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CFC Agency Based Policy Manual

Community First Choice Program
Agency Based Policy Manual

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Section/ Subsection

Title/Content

Forms Number

Issue/ Revised

   

Table of Contents

  04/2017
   

Abbreviations

  04/2017

100

 

RESERVED

   

200

 

RESERVED

   

300

 

RESERVED

   

400

 

ELIGIBILITY FOR SERVICES

  401 Medicaid Eligibility Requirements   04/2015
  402 Program Eligibility   01/2016
  403 General Provisions and Services   07/2015
  404 Service Limitations and Exclusions   07/2015
  405 RESERVED    
  406 RESERVED    
  407 Denial of Services   04/2015
  408 RESERVED    
  409 RESERVED    
  410 RESERVED    
  411 New Admissions   04/2017
  412 Request to Change Agencies   04/2017
  413 Switch in Options   04/2015
  414 High Risk Intake   04/2015
  415 Annual MPQH Reviews   04/2015
  416 RESERVED    
  417 Temporary Authorization   04/2015
  418 RESERVED    
  419 RESERVED    
  420 RESERVED    
  421 Service Plan   04/2015

500

 

MOUNTAIN PACIFIC QUALITY HEALTH

600

 

ADMINISTRATIVE REQUIREMENTS

  605 Fair Hearings   04/2017
  606 Policy Memo CFC/PAS 606 Reimbursement   06/2016
  606 Reimbursement   01/2016
  608 Quality Assurance Review   04/2016
  609 Quality Assurance Review Worksheet   10/2016
  610 Quality Assurance Process-Provider Agency Reports   01/2017

700

 

SERVICE REQUIREMENTS

  701 Agency Requirements   10/2015
  702 Intake Visits   04/2015
  703 180 Day and Annual Recertification   07/2015
  704 Complaint Procedure   04/2015
  705 Termination, Discharge and Temporary Absences   04/2017
  706 Training Attendants   07/2015
  707 Medical Escort and Medical Transportation Mileage   07/2015
  708 Shopping, Community Integration and Mileage   04/2017
  709 Serious Occurrence Report   04/2017
  710 Home and Community Based Waiver Program   04/2015
  711 Live-In Attendants, Family and Significant Others   04/2015
  712 Home Health and Hospice Benefit and Third Party Programs   04/2015
  713 Services to Children Under the Age of 21 years   04/2015
  714 Services to Members with Developmental Disabilities   04/2015
  715 Services to Pregnant Women   04/2015
  716 RESERVED    
  717 Flexibility Parameters   04/2015
  718 Service Delivery Records   07/2015
  719 Amendments   07/2015
  720 Conflict of Interest   04/2015
  721 Skill Acquisition   04/2015
  722 RESERVED    
  723 Shared Cases   04/2015

800

 

RULES AND RESOURCES

900

 

FORMS

  901 General Information/Forms Requisition  SLTC 100 02/2015
  902 General Utilization   02/2015
  903 RESERVED    
  904 Service Plan Form Instructions SLTC 170 02/2015
  905 Member Referral Form Instructions SLTC-154 02/2015
  906 Change in Demographics Form Instructions SLTC-157 02/2015
  907 Unable to Admit/Discharge Form Instructions SLTC-158 02/2015
  908 Agency Start of Care Form Instructions SLTC-163 04/2017
  909 Person Centered Planning Form Instructions SLTC-200 04/2017
  910 RESERVED    
  911 Service Delivery Record Form Instructions - Sample SLTC-220 02/2015
  912 Mileage and Medical Escort Form Instructions SLTC-221 04/2017
  913 Request for Case Review Form Instructions SLTC-MA-128 02/2015
  914 Risk Negotiation Form Instructions SLTC-230 02/2015
  915 Recertification Documentation Instructions SLTC-210 02/2015
  916 Skills Acquisition Endorsement Form Instructions SLTC-215 02/2015
  917 Skills Acquisition Training Plan Form Instructions SLTC-216 02/2015
  924 Internal Quality Assurance Review Summary SLTC-252 01/2017
  925 Provider Prepared Standards SLTC-253 01/2017
  926 Intake Internal Review Worksheet SLTC-244 01/2017
  927 Recertification Internal Review Worksheet SLTC-245 01/2017
  930 PERS Prior Authorization Form Instructions SLTC-240 01/2017
  931 PERS Referral Form Instructions SLTC-241 01/2017

1000

 

RESERVED

   

1100

 

CFC/PAS PERSON CENTERED PLANNING (PCP)

  1101 PCP Requirements Overview   04/2017
  1102 Plan Facilitator vs. Provider Responsibilities   04/2017
  1103 Plan Facilitator Certification for CFC/PAS Providers   04/2017
  1104 PCP Coordinated Visits   04/2017
  1105 MPQH Authorization Documentation   04/2017
  1106 PCP Annual Visits   04/2017
  1107 PCP Re- Admission to CFC/PAS   04/2017
  1108 High Risk Admits   04/2017
  1109 Policy Memo: Plan Facilitator Policy Memo   10/2016
  1109 Plan Facilitator Change: Intake to Waiver/Case Management, Switch in Agency, and Waiver Discharge   04/2017
  1110 Short Term Admits   04/2017
  1111 Personal Emergency Response Systems (PERS)   04/2017  
  1112 Person Centered Planning Form Instructions   04/2017
  1113 Level of Care   04/2017
  1115 Case Manager Plan Facilitator Role When a Member Changes CFC/PAS Provider Agency   04/2016
   

Pre-printed Forms available from Central Office

  SLTC 901 CFC/PAS Requisition Form    
    *Please use the SLTC 901 Requisition Form to order forms which are pre-printed by Central Office. Allow 2 weeks for delivery.