№ files_lp_3_process_7_064625
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This document serves as an assessment tool used by support coordinators to ensure the environment meets the needs of individuals receiving HCBS and complies with relevant regulations.
Note:
Year
Topic:
Home and Community-Based Services
Document Type:
Assessment Form
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2025
Region / city:
Wisconsin
Topic:
HCBS Compliance Review
Document Type:
Compliance Review Request
Organization / institution:
Department of Health Services, State of Wisconsin
Author:
Division of Quality Assurance
Target audience:
Facility administrators and managers of adult family homes, community-based residential facilities, and residential care apartment complexes
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2026
Region / City:
Not specified
Topic:
Facility review, health and safety, environmental and emergency procedures
Document Type:
Review guidelines
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Not specified
Period of Action:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2024
Region / City:
United States
Topic:
Direct Care Workforce, HCBS, Technical Assistance, Workforce Development
Document Type:
Official Announcement
Organization / Institution:
National Council on Aging (NCOA), Administration for Community Living (ACL)
Author:
National Council on Aging (NCOA)
Target Audience:
State governments, HCBS stakeholders, workforce development professionals
Effective Period:
2024
Approval Date:
N/A
Modification Date:
N/A
Year:
2020
Region / City:
Wisconsin
Theme:
Medicaid Services, Home and Community-Based Services
Document Type:
Checklist
Organization / Institution:
Department of Health Services, Division of Medicaid Services
Author:
Not specified
Target Audience:
Nonresidential service providers
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2023
Region / City:
Wisconsin
Theme:
Healthcare, Medicaid, Residential Settings
Document Type:
Instructional Form
Institution:
Department of Health Services (DHS)
Author:
IRIS Consultant Agency
Target Audience:
Healthcare providers, IRIS Consultants, Medicaid participants
Action Period:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2022
Region / City:
Arkansas
Theme:
Medicaid, Home and Community-Based Services
Document Type:
Program Guidelines
Agency:
Arkansas Medicaid
Author:
Division of Provider Services and Quality Assurance
Target Audience:
Healthcare providers and service organizations
Period of Action:
Ongoing, based on program criteria
Approval Date:
10-1-22
Date of Amendments:
10-1-22
Date:
October 13, 2023
Note:
Region/City
Subject:
Revised Notices for Home and Community-Based Services (HCBS) Recipients Determined Nursing Facility Ineligible (NFI)
Document Type:
Operations Memorandum
Agency:
Bureau of Operations
Author:
William Schabener, Tanoa Fagan
Target Audience:
Executive Directors, County Assistance Offices
Period of Applicability:
May 1, 2023 and onward
Approval Date:
April 21, 2023
Date of Changes:
October 13, 2023
Program:
Intellectual Disabilities (ID) Waiver HCBS
Document Type:
Support Plan Addendum Form
Related Plan:
Person-Centered Plan (PCP)
Applicable Service:
Residential Habilitation Services
Administering System:
ADIDIS
Responsible Roles:
Support Coordinator; HCBS Provider
Purpose:
Documentation and approval of HCBS rights modifications
Rights Addressed:
Schedule and activities; Access to food and drink; Visitors; Housemates and roommates; Furnishing and decorating; Lockable doors
Consent Requirement:
Informed consent by person and/or legal guardian
Implementation Requirement:
Based on assessed health and/or safety needs
Submission Method:
Secure email and upload to ADIDIS case file
Effective Date Field:
Effective Date of Modification(s)
Note:
Year
Context:
A provider’s request form to extend the timeline for implementing their HCBS transformation plan, including updates, barriers, and action steps for achieving milestones in the process.
Year:
2021
Region / City:
Massachusetts
Topic:
Home and Community-Based Services (HCBS), Medicaid, Federal Funding
Document Type:
Spending Plan
Organization / Institution:
Executive Office of Health and Human Services (EOHHS)
Author:
Daniel Tsai, Medicaid Director
Target Audience:
Government officials, healthcare providers, community organizations
Effective Period:
2021-2023
Approval Date:
June 17, 2021
Date of Changes:
N/A
Year:
N/A
Region / City:
Massachusetts
Theme:
Healthcare, Government Services
Document Type:
Form
Organization / Institution:
Commonwealth of Massachusetts Executive Office of Health and Human Services
Author:
N/A
Target Audience:
MassHealth providers, service location administrators, healthcare organizations
Period of Action:
N/A
Approval Date:
N/A
Date of Changes:
N/A
Note:
Year
Topic:
Enrollment Packet, NC Medicaid, HCBS
Document Type:
Provider Requirements
Organization / Institution:
NC Medicaid
Author:
NC Medicaid
Target Audience:
Providers of Home and Community Based Services
Effective Period:
Ongoing
Document Type:
Staff training record form
Regulatory Framework:
245D HCBS Standards, section 245D.09
Related Regulations:
Sections 13.01–13.10 and 13.46; Health Insurance Portability and Accountability Act of 1996 (HIPAA); 245D.061; 245D.06 subdivision 5; Positive Supports Rule 9544.0090 subpart 3
Compliance Date Referenced:
August 1, 2020
Intended Users:
245D license holders and program staff
Purpose:
Documentation of annual staff training and competency
Training Topics:
Maltreatment reporting, data privacy, service recipient rights, person-centered planning, manual restraint, prohibited procedures, sexual violence risk reduction, First Aid, CPR, Positive Supports Rule refresher
Evaluation Component:
Performance evaluations and competency verification
Signatures Required:
Supervisor and Employee
Certification Tracking:
First Aid and CPR certification status and expiration dates
Jurisdiction:
California
Governing Authority:
Department of Developmental Services
Regulatory Framework:
Home and Community-Based Services (HCBS) Rules
Funding Type:
Compliance Funding
Document Type:
Provider Evaluation Form
Applicable Providers:
HCBS service providers requesting compliance funding
Service Scope:
Residential and Non-Residential Settings
Additional Scope:
Provider-Owned or Controlled Residential Settings
Federal Requirements Covered:
#1–10
Purpose:
Determination of eligibility for compliance funding
Required Responses:
Yes/No with explanation
Related Document:
Provider Compliance Funding Concept
Contact Information:
[email protected]
Reference Website:
www.dds.ca.gov/HCBS
Year:
2020
Region / City:
United States
Subject:
COVID-19 Emergency, Long-Term Care, Home and Community-Based Services
Document Type:
Policy Clarification
Agency:
CAOs
Author:
Division of Health Services
Target Audience:
Caseworkers, Health Services Personnel
Effective Period:
03/18/2020 - Until End of COVID-19 Emergency
Approval Date:
06/01/2020
Amendment Date:
None
Note:
Year
Topic:
Produce Prescription Program, Community-Based Partnerships
Document Type:
Memorandum of Understanding (MOU)
Target Audience:
Community-based organizations, healthcare providers, clinics
Context:
Template for establishing a formal partnership agreement between a community-based organization and a clinic to implement a produce prescription program.
Year:
2024
Region / City:
United States
Topic:
Parenting, Fatherhood
Document Type:
Survey
Organization:
Healthy Marriage and Responsible Fatherhood (HMRF)
Author:
N/A
Target Audience:
Participants of the Community-Based Fathers Program
Effective Period:
N/A
Approval Date:
N/A
Date of Amendments:
N/A
Year:
2025
Region / city:
Wisconsin
Topic:
HCBS Compliance Review
Document Type:
Compliance Review Request
Organization / institution:
Department of Health Services, State of Wisconsin
Author:
Division of Quality Assurance
Target audience:
Facility administrators and managers of adult family homes, community-based residential facilities, and residential care apartment complexes
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Organization:
XYZ Community-Based Care, Inc.
Document type:
Cost Allocation Plan
Sector:
Child welfare
Jurisdiction:
Florida, United States
Regulatory framework:
2 CFR Part 200
Allocation method:
Direct Allocation Method
Accounting basis:
Current reporting month
Certifying authority:
Chief Executive Officer
Related systems:
Florida Safe Families Network (FSFN)
Related plans:
Public Assistance Cost Allocation Plan (PACAP)
Attachments:
Position Listing; Sub-contract Listing; Title IV-E Maintenance; Organization Chart; Chart of Accounts
Note:
Year
Theme:
Home and Community-Based Waiver, Brain Injury Care
Document Type:
Policy Guide
Institution:
Department of Health and Human Services (DHHS)
Target Audience:
Adults with brain injuries, caregivers, healthcare providers