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Home and Community Based Services

Big Sky Bonanza Manual

 

TABLE OF CONTENTS

 

 

INDEXES

DATE REVISED

001

Index

8/11/10

002

Alpha Subject Index

8/11/10

003

Definitions

8/01/08

004

Abbreviations/Acronyms/Initials 

8/01/08

 

 

 

400

ELIGIBILITY FOR SERVICES

 

401

Big Sky Bonanza (BSB) Eligibility Requirements

8/01/08

402

Big Sky Bonanza (BSB) Training Requirements

8/01/08

403

Big Sky Bonanza (BSB) Enrollment

8/11/10

404

Entrance/Discharge into Medicaid and HCBS Instructions & Form  (DPHHS-DD/SLTC-55)

8/11/10

405

Termination of Services

8/01/08

406

Medically Needy Billing Procedures

8/01/08

407

Transferring Back to the Traditional HCBS

8/01/08

408

Residency Requirements

8/01/08

409

Out- Of- State Services

8/01/08

410

Retainer Reimbursement Days

8/01/08

 

 

 

500

BIG SKY BONANZA SCREENING REQUIREMENTS

 

501

Mountain-Pacific Quality Health (M-PQH) Initial Evaluation

8/11/10

502

Mountain-Pacific Quality Health (M-PQH) Reevaluations

8/01/08

503

BSB Consumer Profile (DPHHS-SLTC-155 ) Instructions and Form

8/01/08

504

Level of Care Preadmission Criteria

8/01/08

505

Request for Level of Care (DPHHS-SLTC-85) Instructions & Form

8/01/08

599-1

Screening Determination (DPHHS-SLTC-61)

8/01/08

 

 

 

600

ADMINISTRATIVE REQUIREMENTS

 

601

Consumer-Directed Provider Eligibility and Responsibility

8/01/08

602

Traditional Waiver Provider Eligibility and Responsibility

8/01/08

603

Consumer-Directed Provider Enrollment

8/01/08

604

Traditional Waiver Provider Enrollment

8/01/08

605

Consumer-Directed Provider Payment Requirements

8/01/08

606

Traditional Waiver Provider Payment Requirements

8/01/08

607

Consumer-Directed Provider Payment Processing

8/11/10

608

Traditional Waiver Provider Payment Processing

8/11/10

609

Consumer-Directed Reimbursement Methodology

8/01/08

610

Traditional Waiver Provider Reimbursement Methodology

8/01/08

611

Consumer-Directed Provider Licensure Requirements

8/01/08

612

Traditional Waiver Provider Licensure Requirements

8/01/08

613

Independence Advisor (IA) Requirements

8/01/08

614

Financial Manager (FM) Requirements

8/01/08

615

Quality Improvement Process

8/11/10

616

Provider Prepared Standards, Department Review Standards-IA

8/11/10

617

Provider Prepared Standards, Department Review Standards-FM

8/01/08

699-1

CMS 1500 Claim Form & Instructions

8/11/10

 

 

 

700

SERVICES 

 

701

Covered Services

8/01/08

702

Service Limitations and Exclusions

8/01/08

703

Adult Day Health

8/01/08

704

Chemical Dependency Counseling

8/01/08

705

Community Support Services

8/01/08

706

Consumer-Directed Goods and Services

8/01/08

707

Environmental Accessibility Adaptations

8/01/08

708

Financial Management (FM) Services

8/01/08

709

Habilitation Aide

8/01/08

710

Independence Advisor (IA) Services

8/01/08

711

Nutrition and Dietitian Services

8/01/08

712

Occupational Therapy

8/01/08

713

Personal Emergency Response System (PERS)

8/01/08

714

Physical Therapy Services

8/01/08

715

Private Duty Nursing

8/01/08

716

Respiratory Therapy

8/01/08

717

Specialized Medical Equipment and Supplies

8/01/08

718

Speech Therapy and Audiology Services

8/01/08

799-1

HCBS Administrative Rules of Montana (ARM)

8/01/08

799-2

BSB Procedure Codes and Rates .xls

8/01/08

799-3

Directory of Assistive Technology

8/01/08

799-4

Consumer Equipment Recycling Agreement

8/01/08

 

 

 

800

SUPPORT BROKERAGE SYSTEM

 

801

Independence Advisor Checklist and Monthly Contact Form

8/11/10

802

FM Checklist and Reevaluation Form (DPPHS-SLTC 223)

8/11/10

803

IA Record Requirements

8/11/10

804

FM Record Requirements

8/11/10

805

IA Provider Termination and Transition

8/01/08

806

FM Provider Termination and Transition

8/01/08

807

Transfer of consumers

8/01/08

808

Medicaid Fraud and Abuse

8/01/08

899-1

Intake Instructions and Form (DPHHS-SLTC-136)

8/01/08

899-2

Discharge Instructions and Form (DPHHS-SLTC-137)

8/01/08

899-3

Incurment Instructions and Form (DPHHS-SLTC-131)

8/01/08

899-4

Letter of Notification (DPHHS-SLTC-144)

8/01/08

899-5

Independence Advisor Oversight Instructions and Form (DPHHS-SLTC-221)

8/01/08

899-6

Monthly Individual Spending Report & Instructions

8/11/10

899-7

General Utilization

8/11/10

 

900

Section – Consumer Section

901

Big Sky Bonanza (BSB) Consumer-Directed Waiver Training Manual

902

Consumer Agreement and Form (DPHHS-SLTC-201)

903

Personal Representative Agreement and Form (DPHHS-SLTC-203)

904

Consumer and Independence Advisor (IA) Agreement and Form  (DPHHS-SLTC-205)

905

Consumer and Financial Manager (FM) Agreement and Form (DPHHS-SLTC-207)

906

Person-Centered Planning Process

907

Support Services and Spending Plan (SSSP) Introduction

908

Preplanning Documents

909

Consumer-Directed Services List and Definitions

910

Traditional Waiver Services List and Definitions

911

Support Services and Spending Plan (SSSP) Development

911a

Support Services and Spending Plan (SSSP)--Form and Sample (DPHHS-SLTC-209)

912

Big Sky Bonanza (BSB) Budget

913

Monthly Spending Reports

914

Health Care Professional Authorization and Form (DPHHS-SLTC-213)

914a

Sample Health Care Professional Letter

915a

Risk Prevention, Assessment, Management, and Form (DPHHS-SLTC-250)

915b

Risk Negotiation Agreement Process and Form (DPHHS-SLTC-251)

916

Emergency Backup Plans

917

Support Services and Spending Plan (SSSP) Approval

918a

Support Services and Spending Plan (SSSP) Amendments

918b

Amendment Process Flowchart

918c

Amendment-Contingency Funds Form and Instructions (DPHHS-SLTC-219)

919

Contingency Funds

920

Independence Advisor Six-Month Oversight

921

Financial Manager Six-Month Reevaluation

922

Support Services and Spending Plan (SSSP) Annual Update

923

Reserved

924

Consumer Purchase Invoice and Sample Form

925

Paying Legally Responsible Relatives

926

Serious Occurrence Report (SOR) and Form

927

Co-Employer Responsibilities

928

Employer and Employee Relationship, Agreement, and Form

929

Service Delivery Record (SDR) and Form

930

Medicaid Fraud and Abuse

931

Corrective Action Plan (DPHHS-SLTC-230)

931a

Corrective Action Plan form

932

Complaint Process and Form

933

Fair Hearings

934

Program Compliance Tool Form and Instructions (DPHHS-SLTC-999)