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UNOFFICIAL 1737-19 (4) To an individual certified to be in need of the services. (A) Ambulatory care resources available in the community do not meet the treatment needs of the recipient; and (B) The services can reasonably be expected to improve the recipient’s condition or prevent further regression so that the services will no longer be needed. (b) The individual shall receive active treatment which involves a developed and supervised individual plan of care to improve the individual’s condition to the extent that inpatient care is no longer necessary. The plan of care shall: (1) Be based on a diagnostic evaluation that includes examination of the medical, psychological, social, behavioral and developmental aspect of the recipient’s situation and reflects the need for inpatient psychiatric care; (2) Be developed by a team of professionals in consultation with the recipient, and his parents, legal guardians, or others in whose care he will be released after discharge; (3) State treatment objectives; (4) Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives; (5) Include, at an appropriate time, post-discharge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the recipient’s family, school, and community upon discharge; (6) The plan shall be reviewed every thirty days to: (A) Determine that services being provided are or were required on an inpatient basis; and (B) Recommend changes in the plan as indicated by the recipient’s overall adjustment as an inpatient. (c) The individual plan of care must be developed by an interdisciplinary team of physicians and other personnel who are employed by, or provide services to patients in, the facility. (1) The interdisciplinary team shall be capable of: