Self Advocacy Association of New York State

Medicaid Service Coordination
pg 1 | pg 2 | pg 3

~ Introduction - What is it all about?
~ Rules for Service Coordination
~ Paperwork
~ Working Out Issues
~ Choices
~ Brochure
~ Click here to download a booklet about the above information, updated 2007 - PDF
Activity Plan

The activity plan is the second part of the service coordination agreement. As with the basic agreement, the activity plan should be updated minimally every six months or if changes are made to the plan. This document describes the most important service coordination activities you want and need. The services you want your service coordinator, or others to provide needs to be documented here.

The activity plan is a two-sided document. You can look at it on the next two pages.

The first section is for your name. The next three sections on the first page of the activity plan are identical. It is the section that shows that you have asked for a service or set a personal goal that your service coordinator will be assisting you in. There is a place to state what your request is. Then, there are sections to indicate what responsibilities your service coordinator will have in helping you accomplish this request. There is also a section showing what activities or responsibilities you, your family members, or your advocate will have. Beneath this is a comment section. There are start and completion dates for each section.

This section is repeated two more times on the second page of the activity plan.

The last section on the second page of the activity plan gives instructions on how to fill out this form and what kind of information should go in each section.

SANYS, Self-Advocacy Association of NYS, Inc.