№ lp_1_35920
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Character count: 18276
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This document is a licensing application for new providers seeking to open a Community-Based Residential Facility (CBRF) in Wisconsin, outlining the required steps for the licensure process, including plan review, background check, application completion, compliance statement, and onsite visit.
Year:
2017
Region / City:
Wisconsin
Theme:
Licensing process for community-based residential facilities (CBRF)
Document Type:
Application form
Organization / Institution:
Department of Health Services, Division of Quality Assurance
Author:
Department of Health Services
Target Audience:
New CBRF providers
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
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Year:
2009
Region / City:
Wisconsin, USA
Document Type:
Inspection Form
Authority:
Department of Health Services, Division of Quality Assurance
Legal Reference:
DHS 83.47(3), Wisconsin Administrative Code
Target Audience:
Facility administrators and fire inspectors
Scope:
Annual fire safety and extinguisher compliance for CBRFs
Date of Revision:
April 2009
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
Program:
Home and Community-based Services (HCS)
Document type:
Billing requirements
Governing body:
Health and Human Services Commission
Jurisdiction:
Texas
Legal basis:
40 TAC §9.170
Provider obligations:
Service claim preparation and submission
Effective dates:
January 1, 2023; March 1, 2023; November 15, 2019; September 1, 2021
Revision identifiers:
Revision 19-1; Revision 21-3; Revision 23-1; Revision 23-2
Service components covered:
Professional therapies, residential assistance, respite, nursing, employment services, adaptive aids, home modifications, dental treatment, transition assistance
Compliance oversight:
Provider Fiscal Compliance Reviews
Appendices included:
Provider Fiscal Compliance Review Protocol, forms, revisions, contact information
Year:
2026
Region / City:
United States
Subject:
Emergency Preparedness, Risk Assessment
Document Type:
Guidance / Regulatory Reference
Organization / Agency:
Centers for Medicare & Medicaid Services (CMS)
Author:
CMS
Audience:
Healthcare providers and suppliers
Applicable Period:
Ongoing, per CMS regulations
Reference:
§483.70(e), §483.73, Final Rule 81 Fed. Reg. 63860 (Sept. 16, 2016)
Year:
2026
Region / City:
Texas
Topic:
Medicaid Waiver Programs, Intellectual Disability Services
Document Type:
Legislation
Organization / Institution:
Department of Aging and Disability Services (DADS)
Author:
Not specified
Target Audience:
Service providers, applicants, individuals with intellectual disabilities
Period of Action:
Ongoing
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2013
Region / City:
Washington
Topic:
Bed Safety, Health and Safety Guidelines
Document Type:
Procedure
Organization / Institution:
Department of Social and Health Services
Author:
Bea Rector, Kathy Leitch
Target Audience:
Case Managers, Social Workers, Nurses, Home Care Providers
Period of Application:
2013
Approval Date:
March 26, 2013
Date of Changes:
N/A
Year:
2026
Region:
Canberra, Australian Capital Territory
Subject:
Health care administration, clinical record management
Document Type:
Clinical procedure
Organization:
Canberra Health Services
Audience:
Community nursing and health centre administration staff
Scope:
Management, filing, tracking, and archiving of community-based clinical records
Attachments:
Community-Based Services Clinical Record Request Form, Document Tracking forms, Labelling guides, ACTPAS Document Types
End-user system:
ACT Patient Administration System (ACTPAS)
Compliance:
Legislative requirements for clinical record management
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:
2024
Region/City:
N/A
Theme:
Social Welfare and Development
Document Type:
Accreditation Assessment Tool
Organ/Institution:
Department of Social Welfare and Development (DSWD)
Author:
N/A
Target Audience:
Social Welfare and Development Agencies (SWDAs), Accreditation Assessors
Period of Effect:
N/A
Approval Date:
N/A
Amendment Date:
N/A
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
Note:
Year
Organization / Institution:
Oregon Department of Education, Teacher Standards and Practices Commission
Chapter 74 Guide for Vocational/Career Administrator and Cooperative Education Coordinator Licensure
Year:
2020
Region / City:
Massachusetts
Topic:
Vocational Education, Licensure
Document Type:
Guide
Organization / Institution:
Massachusetts Department of Education
Author:
Massachusetts Department of Education
Target Audience:
Vocational administrators, educators, and applicants for licensure
Effective Period:
2020-2025
Approval Date:
2020
Date of Changes:
N/A
Institution:
Northern New Mexico College
Program:
Alternative Licensure Program
Document type:
Application form
Educational level:
K–12 teacher licensure
Teaching fields:
Elementary K–8; Secondary 7–12; Special Education K–12
Admission requirement:
Acceptance to Northern New Mexico College
Examinations referenced:
Praxis Entrance Exams
Degrees referenced:
Bachelor’s; Master’s; Doctoral
Background check requirement:
Yes
Supporting documents required:
Letter of Intent; Philosophy Statement; College transcripts; Letters of recommendation; Assurance Form; Background check confirmation
Submitting authority:
Coordinator of Student and Faculty Services or program advisor
Related authorities:
New Mexico Public Education Department
Source type:
Institutional administrative document
Note:
Year