(1) The ISP must be developed with the fullest possible participation of each of the following persons, collectively referred to as the "team":

1. (a) the individual;
2. (b) members of the individual's family, if authorized;
3. (c) the individual's guardian(s), if any;
4. (d) the individual's service coordinator;
5. (e) representatives of providers of supports to the individual, provided that, at the individual's, guardian's, or family's request, the service coordinator may limit the participation of a provider representative to those portions of the ISP meeting which concern the supports being provided by the provider;
6. (f) the individual's designated representative and others who provide friendship and support to the individual or whom any of the participants consider necessary, unless the individual or guardian knowingly objects to such persons' participation.

(3) The responsibilities of the individual in the ISP process are:

1. (a) To participate in the ISP process as fully as possible;
2. (b) To work with the service coordinator, to the extent possible, to develop his or her vision statement, determine the issues for discussion at the ISP meeting, the format of the meeting, who should be invited to attend, and when and where the meeting should be held;
3. (c) To indicate (by word, action, or any other means) approval or appeal of the ISP;
4. (d) To participate fully in the implementation, modification, and review of the ISP; and
5. (e) To provide ongoing feedback to team members regarding his or her satisfaction with the ISP, its implementation, and the need for modification.

(4) The individual's family is encouraged to participate in all aspects of the ISP process, provided that the individual or the individual's guardian, if any, does not knowingly object. The responsibilities of the family and guardian in the ISP process are:

1. (a) To participate in the ISP process as fully as possible;
2. (b) To work collaboratively with the individual and other team members to identify the individual's goals, and to develop an ISP which is likely to be effective in assisting the individual to achieve those goals;
3. (c) To approve or appeal the ISP if authorized to do so pursuant to 115 CMR 6.32; and
4. (d) To provide ongoing feedback to the service coordinator and providers regarding their satisfaction with the ISP and the implementation thereof, and regarding the need for modification of the ISP.

(5) The responsibilities of the service coordinator in the ISP process are:

1. (a) To consult with the individual, and to consult with the individual’s guardian(s), if any, for whom an ISP is to be developed within 15 days of the initiation of supports or at least 45 days prior to the projected date of the ISP meeting in order to explain the purpose of the ISP and the ISP meeting, to develop an understanding of the individual's vision statement, goals, satisfaction with services, and current circumstances, and to determine, in conjunction with the individual, and the guardian(s), if any, the issues to be reviewed at the ISP meeting, who should be invited to attend, and when and where the ISP meeting should be held. Service coordinators shall conduct an in-person meeting with the individual and, if possible, with the guardian(s) to:

   1. 1. develop the vision statement for an individual's first ISP;
   2. 2. when significant changes have occurred or are anticipated in the individual's life; or
   3. 3. at the request of the individual or guardian(s).
2. (b) To consult with the individual's family, if authorized, and guardian(s), if any, regarding the purpose of the ISP, the process through which the ISP will be developed, the individual's vision statement, goals and current circumstances, the issues to be discussed at the ISP meeting, their role in the development, approval, implementation, and review of the ISP, and scheduling of the ISP meeting;
3. (c) Within 15 days of the initiation of supports or at least 45 days prior to the projected date of the ISP meeting, to determine, in conjunction with the individual and other team members what, if any, assessments or professional consultations are necessary for the development, modification, or review of the ISP, and, subject to the availability of resources, to arrange for assessments and consultations which are not the responsibility of any current provider;
4. (d) To provide written notice to the individual and other members of the ISP team, of the date, time, place, and purpose of each ISP meeting held pursuant to 115 CMR 6.23 or 6.24 at least 30 days in advance of the meeting;
5. (e) To make assessments and consultations available, with appropriate authorization, upon request, to the individual, guardian(s), family, and other team members at least seven days in advance of such meeting;
6. (f) To convene and facilitate meetings for the development, modification, and review of the individual's ISP in accordance with the timeframes established in 115 CMR 6.20 through 6.25;
7. (g) To ensure that ISP meetings are conducted in accordance with 115 CMR 6.00 and in a manner which promotes meaningful participation by the individual, and to arrange for reasonable assistance and accommodations to enable the individual and other members of the team to participate meaningfully in the development, review, and modification of the ISP;
8. (h) To monitor the implementation of the ISP and the adequacy and appropriateness of supports being provided based on the requirements in the ISP;
9. (i) To coordinate the provision of supports to the individual in accordance with the ISP; and
10. (j) On a semi-annual basis, to review and evaluate the implementation of the ISP and the need for any modifications, as well as the satisfaction of the individual and the individual's family and guardian, if any, with the supports provided. A record of the service coordinator’s review shall be maintained in the individual's record.

(6) The responsibilities of the provider in the ISP process are:

1. (a) To complete assessments or professional consultations of the individual that are within the legal or contractual responsibility of the provider and forward them to the individual's service coordinator at least 15 days in advance of the ISP meeting. Assessments shall be based on current, complete and accurate information and focused on the individual's relative strengths, needs, and opportunities for development;
2. (b) To work collaboratively with the individual and other team members to identify the individual's goals, and to participate in the development an ISP which is likely to be effective in assisting the individual to achieve those goals;
3. (c) To develop proposed ISP objectives and support strategies that may relate to the individual's vision statement and are consistent with the individual's assessed needs and to forward them to the individual service coordinator at least 15 days prior to the ISP meeting. Objectives and support strategies shall be individualized, measurable, and include methods for evaluating progress;
4. (d) To implement the ISP by providing the agreed upon supports;
5. (e) To provide reports regarding the implementation of the ISP and provision of services to the service coordinator, individual, guardian(s), if any, and family, if authorized, with such frequency as are requested by the individual or guardian(s), if any, subject to the service coordinator's agreement as to the reasonableness of such request, but at least every six months; and
6. (f) To promptly notify the service coordinator of issues or circumstances which may affect the appropriateness of the current ISP or which may warrant modification of the ISP.