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DDES Memo Series 2006-13

Date: August 25, 2006

To: Listserv

For: Area Administrators / Human Services Area Coordinators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Licensing Chiefs / Section Chiefs
Tribal Chairpersons / Human Services Facilitators

From: Sinikka Santala

Subject: Release of Revised Medicaid Waiver ISP form (DDE 445) and new DDE 445a

Document Summary

This memo announces the release of a revised Individual Service Plan (ISP) and a new companion document which addresses individual outcomes (DDE-445a). The use of these new forms (DDE-445 and 445a) will be required in all Medicaid waiver programs. Waiver agencies may use a locally developed ISP form and Individual Outcomes ISP if the local versions contain all of the information on the DDE 445 and the DDE 445a and the agency receives prior approval from the Bureau of Long Term Support or the Bureau of Mental Health and Substance Abuse Services.


The Individual Service Plan (DDE-445) is a required document in all of the Medicaid waiver programs. There are a number of versions currently in use; many are local agency adaptations of the form, while others are outdated versions of the model form produced by the Department. The form has not been revised in several years while the number of waiver programs have grown and a need for the collection of new data has become apparent. In an effort to create a modern version of the DDE-445, staff from the Developmental Disabilities Services Section, the Children's Services Section and the Community Options Section of the Bureau of Long Term Support and the staff from Bureau of Mental Health and Substance Abuse Services have collaborated in the development of a new Individual Service Plan (ISP) form.

The new ISP form has been reconfigured and is now applicable to all of the Medicaid waiver programs, including the Children's waivers. The form will also be used in the Community Opportunities and Recovery waiver program when that waiver program becomes operational. The new ISP also contains additional elements designed to gather information that had heretofore not been collected on the form. These new elements include fields to record the parental fee (if applicable), the personal discretionary funds available to the participant, and a field to record the total waiver program start up and/or one time costs.

Also new to the Individual Service Plan in this revision is a companion document, the Individual Service Plan - Individual Outcomes, the DDE-445a. The DDE-445a provides a means to identify and document the participant's desired individual outcomes that the service plan will address. The form will also allow the care manager/support and service coordinator to monitor and document the progress/status toward the achievement of the participant's individual outcomes.


As soon as practicable but no later than January 1, 2007, all waiver agencies must begin to use the revised Individual Service Plan form (DDE-445) and the companion document, the Individual Service Plan - Individual Outcomes (DDE-445a) or a locally developed, Bureau approved version of the form(s), as part of all new waiver applications. And, after January 1, 2007, as agencies complete annual recertifications throughout the year, the revised DDE-445 and the new DDE-445a or an approved local version must be used.

With the introduction of the new ISP form the long established requirements for the completion of the DDE-445, at application, recertification and update do not change. The primary change is that while agencies may continue to use locally designed ISP forms, these form(s) must be prior approved by the appropriate Bureau.


Individual outcomes have typically been a part of the conversation between the participant and the care manager/support and service coordinator, in the assessment process. Individual outcomes have also been a part of the discussion in program monitoring (CIP II/COP-W). With the implementation of the revised DDE-445 and with the addition of new DDE-445a, a change in focus will occur as the participant's individual outcomes become more formally integrated into service plan development. As service plans are developed, local waiver agency staff will work with participants to identify and prioritize their individual outcomes and to put in place the waiver and non-waiver services that support the person in achieving those outcomes.

As agencies begin to use the DDE-445a, waiver agency staff should be identifying, prioritizing and documenting their participant's individual outcomes on the form at the time of application. While every individual outcome identified may not be directly associated with a service listed on the ISP, all of the participant's individual outcomes that are identified should be listed on the 445a. When an individual outcome does correspond to a provided service, it must be indicated on the corresponding service strip of the ISP. Thereafter, as individual service plans are updated, and at plan review and recertification, agency staff should be noting progress toward the individual outcomes listed on the 445a and identifying any outcomes that should be added to the plan.

This document announces the release of the revised ISP and the new DDE-445a. To assist in the transition to incorporating outcomes into care plan development, a Web-based training has been developed and will be available soon. In addition, outcomes training will be a focus of this year's Long Term Care Fall Conference. It is expected that there will be a period of transition as agencies move toward integrating individual outcomes into the plan development process. We recognize that this transition will take time. However, we believe that as agencies take advantage of the outcomes training provided and gain "on the job" experience, this transition will be successfully accomplished.

Attached to this memo are instructions to guide agency staff in the completion of both the DDE- 445 and the DDE-445a forms. As agencies begin to work with these new forms and in the process, begin to integrate individual outcomes into the service plan process it is expected that questions will arise. Waiver staff should direct their questions to their assigned quality assurance staff.

Local program staff working in the CIP II or COP-Waiver programs should contact TMG. For CIP 1A/1B and BIW programs, agency staff should contact the assigned CIS. For CLTS waivers, local agency staff should contact central office.

Agencies that decide to use locally developed ISP and Individual Outcomes forms should seek prior approval as follows:

  • For CIP 1A/1B and BIW waivers, the agency should contact the DDSS central office staff.
  • For CLTS waivers, the agency should contact their regional CSS.
  • For CIP II/COP-W, the agency should contact the COP Section central office staff.
  • For COR waiver (when that waiver becomes operational), the agency should contact central office staff.

Action Required

Beginning January 1, 2007, the new DDE-445 and 445a or an approved local version must be used as new waiver applications and annual recertifications are completed. County agencies may begin to utilize the revised forms prior to January 1, 2007, at their discretion.

REGIONAL OFFICE CONTACT: Community Integration Specialists
Human Services Area Coordinators

Bureau of Long-Term Support
Developmental Disabilities Section
1 W. Wilson St. Room 418
P.O. Box 7851
Madison, WI 53707-7851
Phone: 608- 261-6749 phone
Fax: 608- 261-6752

Kevin Lafky, (CIP II/COP-W)
Bureau of Long-Term Support
Community Options Section
1 W. Wilson St. Room 450
P.O. Box 7851
Madison, WI 53707-7851
Phone: 608 266-7754
Fax: 608- 2267-2913

Julie Bryda (CLTS)
Bureau of Long-Term Support
Children's Services Section
1 W Wilson St. Room 418
P.O. Box 7851
Madison, WI 53707-7851
Phone: 608- 650-4445
Fax: 608- 261-6752

Cheryl Lofton (COR)
Bureau of Mental Health and Substance Abuse Services
1 West Wilson Street, room 850
P.O. Box 7851
Madison, WI 53707-7851
Phone: 608 267-1427
Fax: 608 267-7793


Individual Service Plan (DDE-445) (PDF, 75 KB)
DDE-445 Word Fillable version 
Individual Service Plan - Individual Outcomes (DDE-445a) (PDF, 79 KB)
DDE-445a Word Fillable version
DDE-445 Instructions (PDF, 32 KB)


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Last Revised: September 13, 2010