Chapter

Policy

Policy Number

1. Introduction

Index

 

2. Medicaid Funding

Medicaid Eligibility

2.00

3. Available Home and Community Based Services

Home and Community Based Service (HCBS) Introduction

3.00

4. Home and Community Based Assessment, Care Planning and Authorization Process

HCBS Service Processes Introduction

4.00

Participant Choice Statement Form and Instructions (Agency, CDS, and ADC)
Form / Instructions

4.00 Appendix 2a

Participant Choice Statement Form and Instructions (RCF/ALF)
Form / Instructions

4.00 Appendix 2b

In-Home Services Worksheet
Form / Instructions

4.00 Appendix 3

Consumer-Directed Services Worksheet
Form / Instructions

4.00 Appendix 4

Physician Notification
Form / Instructions

4.00 Appendix 5

SLUMS
Form / Instructions

4.00 Appendix 8

Self Direction Assessment Questions
Form / Instructions

4.00 Appendix 10

Participant Contact Letter
Form / Instructions

4.00 Appendix 11

Healthcare Professional Inquiry
Form / Instructions

4.00 Appendix 13

HCBS Assessment Attestation
Form / Instructions

4.00 Appendix 14

Healthcare Information Request
Form / Instructions

4.00 Appendix 15

5. Adverse Action

Adverse Action

5.00

Adverse Action
Form / Instructions

5.00 Appendix 3

Application for a State Hearing
Form / Instructions

5.00 Appendix 4

Reversal of Adverse Action
Form / Instructions

5.00 Appendix 5

Notice of Closure
Form / Instructions

5.00 Appendix 6

6. Appeals and Hearing Process

Appeal and Hearing Process

6.00

Cover Letter to Participant
Form / Instructions

6.00 Appendix 4

Cover Letter to Authorized Representative
Form / Instructions

6.00 Appendix 5

CMS Letter

6.00 Appendix 6

Cover Letter

6.00 Appendix 7

7. Money Follow the Person Program

Money Follows the Person (MFP)

7.00

MFP Approval Notice Plan
Form / Instructions

7.00 Appendix 6

MFP Ombudsman Referral
Form / Instructions

7.00 Appendix 7

8. Miscellaneous and Forms

Abuse, Neglect and Exploitation

8.00

HCBS General Health Evaluation and Level of Care Recommendation
Form / Instructions
Form

8.00 Appendix 4

9. Confidentiality and HIPAA

Confidentiality Requirements

9.00

Acknowledgement
Form / Instructions

9.00 Appendix 5

Authorization
Form / Instructions

9.00 Appendix 6

10. HCBS Web Tool Guide

Web Tool - Introduction

10.00

HCBS Memos