Department of Public Health and Human Services

Home » Senior and Long Term Care » Community First Choice Self-Direct Policy Manual

Main Content

Community First Choice Self-Direct Policy Manual

Community First Choice Program
Self-Direct Policy Manual

Printing the manual material found at this website for long-term use is not advisable. Department Policy material is updated periodically and it is the responsibility of the users to check and make sure that the policy they are researching or applying has the correct effective date for their circumstances. State Website Disclaimer.

If you experience any difficulty opening a policy from this page,
please email HHS Technology Services Center.

Section/
 Subsection

Title/Content

 Forms

Issued/
Revised

 

 

Table of Contents

 

07/2017

 

 

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   07/2017
  414 High Risk Intake   04/2015
  415 Annual MPQH Reviews   04/2015
  416 Reserved    
  417 Temporary Authorization   04/2015
  418 Health Care Professional Authorization   10/2015
  419 Reserved    
  420 Reserved    
  421 Service Plan   04/2015

500

Mountain Pacific Quality Health

 

600

Administrative Requirements

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

700

Service Requirements

 
  701 Agency Requirements   07/2017
  702 Intake Visits   07/2017
  703 180 Day and Annual Recertification   07/2015
  704 Complaint Procedure   04/2015
  705 Termination, Discharge, and Temporary Absences   04/2017
  706 Training Attendants   04/2015
  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   07/2015
  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 Personal Representative   10/2015
  717 Flexibility Parameters   04/2015
  718 Service Delivery Records   04/2015
  719 Amendments   07/2015
  720 Conflict of Interest   04/2015
  721 Skill Acquisition   07/2015
  722 Member Capacity and Compliance   04/2015

800

Rules and Resources

 

900

Forms

 
  901 General Information   02/2015
  902 General Utilization   02/2015
  903 Reserved    
  904 Service Plan Form Instructions  SLTC-175 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 Instruction  SLTC-200 04/2017
  910 Reserved    
  911 Service Delivery Record Form Instructions  SLTC-222 02/2015
  912 Mileage and Medical Escort Form Instructions  SLTC-221 04/2017
  913 Request for Case Review Form Instructions  SLTC-MA128 02/2015
  914 Risk Negotiation Form Instructions  SLTC-230 02/2015
  915 Recertification Documentation Form Instructions  SLTC-210 02/2015
  916 Skills Acquisition Endorsement Form Instructions  SLTC-215 02/2015
  917 Skills Acquisition Training Form Instructions  SLTC-216 02/2015
  918 Reserved    
  919 Program Compliance Tool Form Instructions  SLTC-167 02/2015
  920 Health Care Professional Authorization Form SLTC-160 02/2015
  921 Member Agreement Form Instructions  SLTC-159 07/2015
  922 Reserved    
  923 Personal Representative Agreement Form Instructions SLTC-166 07/2015
  924 Agency Internal Quality Assurance Review SLTC-250 01/2017
  925 Provider Prepared Standards SLTC-251 01/2017
  926 Intake Internal Review SLTC-246 01/2017
  927 Recertification Internal Review Worksheet SLTC-247 01/2017

1000

Reserved

 

1100

CFC/PAS Person Centered Planning

 
  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 Documents   04/2017
  1106 PCP Annual Visits   04/2017
  1107 PCP Re-Admissions to CFC/PAS   04/2017
  1108 High Risk Admits   04/2017
  1109 Memo 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)   07/2017
  1112 PCP Planning Form Instructions SLTC-200 04/2017
  1113 Level of Care   04/2017
  1115 Case Manager Plan Facilitator Role When Member Changes CFC/PAS Provider Agency   07/2017
 

Pre-printed Forms available from Central Office

  901 SD-Requisition Form - Self Direct   02/2015
    *Please use the SLTC 901 Requisition Form to order forms which are re-printed by Central Office. Allow 2 weeks for delivery.