№ lp_2_3_62024
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Administrative compliance record documenting annual training, regulatory requirements, and performance evaluations for staff in a 245D HCBS licensed program.
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
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
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
Note:
Year
Topic:
Home and Community-Based Services
Document Type:
Assessment Form
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
Year:
2012/17
Region / City:
United States
Subject:
Postsecondary Education, Longitudinal Studies
Document Type:
Statistical Study
Agency / Institution:
National Center for Education Statistics, U.S. Department of Education
Author:
National Center for Education Statistics
Target Audience:
Researchers, Policymakers, Educational Institutions
Period of Action:
2017
Approval Date:
August 2016
Amendment Date:
April 2017
A document detailing the data collection procedures and methodology for the 2012/17 Beginning Postsecondary Students Longitudinal Study (BPS:
12/17) conducted by the U.S. Department of Education, including data collection instruments, testing, and confidentiality procedures.
OMB Control Number:
0704-0173
Document Type:
Supporting statement for federal information collection
Subject:
Military enlistment eligibility and processing records
Forms Covered:
DD Form 1966; USMEPCOM Form 680-3A-E
Legal Authority:
Title 10 U.S. Code §§ 504, 505, 508, 1012; Title 14 U.S. Code §§ 351, 632; Title 50 U.S. Code App. § 451; Executive Order 9397
Issuing Bodies:
Department of Defense; Military Entrance Processing Command; Armed Forces of the United States; United States Coast Guard
Purpose:
Collection and verification of applicant data for enlistment eligibility and personnel records
Population Covered:
Applicants for enlistment in the Armed Forces and Coast Guard
Information Handling:
Personally Identifiable Information maintained under DoD privacy and security regulations
Publication Dates:
Federal Register notices published June 4, 2014 and July 31, 2014
Regulatory Framework:
5 CFR 1320.5 and 5 CFR 1320.8
Year:
2015
Organization:
National Animal Health Monitoring System
Address:
2150 Centre Ave, Bldg B, Fort Collins, CO 80526
Agency:
Animal and Plant Health Inspection Service, Veterinary Services
Form Approval:
OMB Number 0579-0269
Form Expiration Date:
XX/20XX
Document Type:
Data collection instructions and record
Target Species:
Equids (horses, mules, donkeys, ponies)
Data Collection Period:
July 2014 – 2015
Year:
2023
Region / city:
Migori
Topic:
Appeal proceedings, judicial review
Document type:
Court ruling
Institution:
Environment and Land Court, Migori
Author:
Not specified
Target audience:
Legal professionals, litigants
Period of validity:
2023
Approval date:
2025
Date of amendments:
None
Note:
Contextual description