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CFC Agency Based Policy Manual

Community First Choice Program
Agency Based 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.

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Section/ Subsection

Title/Content

Forms Number

Issue/ Revised
   

Table of Contents

   10/01/2018
   

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   04/01/2018
  403 General Provisions and Services Policy Memo - supercedes policy memo 403 General Provisions and Services Policy Memo dated 01/04/2018   11/21/2018
  403 General Provisions and Services Policy Memo   01/04/2018
  404 Service Limitations and Exclusions   10/01/2018
  405 Reserved    
  406 Reserved    
  407 Denial of Services   04/2015
  408 Reserved    
  409 Reserved    
  410 Reserved    
  411 New Admissions   10/2017
  412 Request to Change Agencies   07/01/2018
  413 Switch in Options   07/2017
  414 High Risk Intake   04/01/2018
  415 Annual MPQH Reviews   04/2015
  416 Reserved    
  417 Temporary Authorization   07/01/2018
  417 Temporary Authorization Policy Memo   11/21/2018
  418 Reserved    
  419 Reserved    
  420 Reserved    
  421 Service Plan   07/01/2018

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
  610 Quality Assurance Process-Provider Agency Reports Policy Memo   01/04/2018

700

Service Requirements
  701 Agency Requirements   07/01/2018
  702 Intake Visits   04/01/2018
  703 180 Day and Annual Recertification   07/01/2018
  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   07/01/2018
  719 Amendments Policy Memo   11/21/2018
  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* 01/01/2018
  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
  909 909 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* 01/01/2018
  925 Provider Prepared Standards SLTC-253* 01/01/2018
  925 Provider Prepared Standards Policy Memo   01/04/2018
  926 Intake Internal Review Worksheet SLTC-244* 01/01/2018
  927 Recertification Internal Review Worksheet SLTC-245* 01/01/2018

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)   07/2017  
  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   07/2017
   

Pre-printed Forms available from Central Office
  SLTC 901 CFC/PAS Requisition Form*    
    CFC/PAS Booklet Requisition Request Form SLTC-260 01/01/2018
    *Documents may be obtained by contacting Abby Holm, CFC Program Manager 444-4564 or emailing: abholm@mt.gov    
    **Please use the SLTC 901 Requisition Form to order forms which are pre-printed by Central Office. Allow 2 weeks for delivery.