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001
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Table of Contents
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07/01/2020
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002
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Alpha Subject Index
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03/01/2012
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400
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ELIGIBILITY FOR SERVICES
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401
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Eligibility for Services
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BSW-101
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04/01/2019
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401
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BSW Program Approval Notice
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BSW-102
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01/01/2019
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402
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Slot Categories
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04/01/2016
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403
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Prior Authorizations
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Policy
SLTC-148
SLTC-149*
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04/01/2020
01/01/2018
07/01/2018
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405
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Referrals for Services
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07/01/2020
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406
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Wait List Criteria
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10/01/2019
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406
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Wait List Placement Approval Notice
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BSW-103
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01/01/2019
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406
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Wait List-Deeming Form
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BSW-101-18
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07/01/2018
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406
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Wait List Criteria Tool
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SLTC-146
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10/01/2019
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407
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Medically Needy Billing Procedures
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Policy
SLTC-131
SLTC-132
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01/01/2019
01/01/2018
01/01/2018
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408
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Residency Requirements
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01/01/2012
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409
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Out-of-State Services
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01/01/2012
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410
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Retainer Payments
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01/01/2019
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410-1
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Attachment A, Public Institutions
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01/01/2012
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411
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Individuals with Intellectual Disabilities
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01/01/2017
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412
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Adverse Action
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Policy
SLTC-137
SLTC-144
SLTC-150
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10/01/2019
01/01/2018
07/01/2020
07/01/2020
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413
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Fair Hearings
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04/01/2017
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414
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Assisted Living At-Risk Slot Process
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04/01/2019
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415
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Temporary Absences
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07/01/2018
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499-1
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DPHHS Release of Information HPS 402
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10/01/2015
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500
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PREADMISSION SCREENING
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501
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Screening Requirements Preadmission Screening
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07/01/2020
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502
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Screening Referral Procedures
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07/01/2020
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503
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Level of Care Reevaluations
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07/01/2020
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504
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RESERVED
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599-1
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Screening Determination Form*
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SLTC-61*
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01/01/2019
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600
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ADMINISTRATIVE REQUIREMENTS
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601
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Provider Eligibility
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01/01/2012
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602
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Provider Responsibilities
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01/01/2019
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602-1
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Progress Notes
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01/01/2017
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603
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Provider Enrollment
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04/01/2017
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604
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Payment Requirements
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01/01/2016
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604-1
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Payment of Legally Responsible Individuals
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01/01/2016
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605
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Payment Processing
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07/01/2018
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606
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Reimbursement Methodology
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01/01/2012
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607
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Licensure Requirements
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07/01/2016
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608
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Quality Assurance Process
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07/01/2018
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608-1
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Quality Assurance Communication
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10/01/2019
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608-2
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Recoveries
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04/01/2020
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609
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Serious Occurrence Report
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04/01/2017
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610
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Quality Improvement Projects
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04/01/2020
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699-1
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Provider Requirements
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01/01/2016
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699-2
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CMS 1500 Claim Form
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02/01/2012
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699-3
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File Transfer
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01/01/2012
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699-4
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RESERVED
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699-5
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HCBS Referral for Services Form
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04/01/2007
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700
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SERVICES
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701
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Covered Services
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08/01/2011
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702
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Service Limitations and Exclusions
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01/01/2019
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703
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Adult Day Health
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08/01/2011
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704
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Case Management
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08/01/2011
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705
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Community Supports
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08/01/2011
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706
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Community Transition
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08/01/2011
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707
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Consultative Clinical and Therapeutic Services
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08/01/2011
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708
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Consumer Goods and Services
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08/01/2011
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709
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Day Habilitation
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08/01/2011
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710
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Dietetic Services
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08/01/2011
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711
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Environmental Accessibility Adaptations
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04/01/2018
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712
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Family Training and Support
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08/01/2011
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713
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Financial Management Services
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08/01/2011
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714
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Health and Wellness
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08/01/2011
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715
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Homemaker
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01/01/2012
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716
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Homemaker Chore
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01/01/2012
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717
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Independence Advisor
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07/01/2018
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718
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Non-Medical Transportation
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01/01/2019
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719
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Nutrition
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01/01/2012
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720
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Occupational Therapy
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07/01/2020
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721
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Pain and Symptom Management
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01/01/2012
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722
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Personal Assistance Services
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01/01/2019
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723
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Personal Emergency Response System
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07/01/2016
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724
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Physical Therapy
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07/01/2020
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725
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Post Acute Rehabilitation Services
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07/01/2018
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726
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Prevocational Services
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08/01/2011
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727
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Private Duty Nursing
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01/01/2019
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728
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Residential Habilitation
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01/01/2012
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729
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Respiratory Therapy
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07/01/2020
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730
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Respite Care
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08/01/2011
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731
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Senior Companion
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08/01/2011
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732
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Special Child Care for Medically Fragile Children
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08/01/2011
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733
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DME: Specialized Medical Equipment, Supplies and Technology
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07/01/2018
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733-1
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DME Specialized Medical Equipment, Supplies and Technology: Consultations
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02/01/2017
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733-2
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DME Specialized Medical Equipment, Supplies, and Technology: Commonly Covered Items under Big Sky Waiver
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02/01/2017
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734
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Speech Therapy and Audiology
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07/01/2020
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735
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Supported Employment
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08/01/2011
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736
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Supported Living
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10/01/2019
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737
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Vehicle Modification
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04/01/2018
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799-1
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Administrative Rules of Montana
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10/01/2015
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799-2
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CFC/PAS Consumer Referral Form
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SLTC-154
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10/01/2015
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799-3
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Service Animal: Case Management Team Role
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10/01/2015
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799-4
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Service Animal: Member Responsibilities
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10/01/2015
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799-5
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Service Animal: Acquisition Procedure
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10/01/2015
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799-6
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Consumer Recycling Agreement
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03/01/2005
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800
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CASE MANAGEMENT SERVICES
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801
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Case Management Requirements
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07/01/2018
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802
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Case Management Team Requirements
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01/01/2012
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803
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Service Areas
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03/01/2012
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804
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Record Requirements
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04/01/2019
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805
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Budget Requirements
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03/01/2005
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806
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Reporting Requirements
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01/01/2012
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807
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Contract Termination and Transition
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03/01/2005
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808
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Transfer of Members or Change in Member Classification
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07/01/2018
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809-1
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Service Plan Development
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07/01/2016
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809-2
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Service Plan Components
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01/01/2012
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809-3
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Service Plan Requirements
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01/01/2012
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809-4
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Service Plan Costs
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01/01/2012
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809-5
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Service Plan Reevaluations
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10/01/2019
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809-6
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Service Plan Amendment
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SLTC-141
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01/01/2018
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809-7
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Service Plan Annual Updates
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01/01/2012
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810
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Member Input
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01/01/2012
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812
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Risk Negotiation Process
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01/01/2012
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FORMS
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899-2
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Reporting Requirements, Forms & Instructions
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04/01/2016
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899-2a
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Internal Chart Audit Form
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01/01/2009
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899-2b
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Utilization Report
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01/01/2012
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899-2c
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Nursing Facility Transfer Report
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01/01/2009
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899-3
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CMS Assurances
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04/01/2020
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899-4
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HCBS Forms Requisition
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01/01/2006
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899-5
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Service Plan Cost Limits
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07/01/2020
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899-6
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Entrance into Medicaid Instructions
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SLTC-55
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02/01/2007
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899-7
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Request for Level of Care
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SLTC-85
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01/01/2006
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899-8
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Level of Care Determination
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01/01/2016
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899-10
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Service Plan & Cost Sheet
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SLTC-134
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01/01/2012
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899-11
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Service Plan Instructions
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04/01/2016
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899-11
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HCBS Service Plan Form
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SLTC-135
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04/01/2016
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899-11b
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Service Plan Short Form (135b) Instructions
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04/01/2016
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899-11b
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Service Plan Short Form
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SLTC 135b
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04/01/2016
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899-12
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Intake Sheet Form Instructions
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SLTC-136
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01/01/2016
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Authorized Services for Spend Down
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SLTC-131
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01/01/2018
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899-15
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Re-Evaluation Form
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SLTC-139
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01/01/2012
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899-17
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Psychosocial Summary Form Instructions
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SLTC-143
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01/01/2016
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899-19
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Level I Screen
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SLTC-145
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01/01/2006
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899-23
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Service Animals Provider Assurance Form Instructions
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SLTC-142
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10/01/2015
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899-24
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Service Animal Stewardship Agreement Instructions
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SLTC-147
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10/01/2015
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899-25
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Waiting List Database
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03/01/2005
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899-26
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State Supplement Instructions & Forms
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02/01/2007
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899-27
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Nursing Home Transition Process & Form
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03/01/2011
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899-29
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Risk Negotiation Form & Instructions
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SLTC-157*
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04/01/2018
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1100
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Person Centered Planning
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1101
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Person-Centered Planning Requirements Overview
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04/01/2017
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1102
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Plan Facilitator vs. Provider Responsibilities
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04/01/2017
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1103
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Plan Facilitator Certification for CFC/PAS Providers
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04/01/2017
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1104
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Person Centered Planning Coordinated Visit
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04/01/2017
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1105
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Mountain Pacific Quality Health Authorization Documents
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04/01/2017
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1106
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Person Centered Planning Annual Visits
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04/01/2017
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1107
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Person Centered Planning - Readmission
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07/01/2017
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1108
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High Risk Admits
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07/01/2017
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1109
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Change in Plan Facilitator
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07/01/2017
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1110
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Short Term Admits
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07/01/2017
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1111
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Personal Emergency Response Systems (PERS)
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07/01/2017
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1112
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Person Centered Plan Form Instructions (SLTC 200)
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SLTC-200*
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04/01/2017
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1113
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Level of Care
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07/01/2017
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1115
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Case Manager Role When Switching Agencies
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07/01/2017
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Appendix
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9901
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Definitions
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03/01/2005
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9902
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Abbreviations/Acronyms/Initials
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01/01/2017
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