Care Coordination & Provider Resource Materials
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STAFF LISTINGS
POLICIES
IMPORTANT LINKS & INFO
Home and Community-Based Waiver Service Provider Resources
Home and Community-Based Waiver Services Regulations 7 AAC 13
Self-paced Care Coordinators Training
FORMS
Common Program Forms
- Critical Incident Report
- All-Waivers Plan of Care(word)
- All-Waivers Amendment to Plan of Care(word)
- Appointment of Care Coordinator Services
- All-Waivers Plan of Care Guidelines
- Program Recipient Right
- Notice of Adverse Actions
- Request for Exception from Waiver Requirement for Face-to-Face Monthly Visit
- Transfer of Care Coordination Services
- Mini–grants Application
- Mini–grants Annual Fiscal Report.
- Core Services and Funding Agreement
- Eligibility Determination and Request for Services Application and Instructions
- 04-Developmental Disabilities Registration and Review (formerly Waitlist Criteria Assessment)
All other cost sheets dated prior to February 28, 2011 are superseded and this Waiver Service Overview will be the only sheet accepted after April 15, 2011.
- Waiver Services Overview for MRDD and CCMC Waivers (Excel)
- Waiver Services Overview for MRDD and CCMC Waivers (PDF)
- 08-Guidelines for ICAP Process
- 09-ICAP Process and ICAP Information List
- DHSS Table of ICAP scores
- 10-SOA-Division of Medial Assistance Nursing Facility Level of Care Assessment Form for Children
- 15-Change of Status Form
- STAR Discretionary Funds Awards
- Demographic Form for Interim ICF/MR Level of Care
- ICF/MR Level of Care Determination
- Guidelines for QDC Form & Memorandum
- Qualifying Diagnosis Certification Form
- Memorandum for QDC
All other cost sheets dated prior to February 28, 2011 are superseded and this Waiver Service Overview will be the only sheet accepted after April 15, 2011.
- OA-AP Waiver Services Overview (excel)
- OA-AP Waiver Services Overview (PDF)
- 01-Document Cover Sheet
- 02-Authorization for Release of Information (enrollment, eligibility)
- 04-Consumer Assessment Tool
- 05-Authorization for Release of Information (non-enrollment, non-eligibility)
- Verification of Diagnosis
- 08-Screening & Renewal Instructions
Environmental Modification Forms for All Waivers (OA/APD, MRDD, CCMC)
- EMOD Review Tool (helpful hints guide for EM planning)
- Property Owners Consent to Environmental Modification
- Request for Cost Estimate-Bathroom Accessibility
- Request for Cost Estimate-Blank
- Request for Cost Estimate-Door Accessibility
- Request for Cost Estimate-Elevated Toilet with Grab Bars\
- Request for Cost Estimate-Hand Rails and Grab Bars
- Request for Cost Estimate-Ramp Access
- Request for Cost Estimate-Ramp Cover
- Request for Cost Estimate-Roll In Shower
- Request for Cost Estimate-Stair Lift
- Request for Cost Estimate-Vertical Lift
- Request for Exception to Three Estimates
- Request to Select Cost Estimate other than Lowest
HSS DSDS Training
550 W 8th Ave
Anchorage, AK 99501
Phone: (907) 269-3685 Fax: (907) 269-4973
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