№ lp_2_1_19785
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Character count: 16951
File size: 138 KB
Administrative waiver form establishing procedures and documentation requirements for assessing, approving, recording, and implementing modifications to specified HCBS rights within Residential Habilitation services under the ID Waiver program.
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)
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2021
Organization:
Community Mental Health for Central Michigan
Document Type:
Training Record / Verification
Audience:
Service Providers and Staff
Purpose:
Document completion of training on Person-Centered Plans and Addenda
Fields Included:
Consumer Name, Date of Birth, Case Number, Provider Agency, Date of Plan/Addendum, Trainer Name/Signature/Title, Date of Training
Instructions:
Multiple staff per record allowed, separate records for different trainers, scan and attach to consumer’s Plan/Addendum
Year:
2023
Region / City:
United States
Topic:
Person-Centered Planning
Document Type:
Guidance Document
Agency:
Division of Mental Health Developmental Disabilities and Substance Abuse Services (DMHDDSAS)
Author:
Division of Mental Health Developmental Disabilities and Substance Abuse Services (DMHDDSAS)
Target Audience:
Qualified Professionals, Licensed Professionals
Effective Period:
Ongoing
Approval Date:
2023
Date of Changes:
Not specified
Year:
2023
Region / City:
N/A
Subject:
Nursing / Wound Care
Document Type:
Educational Lesson Plan
Institution:
N/A
Author:
Lynn Taylor, Bartlett
Target Audience:
Nursing Students
Period of Validity:
N/A
Approval Date:
N/A
Date of Last Revision:
N/A
Context:
Educational lesson plan focused on the anatomy, physiology, and healing processes of wounds, with nursing strategies to manage and prevent skin issues, primarily aimed at nursing students.
Year:
2026
Region / City:
Not specified
Topic:
Compassion, Psychological Outcomes, Attachment
Document Type:
Research Supplement
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Researchers, Psychologists
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
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
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
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:
2008
Region / City:
Durban
Subject:
Intellectual Property, Technology Transfer
Document Type:
Agreement, Policy Guidelines
Organization / Institution:
University of KwaZulu-Natal (UKZN)
Author:
University of KwaZulu-Natal
Target Audience:
Researchers, Students
Period of Validity:
Ongoing
Approval Date:
Not specified
Amendment Date:
November 2010