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.

*To obtain copies of this document, contact Gloria Garceau-Glaser at (406) 941-0250 or email ggarceau-glaser@mt.gov

Section/
 Subsection		 Title/Content  Forms Issued/
Revised
    Table of Contents   04/01/2020
    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
  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   04/01/2018
  418 Health Care Professional Authorization   10/2015
  419 Reserved    
  420 Reserved    
  421 Service Plan   04/01/2018
500   Mountain Pacific Quality Health  
  501 Prior Authorization Contract Requirements (MPQH)   04/01/2019
  504 MPQH Service Profile   04/01/2019
600 Administrative Requirements  
  605 Fair Hearings   04/2017
  606 Policy Memo CFC/PAS Reimbursement*   06/2016
  606 Reimbursement   01/2016
  607 Recoveries   04/01/2020
  608 Quality Assurance Review   04/2016
  609 Quality Assurance Review Work Sheet   10/2016
  610 Quality Assurance Process-Provider Agency Reports   01/01/2019
  611 Quality Assurance Communication   10/01/2019
700 Service Requirements  
  701 Agency Requirements   07/2017
  702 Intake Visits   04/01/2018
  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   04/01/2019
  717 Flexibility Parameters   10/01/2019
  718 Service Delivery Records   04/2015
  719 Amendments   04/01/2018
  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   01/01/2018
  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* 01/01/2018
  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-MMA 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 11/2015
  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* 01/01/2018
  925 Provider Prepared Standards SLTC-251 01/01/2018
  925 Provider Prepared Standards Policy Memo   01/04/2018
  926 Intake Internal Review SLTC-246* 01/01/2018
  927 Recertification Internal Review Worksheet SLTC-247* 01/01/2019
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 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* 04/01/2019
  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
    CFC/PAS Booklet Requisition Request Form SLTC-260 01/2018

Please use the SLTC 901 Requisition Form to order forms, which are preprinted by Central Office. Allow two weeks for delivery.