Regional Consultation Program
500 Victory Road, Quincy, MA 02171
617-774-1040 • FAX 617-847-0915

 

Respite Funding Request Form
Family rights and Responsibilites
Resources
   
 

Respite Handbook
Referral and Selection Process

Referrals to Family Support and Respite Services will be made in the following manner:

Non-EI Participant
 

EI Participant

Children not already enrolled in EI but appear eligible for respite services would be referred to the EI Program that serves the area.
OR
EI clients who appear eligible for respite services will be identified by EI Programs.
Regional Team, made up of the DPH Case Manager, EI Regional Specialist, Regional Consultation Program Director and Family Ties Staff (when available), review requests, approve or deny, then determine parameters (amount of time /$/etc.) for approvals. Parameters of service will be based on intensity of the family’s stressors and the severity of child’s condition at the time of the review. [Please note: Regional Teams will be responsible for developing protocols for reviewing requests in a timely manner.]

within 24 – 48 business hours for emergency respite, of the determination (approved or denied). See attachments for sample letters for approval and denial.

 

Approved
 

Denied

Approval notification will include explanation of all aspects of the program as well as parameters of service.
OR
Family may appeal the decision to the EI Director of Program Policy, Planning and Training or his/her designee.
DPH Central Office reimburses the Regional Consultation Program after submission of invoice and proof of services provided.    

The RCP will be responsible for ensuring that families submit the Family Rights and Responsibilities with the Respite Funding Request Form (see attachments for copies of these forms.)

The RCP will be responsible for maintaining all documentation pertaining to the program including, but not limited to, the following: the Respite Funding Request form, the Family Rights and Responsibilities form, the original Respite Service Invoice (copies submitted to DPH for reimbursement), the Utilization Waiver Request, and copies of all correspondence between the RCP and families (both those who are approved and those denied.)