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Community Services

Home and Community Based Waiver Manual

Table of Contents

  INDEXES DATE REVISED
  001 Index 03/01/12
  002 Alpha Subject Index 03/01/12
400 Eligibility for Services  
  401 H & C Based Services Eligibility Requirements 03/01/12
  402 Care Categories 03/01/12
  403 Prior Authorization by the CSB 03/01/12
  404 Termination of Services 08/01/11
  405 Referrals for Services 03/01/12
  406 Waiting List Criteria 02/01/07
  407 Medically Needy Billing Procedures 03/01/12
  408 Residency Requirements 03/01/12
  409 Out-of-State Services 03/01/05
  410 Bed-Hold Days 3/1/2011
  410A Attachment A  
  411 Developmentally Disabled 02/01/07
  499-1 Provider Information Memo (DPHHS-HCS-454) 03/01/05
500 PreAdmission Screening  
  501 Screening Requirements 03/01/12
  502 Screening Referral Procedures 03/01/12
  503 Level of Care Reevaluations 3/1/2011
  504 Reserved 01/01/06
  504 ScAN  
  599-1 Screening Determination (DPHHS-SLTC-61) 3/1/2011
600 Administrative Requirements  
  601 Provider Eligibility 03/01/12
  602 Provider Responsibilities 03/01/12
  603 Provider Enrollment 01/01/06
  604 Payment Requirements 02/01/07
  604-1 Payment to Legally Responsible Individuals
03/01/12
  605 Payment Processing 03/01/12
  606 Reimbursement Methodology 03/01/12
  607 Licensure Requirements 03/01/05
  608 Quality Assurance Process 03/01/12
  699-1 Provider Requirements 03/01/12
  699-2 CMS 1500 Claim Form IN PDF FORMAT 04/01/07
  699-3 HCBS Procedure Codes & Rates 03/01/12
  699-4 Medicaid Nursing Facility Reimbursement Rates 01/01/06
  699-5 Prior Authorization Form 04/01/07
700 Services  
  701 Covered Services 08/01/11
  702 Service Limitations & Exclusions 08/01/11
  703 Adult Day Health 08/01/11
  704 Adult Residential Care 08/01/11
  705 Behavioral Programming 08/01/11
  706 Case Management 08/01/11
  707 Chemical Dependency Counseling  08/01/11
  708 Cognitive Rehabilitation  08/01/11
  709 Community Residential Rehabilitation 08/01/11
  710 Comprehensive Day Treatment 08/01/11
  711 Day Habilitation 08/01/11
  712 Dietitian/Nutritionist 08/01/11
  713 Environmental Accessibility Adaptations 08/01/11
  714 Habilitation 08/01/11
  715 Homemaker 03/01/05
  716 Nutrition 03/01/05
  717 Occupational Therapy 08/01/11
  718 Personal Assistance 08/01/11
  719 Personal Emergency Response System 3/1/2011
  720 Physical Therapy 03/01/05
  721 Prevocational Training 04/01/07
  722 Private Duty Nursing 01/01/06
  723 Psychosocial Consultation 08/01/11
  724 Registered Nurse Supervision 08/01/11
  725 Respiratory Therapy 08/01/11
  726 Respite Care 08/01/11
  727 Special Child Care for Medically Fragile Children 08/01/11
  728 Specialized Medical Equipment & Supplies 08/01/11
  729 Specially Trained Attendants 08/01/11
  730 Speech Therapy and Audiology 08/01/11
  731 Supported Employment 08/01/11
  732 Supported Living 08/01/11
  733 Transportation 08/01/11
  734 Consumer/Family Intensive Support Service 08/01/11
  735 Family Training and Support 08/01/11
  799-1 Home & Community Based Services 03/01/05
  799-1 Administrative Rules of Montana
37.40.1401 - 37.40.1488  
 
  799-2 PAS Consumer Referral/Overview (DPHHS-SLTC-154) 01/01/06
  799-3 Service Animals - Case Management Team’s Role 03/01/05
  799-4 Service Animals – Consumer’s Role 03/01/05
  799-5 Directory of Assistive Technology Practitioners   03/01/05
  799-6 Consumer Recycling Agreement 03/01/05
  799-7 Field Memorandum FY95 01/01/06
800 Case Management System  
  801 Case Management Requirements 03/01/12
  802 Case Management Team Requirements 03/01/12
  803 Service Areas 03/01/05
  804 Record Requirements 3/1/2011
  805 Budget Requirements 01/01/06
  806 Reporting Requirements 03/01/12
  807 Contract Termination & Transition 03/01/05
  808 Transfer of Consumers or Change of  
      Consumer’s Classification 3/1/2011
  809-1 Plan of Care: Development 03/01/12
  809-2 Plan of Care: Components 03/01/12
  809-3 Plan of Care: Requirements 03/01/12
  809-4 Plan of Care: Costs 03/01/12
  809-5 Plan of Care: Reevaluations 03/01/12
  809-6 Plan of Care: Amendments 03/01/12
  809-7 Plan of Care: Annual Updates 03/01/12
  810 Consumer Advisory Councils 03/01/12
  811 Year-End Money 01/01/06
  812 Risk Negotiation Process 03/01/12
  899-1 Year-End Money Form 03/01/05
  899-2 Reporting Requirements 3/1/2011
  899-2a Provider Prepared Standards CMT
3/1/2011
  899-2b Utilization Report
03/01/12
  899-2c Nursing Facility Transfer Report
3/1/2011
  899-3 Reserved 03/01/12
  899-4 HCBS Forms Requisition Page 2 01/01/06
  899-5 Plan of Care Cost Limits 03/01/12
  899-6 Entrance Into Medicaid & HCBS  
      (DPHHS-SLTC-55) Instructions 03/01/05
  899-7  Request for Level of Care  
    (DPHHS-SLTC-85) Instructions 01/01/06
  899-8 Level of Care Determination  
      (DPHHS-SLTC-86) Instructions 01/01/06
  899-9 Adult Residential Care Calculation Page 2  
      (DPHHS-SLTC-132) Instructions 03/01/12
  899-10 Plan of Care Cost Sheet  
      (DPHHS-SLTC-134) Instructions 03/01/12
  899-11 Plan of Care (DPHHS-SLTC-135)  
    Instructions 3/1/2011
  899-11B Plan of Care Short Form 03/01/12
      (DPHHS-SLTC-135B) Instructions 01/01/06
  899-12 Intake Sheet (DPHHS-SLTC-136)  
    Instructions 01/01/06
  899-13 Discharge Sheet (DPHHS-SLTC-137)  
      Instructions 01/01/06
  899-14 Authorized Services for Incurment  
      (DPHHS-SLTC-131) Instructions 03/01/12
  899-15 Reevaluation Form (DPHHS-SLTC-139)  
      Instructions 03/01/12
  899-16 Amendment Form (DPHHS-SLTC-141)  
      Instructions 03/01/12
  899-17 Psychosocial Summary (DPHHS-SLTC-143)  
      Instructions 03/01/12
  899-18 Letter of Notification (DPHHS-SLTC-144)  
      Instructions 01/01/06
  899-19 Level I Screen (DPHHS-SLTC-145)  
      Instructions 01/01/06
  899-20 Waiting List Criteria Tool (DPHHS-SLTC-146)  
      Instructions 04/01/07
  899-21 Request for Prior Authorization CC3  
      (DPHHS-SLTC-148) Instructions 03/01/12
  899-22 Request for Prior Authorization  
      (DPHHS-SLTC-149) Instructions 03/01/05
  899-23 Service Animals - Provider Assurances  
      (DPHHS-SLTC-142) Instructions 03/01/05
  899-24 Service Animals - Stewardship Agreement  
      (DPHHS-SLTC-142) Instructions 03/01/05
  899-25 Waiting List Database Instructions 03/01/05
  899-26 State Suppliment 3/1/2011
  899-27 Nursing Home Transition Request 3/1/2011
  899-28 Assisted Living Reserved Slots Form 3/1/2011
  899-29 Risk Negotiation Form 03/01/12
  899-29a Risk Assesment Document 3/1/2011
9900 Appendix  
  9901 Definitions 03/01/05
  9902 Abbreviations/Acronyms/Initials   03/01/12