Community Services
Home and Community Based Waiver Manual
TABLE OF CONTENTS
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INDEXES |
DATE REVISED |
Index |
03/01/12 |
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Alpha Subject Index |
03/01/12 |
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400 |
ELIGIBILITY FOR SERVICES |
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H & C Based Services Eligibility Requirements |
03/01/12 |
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Care Categories |
03/01/12 |
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Prior Authorization by the CSB |
03/01/12 |
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Termination of Services |
08/01/11 |
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Referrals for Services |
03/01/12 |
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Waiting List Criteria |
02/01/07 |
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Medically Needy Billing Procedures |
03/01/12 |
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Residency Requirements |
03/01/12 |
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Out-of-State Services |
03/01/05 |
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Bed-Hold Days |
3/1/2011 |
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| 410A | Attachment A |
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Developmentally Disabled |
02/01/07 |
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| 499-1 | Provider Information Memo (DPHHS-HCS-454) | 03/01/05 |
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500 |
PREADMISSION SCREENING |
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Screening Requirements |
03/01/12 |
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Screening Referral Procedures |
03/01/12 |
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Level of Care Reevaluations |
3/1/2011 |
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Reserved |
01/01/06 |
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ScAN |
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Screening Determination (DPHHS-SLTC-61) |
3/1/2011 |
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600 |
ADMINISTRATIVE REQUIREMENTS |
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Provider Eligibility |
03/01/12 |
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Provider Responsibilities |
03/01/12 |
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Provider Enrollment |
01/01/06 |
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Payment Requirements |
02/01/07 |
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Payment to Legally Responsible Individuals |
03/01/12 |
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Payment Processing |
03/01/12 |
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Reimbursement Methodology |
03/01/12 |
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Licensure Requirements |
03/01/05 |
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Quality Assurance Process |
03/01/12 |
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Provider Requirements |
03/01/12 |
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CMS 1500 Claim Form IN PDF FORMAT |
04/01/07 |
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HCBS Procedure Codes & Rates |
03/01/12 |
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Medicaid Nursing Facility Reimbursement Rates |
01/01/06 |
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Prior Authorization Form |
04/01/07 |
700 |
SERVICES |
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Covered Services |
08/01/11 |
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Service Limitations & Exclusions |
08/01/11 |
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Adult Day Health |
08/01/11 |
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Adult Residential Care |
08/01/11 |
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Behavioral Programming |
08/01/11 |
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Case Management |
08/01/11 |
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Chemical Dependency Counseling |
08/01/11 |
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Cognitive Rehabilitation |
08/01/11 |
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Community Residential Rehabilitation |
08/01/11 |
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Comprehensive Day Treatment |
08/01/11 |
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Day Habilitation |
08/01/11 |
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Dietitian/Nutritionist |
08/01/11 |
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Environmental Accessibility Adaptations |
08/01/11 |
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Habilitation |
08/01/11 |
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Homemaker |
03/01/05 |
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Nutrition |
03/01/05 |
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Occupational Therapy |
08/01/11 |
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Personal Assistance |
08/01/11 |
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Personal Emergency Response System |
3/1/2011 |
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Physical Therapy |
03/01/05 |
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Prevocational Training |
04/01/07 |
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Private Duty Nursing |
01/01/06 |
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Psychosocial Consultation |
08/01/11 |
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Registered Nurse Supervision |
08/01/11 |
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Respiratory Therapy |
08/01/11 |
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Respite Care |
08/01/11 |
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Special Child Care for Medically Fragile Children |
08/01/11 |
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Specialized Medical Equipment & Supplies |
08/01/11 |
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Specially Trained Attendants |
08/01/11 |
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Speech Therapy and Audiology |
08/01/11 |
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Supported Employment |
08/01/11 |
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Supported Living |
08/01/11 |
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Transportation |
08/01/11 |
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Consumer/Family Intensive Support Service |
08/01/11 |
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Family Training and Support |
08/01/11 |
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Home & Community Based Services |
03/01/05 |
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Administrative Rules of Montana |
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PAS Consumer Referral/Overview (DPHHS-SLTC-154) |
01/01/06 |
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Service Animals - Case Management Team’s Role |
03/01/05 |
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Service Animals – Consumer’s Role |
03/01/05 |
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Directory of Assistive Technology Practitioners |
03/01/05 |
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Consumer Recycling Agreement |
03/01/05 |
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799-7 |
Field Memorandum FY95 |
01/01/06 |
800 |
CASE MANAGEMENT SYSTEM |
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Case Management Requirements |
03/01/12 |
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Case Management Team Requirements |
03/01/12 |
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Service Areas |
03/01/05 |
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Record Requirements |
3/1/2011 |
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Budget Requirements |
01/01/06 |
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Reporting Requirements |
03/01/12 |
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Contract Termination & Transition |
03/01/05 |
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Transfer of Consumers or Change of |
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Consumer’s Classification |
3/1/2011 |
Plan of Care: Development |
03/01/12 |
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Plan of Care: Components |
03/01/12 |
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Plan of Care: Requirements |
03/01/12 |
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Plan of Care: Costs |
03/01/12 |
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Plan of Care: Reevaluations |
03/01/12 |
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Plan of Care: Amendments |
03/01/12 |
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Plan of Care: Annual Updates |
03/01/12 |
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Consumer Advisory Councils |
03/01/12 |
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Year-End Money |
01/01/06 |
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| 812 | Risk Negotiation Process | 03/01/12 |
Year-End Money Form |
03/01/05 |
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Reporting Requirements |
3/1/2011 |
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Provider Prepared Standards CMT |
3/1/2011 |
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Utilization Report |
03/01/12 |
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Nursing Facility Transfer Report |
3/1/2011 |
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Reserved |
03/01/12 |
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HCBS Forms Requisition Page 2 |
01/01/06 |
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Plan of Care Cost Limits |
03/01/12 |
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Entrance Into Medicaid & HCBS |
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(DPHHS-SLTC-55) Instructions |
03/01/05 |
Request for Level of Care |
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(DPHHS-SLTC-85) Instructions |
01/01/06 |
Level of Care Determination |
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(DPHHS-SLTC-86) Instructions |
01/01/06 |
Adult Residential Care Calculation Page 2 |
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(DPHHS-SLTC-132) Instructions |
03/01/12 |
Plan of Care Cost Sheet |
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(DPHHS-SLTC-134) Instructions |
03/01/12 |
Plan of Care (DPHHS-SLTC-135) |
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3/1/2011 |
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Plan of Care Short Form |
03/01/12 |
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(DPHHS-SLTC-135B) Instructions |
01/01/06 |
Intake Sheet (DPHHS-SLTC-136) |
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01/01/06 |
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Discharge Sheet (DPHHS-SLTC-137) |
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01/01/06 |
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Authorized Services for Incurment |
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(DPHHS-SLTC-131) Instructions |
03/01/12 |
Reevaluation Form (DPHHS-SLTC-139) |
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03/01/12 |
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Amendment Form (DPHHS-SLTC-141) |
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03/01/12 |
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Psychosocial Summary (DPHHS-SLTC-143) |
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03/01/12 |
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Letter of Notification (DPHHS-SLTC-144) |
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01/01/06 |
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Level I Screen (DPHHS-SLTC-145) |
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01/01/06 |
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Waiting List Criteria Tool (DPHHS-SLTC-146) |
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04/01/07 |
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Request for Prior Authorization CC3 |
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(DPHHS-SLTC-148) Instructions |
03/01/12 |
Request for Prior Authorization |
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(DPHHS-SLTC-149) Instructions |
03/01/05 |
Service Animals - Provider Assurances |
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(DPHHS-SLTC-142) Instructions |
03/01/05 |
Service Animals - Stewardship Agreement |
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(DPHHS-SLTC-142) Instructions |
03/01/05 |
Waiting List Database Instructions |
03/01/05 |
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State Suppliment |
3/1/2011 |
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Nursing Home Transition Request |
3/1/2011 |
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Assisted Living Reserved Slots Form |
3/1/2011 |
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Risk Negotiation Form |
03/01/12 |
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Risk Assesment Document |
3/1/2011 |
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9900 |
APPENDIX |
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Definitions |
03/01/05 |
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Abbreviations/Acronyms/Initials |
03/01/12 |


