based upon the results of a formal assessment and identification of needs, provides the actions and outcomes toward which training efforts are directed.

Work/day programs offer individualized services based on the support needs of service recipients. Persons served in work/day settings may include persons with pre-vocational skill training needs, persons who function as elderly with skill maintenance and social/leisure activity needs and persons with very significant behavioral, self-help or medical challenges that require enriched staffing ratios to meet habilitation and support goals. In some cases, individuals with varying services needs may be served under one roof, with staffing ratios and habilitation goals individualized to meet the needs of the recipients. Work/day programs offer one or more services conforming with the following criteria:

*  Pre-vocational services are oriented toward providing training to individuals who are not expected to join the general work force in the immediate future (i.e., within a year).

Pre-vocational services include support and training in self-help skills, motor and physical development, communication skills, functional academics, community life skills, work skills, and leisure skills. These training areas are not primarily directed at teaching specific job skills but at underlying habilitative goals.

If individuals are compensated for the work they do, the compensation is less than 50 percent of the minimum wage.

* Senior day services provide health services, social services, training and supervision based on the needs of the individuals served. Senior day services entail services which provide supports and specific functional training based on the plan of care.

These services are provided to older individuals whose plans of care direct training efforts and specify supports that will enable them to participate in a variety of age-appropriate activities supporting the goal of maintaining the individual's ability to function in the community and to avoid institutionalization.

* Intensive waiver-funded adult habilitation programs are oriented toward serving individuals with more severe disabilities. These individuals display fewer self-help skills and/or more severe problem behaviors than the individuals found in typical work activity centers or sheltered workshops. They have been found to have significant service and support needs based on the Montana Resource Allocation (MONA) instrument and have been determined as inappropriate for placement in less restrictive adult settings. 

Training and support is provided in a highly structured environment, by staff who are sophisticated in the skills of behavior management. Training focuses on the behaviors necessary to maintain the individual in the community-based service system and, if possible, move to a less restrictive setting.

Providers of day habilitation services can be reimbursed only for services delivered to recipients.

Homemaker services consist of general household activities provided by a homemaker when the person regularly responsible for these activities is unable to manage the home and care for himself/herself or others in the home, or is engaged in providing habilitation and support services to the individual with disabilities.

Services in this program include meal preparation, cleaning, simple household repairs, laundry, shopping for food and supplies and routine household care.
Homemaker services are not available under the State Plan.

Personal Care Services Include:

1.  Assistance with personal hygiene, dressing, eating and ambulatory needs of the individual; and
2.  Performance of household tasks incidental to the person's health care needs or otherwise necessary to contribute to maintaining the individual at home;
3.  Supervision for health and safety reasons.

Frequency or intensity will be as indicated in the plan of care.  
Personal care services under the State plan differ in service definition or provider type from the services to be offered under the waiver.  Under the waiver, RN supervision of the personal care worker is not required.

This service is available under the waiver only if the scope, amount or duration of the available Medicaid State Plan Personal Care is insufficient in meeting the needs of the recipient.

Services designed to assist individuals in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and community-based settings. 

Habilitation provided to an individual wherever he or she may live. Settings may include natural homes or the individual's personal home. 

Board and room is not a covered service. Individuals served are responsible for paying for board and room through other funding sources such as Supplemental Security Income (SSI).

The plan of care, based upon the results of a formal assessment and identification of needs, provides the general goals and specific objectives toward which training efforts are directed. The plan of care also specifies the appropriate residential setting in which services will be provided.

Training is provided in basic self-help skills, home and community living skills, leisure and social skills. Support is provided as necessary for the care of the individual. Each training action is specified in the plan of care and is clearly related to the individual's long term goal and is not simply busywork or diversional in nature.

Residential habilitation services are not available to waiver recipients residing in assisted living or adult foster home settings.

Respite care includes any services (e.g., traditional respite hours, recreation or leisure activities for the recipient and care giver; summer camp) designed to meet the safety and daily care needs of the recipient and the needs of the recipient's care giver in relation to reducing stress generated by the provision of constant care to the individual receiving waiver services. These services are selected in collaboration with the unpaid caregiver and are provided by persons chosen and trained by the family. Persons providing respite services will be in compliance with all state and federal respite standards. Respite services are delivered in conformity with an individualized plan of care.

Respite services may be provided in licensed adult day care centers.  Licensed adult day care centers may choose to receive payment directly from the DDP in accordance with the terms of a DDP contract, or be reimbursed for respite services by an agency designated as an OHCDS in their DDP contract.  The respite reimbursement paid by the Department will not exceed the currently approved rate for the service for either reimbursement option.

The amount and frequency of respite care (with the exception of emergencies) is included in each individual's plan of care.
FFP (Federal Financial Participation) will not be claimed for the cost of room and board except when provided as part of respite care furnished in a facility approved by the State that is not a private residence.

Respite is only available to primary caregivers in family settings, including adult foster homes. Respite is available when a primary caregiver is not compensated for providing some or all of the support or supervision needed by the client.

Supported employment is for persons with developmental disabilities who, because of their disabilities, need intensive ongoing support to perform in a work setting.

Supported employment provides the opportunity to: work for pay in regular employment; integrate with non-disabled persons who are not paid care givers; and receive long-term support services in order to retain the employment. The service is designed for individuals with developmental disabilities facing severe impediments to employment due to the nature and complexity of their disabilities.

Supported employment may include the following types of activities designed to assist eligible individuals to access and maintain employment:

a. Pre-placement activities: Pre-placement activities consist of gathering information, conducting employee assessment and completing any steps necessary to implement the job placement process.

b. Job Market Analysis/Job Development: Job market analysis and job development involve identifying and locating potential jobs.

c. Job Match/Screening: Job match and screening involves establishing job requirements and selecting/matching potential employees to jobs.

e. Job Placement/Training: Training is directed toward development of all the skills necessary to succeed in the particular paid job that the individual is hired to do. Training occurs within the actual job environment and addresses naturally occurring demands and contingencies. The trainer assists the employee in completing the job until all the tasks can be performed at the standard established by the employer.

f. Ongoing Assessment and Support and Service Coordination: Ongoing assessment and support involves monitoring the status of the job environment and the employee, and providing interventions as needed to maintain job placement.

g. Transportation: Transportation of a work crew and its equipment to and from the job site may be provided.
Supported employment will be funded under the waiver when not available under Section 110 of the Rehabilitation Act of 1973, as amended, (19 U.S.C. 730).

Non-medical care, supervision and socialization, provided to a functionally impaired adult. Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services. The provision of Companion Services does not entail hands-on nursing care. Providers may also perform light housekeeping tasks which are incidental to the care and supervision of the individual. This service is provided in accordance with a therapeutic goal in the plan of care, and is not purely diversional in nature.

This service will not duplicate Personal Care or Homemaker Services through the waiver, State Plan or any other programs.

This service is defined by adult learning activities such as classes, instruction, tutoring, distance learning, courses, instructional materials including books, software, Internet access fees, enrollment fees, tuition fees, supplies, or other expenses related to the education and skill development of the person as outlined in the plan of care. Relatives and family members may not be reimbursed for the provision of this service. Educational services available through VR or IDEA are not reimbursable with Waiver funds.

Environmental Modifications :
Those physical adaptations to the home, required by the individual's plan of care, which are necessary to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home, and without which, the individual would require institutionalization. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems which are necessary to accommodate the medical equipment and supplies which are necessary for the welfare of the individual. 

In addition to the above, environmental modifications services are measures that provide the recipient with accessibility and safety in the environment so as to maintain or improve the ability of the recipient to remain in community settings and employment. Environmental modifications may be made to a recipient's home or vehicle (wheelchair lift, wheelchair lock down devices, adapted driving controls, etc) for the purpose of increasing independent functioning and safety or to enable family members or other care givers to provide the care required by the recipient. An environmental modification provided to a recipient must:

(a)  relate specifically to and be primarily for the recipient's disability;
(b)  have utility primarily for a person who has a disability;
(c)  not be an item or modification that a family would normally be expected to provide for a non-disabled family member;
(d)  not be in the form of room and board or general maintenance;
(e)  meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI).
(f)  be prior authorized jointly by the provider's board of directors and the DDP if the cost of the project may exceed $4,000.

For individuals requiring ADA accommodations, environmental modifications will meet the ADA requirements. 

Excluded are those adaptations or improvements to the home which are of general utility, and are not of direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc. Adaptations which add to the total square footage of the home are excluded from this benefit. All services shall be provided in accordance with applicable State or local building codes.

Adaptive Equipment: 
Adaptive equipment necessary to obtain and retain employment or to increase independent functioning in completing activities of daily living when such equipment is not available through other sources may be provided. Adaptive equipment as needed to enable family members or other care givers to provide the care needed by the individual. 

A comprehensive list is not possible because sometimes items are created (invented) to meet the unique adaptive needs of the individual, for example, an adult-sized "changing table" to enable a care giver to diaper and dress a person who has severe physical limitations; or specially designed switches that an individual with physical limitations can use to accomplish other tasks. Adaptive equipment will conform to the following criteria:

(a)  relate specifically to and be primarily for the recipient's disability;
(b)  have utility primarily for a person who has a disability;
(c)  not be an item or modification that a family would normally be expected to provide for a non-disabled family member;
(d)  not be in the form of room and board or general maintenance;
(e)  meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI).
(f)  be prior authorized jointly by the provider's Board of Directors and the DDP if the cost of the project may exceed $4,000.

Specialized Medical Equipment and Supplies:

Includes devices, controls, or appliances, specified in the plan of care, which enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. This service also includes items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the Medicaid State plan. Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies furnished under the State plan and shall exclude those items which are not of direct medical or remedial benefit to the individual. All items shall meet applicable standards of manufacture, design and installation.

All Environmental Modifications /Adaptive Equipment/Specialized Medical Equipment and Supplies will be limited to the $7800.

Supports available in this category include those services or supports which reduce known risks, as identified on a risk assessment completed annually as part of the Community Supports planning process and written into the plan of care. Supports in this category may include the purchase of such things as  emergency personal defense devices, monitoring devices and other safety related, risk reducing supports. Supports in this category may not be available through State Plan Medicaid Services or another waiver service category but must relate directly to the needs of the waiver recipient and be documented in the plan of care. Monthly telephone or cell phones fees are excluded. 

All Health/Health Maintenance/Safety Supports must:
(a)  relate specifically to and be primarily for the recipient's disability;
(b)  have utility primarily for a person who has a disability;
(c)  not be an item that a family would normally be expected to provide for a non-disabled family member;
(d)  be prior authorized jointly by the provider's board of directors and the DDP if the cost  exceeds $4,000.

PERS is an electronic device that enables waiver participants to secure help in an emergency. The participant may also wear a portable "help" button to allow for mobility. The system is connected to the participant’s phone and programmed to signal a response center once a "help" button is activated. The response center is staffed by trained professionals.

PERS services may be appropriate for individuals who live alone, or who are alone for parts of the day, and have no regular caregiver for periods of time.
 
Because of the limitations of the PERS service, a cell phone may be a more flexible, cost effective solution in ensuring health and safety for some individuals. Cell phones are not for convenience or general purpose use.  

Guidelines for the use of cell phones include:

1. The individual requires access to assistance or supports and is frequently beyond the range of coverage of a PERS system.
2. Cell phone plans will be basic plans and will not include features unrelated to health and safety issues, such as web access or music services.
3. Individuals may elect to add a usage control feature to their basic plan to eliminate the potential for fee overage.
4. Individuals who do not elect to add a usage control feature and who exceed the fees associated with their plan may require the implementation of a usage control feature to prevent future overages. In all cases of an overage the case manager will be notified.
5. These cell phone guidelines will be reviewed with the individual prior to or at the annual planning meeting.       
Installation, maintenance and monthly fees associated with PERS services and cell phone services may be reimbursed with waiver funds as outlined in the plan of care.

Private Duty Nursing will be made available to individuals with chronic nursing needs for the hours specified by the physician in a private home, foster home, day program, job site or other community location as specified in the plan of care. The use of Private Duty Nursing for persons in Community Supports will be contingent upon a plan approved by the consumer/family/guardian, physician, service provider, and the Department.

NOTE- Nursing services costs will be separate from all other CS services in that these costs will not be factored into the maximum allocation of $7,800.

Nursing services must be specified in the plan of care. It must be ordered in writing by the individual's physician and it must be delivered by a registered nurse (RN) or a licensed practical nurse (LPN). Nursing requirements and duties are further defined as follows:

Nursing services may include:
(a)  medical management;
(b)  direct treatment;
(c)  consultation; and
(d)  training for the recipient or persons providing direct care.

Nursing services must be provided by a registered nurse or licensed practical nurse. Persons providing nursing services must meet the licensure and certification requirements.

These services and supports are designed to address needs related to personal growth and development, community integration, formation of friendships, relationships and social skills and to enhance the quality of life of the individual. These supports often serve to provide primary care givers limited relief from the responsibilities of care giving and supervision.

Reimbursements allowable in this category include those costs associated with the habilitation support and transportation directly associated with the social, leisure and recreational activities as outlined in the plan of care. Fees and equipment costs related to social, leisure and recreational outings are not reimbursable under the waiver.

Transportation through this service will not be duplicated with any other transportation costs or services through the waiver, State Plan or any other programs.

Service offered in order to enable individuals served on the waiver to gain access to waiver and other community services, activities and resources, specified by the plan of care. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State Plan, defined at 42 CFR 440.170(a) (if applicable), and shall not replace them. Transportation services under the waiver shall be offered in accordance with the individual's plan of care. Whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge will be utilized.

Transportation may also include escort services as a component of the transportation service, for the purpose of providing guidance and assistance to a person as outlined in a plan of care. Transportation services may be provided by a family member for the purposes outlined in the plan of care, but will not include payment for the family member's time. Reimbursable transportation expenses may also include assistance with reasonable (as determined by the department) costs related to one or more of the following areas:  operator training and licensure, insurance, registration or other costs associated with a recipient's dependence on the use of a personal vehicle owned by the recipient in accessing work or other community integration activities as outlined in the plan of care.

The following things are excluded (or not included):

1) Adaptations or improvements to the vehicle that are of general utility, and are not of direct medical or remedial benefit to the individual;
2) Purchase or lease of a vehicle; and
3) Regularly scheduled upkeep and maintenance of a vehicle except upkeep and maintenance of any modifications.

Transportation services are not reimbursable in residential and work/day settings, if the transportation service is folded into the rates for these residential and/or work/day settings. Under no circumstances will medically necessary transportation (transportation to medical services reimbursed under the State Plan) be reimbursed under the waiver if the service is reimbursable under State Plan transportation.

The payment for the additional costs of rent and food that can reasonably be attributed to an unrelated live-in caregiver who resides in the same household as the waiver participant.  Payment will not be made when the participant lives in the caregiver’s home, or in a residence that is owned or leased by the provider of Medicaid services.

The staff person providing this service is an employee of an agency with a DDP contract.  The service is provided by staff qualified to deliver residential habilitation.  This service is limited to adult service recipients.  Services are not billable when the caregiver is sleeping.  Specific terms and conditions of the service are specified in a written Live-In Caregiver Agreement between the provider agency, the live-in caregiver and the service recipient and require Department approval.  Additional residential support required by the recipient exceeding the value of the live-in caregiver reimbursement  must be prior authorized by the Regional Manager and delivered in accordance with the plan of care and Live-In Caregiver Agreement.

The service must include an approved backup plan in the event of a service disruption.  The backup system must include an on call system in the event that emergency assistance is needed when the caregiver is not available.  Reimbursement for paid backup support (e.g., the live-in caregiver takes a two week annual vacation) would require the backup agency staff person to meet the qualified provider requirements for residential habilitation.  In this event, the backup staff person’s services would be reimbursed based on the prevailing hourly rate for residential habilitation.

  The personal supports worker assists the participant in carrying out daily living tasks and other activities essential for living in the community.  Services may include assistance with homemaking, personal care, general supervision and community integration.  Personal supports activities are generally defined in the plan of care and are flexible in meeting the changing needs of the recipient.   Personal supports workers do not provide formal training to a participant, but workers may be assigned activities that involve informal training, mentorship, and activities designed to maintain skills.  Personal supports workers may be required to provide transportation to a participant for activities as outlined in the plan of care, including community integration activities, rides to medical appointments, work or school and other community functions.

          Personal supports is available to a participant only when the planning team has approved a back-up plan, serving to ensure the health and safety of the participant in the event of a service disruption.  Respite and agency based residential habilitation are available to a participant receiving personal supports, but waiver-funded adult companion, agency based homemaker services, and personal care services (except for State Plan funded personal care services) are not available to a person receiving personal supports services.  These service exclusions ensure the non-duplication of waiver-funded services.

          Personal supports services are only available to participants who self-direct some or all of their services with employer authority.  The personal supports worker is hired by the designated employer, and is the employee of the participant, family member or representative with employer authority.

          A person receiving personal supports is self-directing this service with employer authority. 

          Other waiver services that may overlap with the activities of the personal supports worker are prohibited.  These include live in care giver services, adult companion, extended personal care services and homemaker.                 

Personal supports services are only available to participants who self-direct some or all of their services with employer authority.  The personal supports worker is hired by the participant or the participant’s representative, and is an employee of the participant or the participant's representative.

Service/function that assists the participant (or the participant's family, or representative, as appropriate) in arranging for, directing and managing services.  Serving as the agent of the participant or family, the service is available to assist in identifying immediate and long-term needs, developing options to meet those needs and accessing identified supports and services.  Practical skills training is offered to enable families and participants to independently direct and manage waiver services.  Examples of skills training include providing information on recruiting and hiring personal care workers, managing workers and providing information on effective communication and problem-solving. The service/function includes providing information to ensure that participants understand the responsibilities involved with directing their services.  The extent of the assistance furnished to the participant or family is specified in the service plan. 

This service does not duplicate other waiver services, including case management

          •This service is limited to participants who direct some or all of their waiver services with employer authority.

          •As discussed in the instructions for Appendix E (Participant Direction of Services), the scope and nature of this  service hinges on the type and nature of the opportunities for participant direct afforded by the waiver.  Through  this service, information may be provided to participant about:

          * person centered planning and how it is applied;

          * the range and scope of individual choices and options;

          * the process for changing the plan of care and individual budget;

          * the grievance process;

          * risks and responsibilities of self-direction;

          * free of choice of providers;

          * individual rights;

          * the reassessment and review schedules; and,

          * such other subjects pertinent to the participant and/or family in managing and directing services.

          Assistance may be provided to the participant with:

          * defining goals, needs and preferences, identifying and accessing services, supports and resources;

          * practical skills training (e.g., hiring, managing and terminating workers, problem solving, conflict resolution)

          * development of risk management agreements;

          * development of an emergency back up plan;

          * recognizing and reporting critical events;

          * independent advocacy, to assist in filing grievances and complaints when necessary; and,

          * other areas related to managing services and supports.

          This service may include the performance of activities that nominally overlap the provision of case management services.  Where the possibility of duplicate provision of services exists, the participant’s service plan should clearly delineate responsibilities for the performance activities.

          This service is capped annually at $2,000.  This cap can be exceeded for a limited time period in extraordinary circumstances, with the prior approval of the DDP program director.

Service/function that assists the participant (or the participant's family, or representative, as appropriate) in arranging for, directing and managing services.  Serving as the agent of the participant or family, the service is available to assist in identifying immediate and long-term needs, developing options to meet those needs and accessing identified supports and services.  Practical skills training is offered to enable families and participants to independently direct and manage waiver services.  Examples of skills training include providing information on recruiting and hiring personal care workers, managing workers and providing information on effective communication and problem-solving. The service/function includes providing information to ensure that participants understand the responsibilities involved with directing their services.  The extent of the assistance furnished to the participant or family is specified in the service plan. 

This service does not duplicate other waiver services, including case management

          •This service is limited to participants who direct some or all of their waiver services with employer authority.

          •As discussed in the instructions for Appendix E (Participant Direction of Services), the scope and nature of this  service hinges on the type and nature of the opportunities for participant direct afforded by the waiver.  Through  this service, information may be provided to participant about:

          * person centered planning and how it is applied;

          * the range and scope of individual choices and options;

          * the process for changing the plan of care and individual budget;

          * the grievance process;

          * risks and responsibilities of self-direction;

          * free of choice of providers;

          * individual rights;

          * the reassessment and review schedules; and,

          * such other subjects pertinent to the participant and/or family in managing and directing services.

          Assistance may be provided to the participant with:

          * defining goals, needs and preferences, identifying and accessing services, supports and resources;

          * practical skills training (e.g., hiring, managing and terminating workers, problem solving, conflict resolution)

          * development of risk management agreements;

          * development of an emergency back up plan;

          * recognizing and reporting critical events;

          * independent advocacy, to assist in filing grievances and complaints when necessary; and,

          * other areas related to managing services and supports.

          This service may include the performance of activities that nominally overlap the provision of case management services.  Where the possibility of duplicate provision of services exists, the participant’s service plan should clearly delineate responsibilities for the performance activities.

          This service is capped annually at $2,000.  This cap can be exceeded for a limited time period in extraordinary circumstances, with the prior approval of the DDP program director.

Individual Goods and Services are services, supports or goods that enhance opportunities to achieve outcomes related to living arrangements, relationships, inclusion in the community and work as clearly identified and documented in the service plan.  Items or services under individual goods and services fall into the following categories:

          *Membership/Fees:  fitness memberships, tuition/classes, summer day programs, social membership (for example: Sierra Club, outdoor clubs, rotary club, friendship clubs and girl scouts) and socialization supports (for example: fees associated with participating in Special Olympics and community events such as the annual pancake breakfast, community picnics, fairs, art shows and cultural events.  Membership and activity fees are permissible only if there is an assessed need, the membership fee or activity helps prevent the person from being socially isolated, and the service helps the individual remain in an appropriate community placement. 

          *Devices/Supplies: batteries for hearing aids and batteries for assistive technology devices, nutritional supplements, diapers, instructional supplies, instructional books and computers.

          Items covered under individual goods and services must meet the following requirements:

          - The item or service is designed to meet the participant's functional, medical or social needs and advance the desired outcomes in his/her plan of care; 

          - The item or service is not prohibited by Federal or State statutes or regulations;

          - One or more of the following additional criteria are met:

          1. The item or service would increase the participants functioning related to the disability; 

          2. The item or service would increase the participants safety in the home environment; or

          3. The item or service would decrease dependence on other Medicaid services;

          - The item or service is not available through another source; and

          - The service does not include experimental goods/services.

Recreational activities provided under Individual Goods and Services may be covered only to the degree that they are not diversional in nature and are included in a planning objective related to a specific therapeutic goal.

          Montana assures that services, supports or goods provided under this definition are not covered under the Individuals with Disabilities Education Act (IDEA) or Section 110 of the Rehabilitation Act or available through any other public funding mechanism.     

          Individual goods and services must be approved by the planning team prior to purchase and reimbursement.  In addition, goods and services purchased on behalf of the recipient by legal guardians, legally responsible persons, or other non-employees acting on behalf of the recipient are reimbursable only if receipts for such purchases are submitted to the agency with a DDP contract.  The receipts are reimbursable only if all the requirements listed above have been met.

This service is capped at $2,000 annually.  The $2,000 dollar cap is a "cap within a cap", meaning that a service recipient receiving $2,000 in goods and services will have a maximum of $5,800 available for the purchase of all other services*.