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HCBS Service Plan
This is an UPDATED version of the the HCBS Service Plan tool to coincide with the Provider Self Assessment. This document will assist programs to meet the settings guidelines established by CMS.
Medicaid Fee Breakdown Tool
This document will meet the requirement of a Fee Breakdown for HCBS Waiver Providers.
Assisted Living Service
This tool can be used to document for Assisted Living Service. Also refer to Assisted Living Service weekly documentation form as another option for documentation.
Assisted Living Service - Weekly Form
This tool can be used to document Assisted Living Service on a weekly basis.
Meal Census Form
This tool can be used to record meals for Medicaid Home Delivered Meals.
Sample - AL Service Documentation
This document will provide guidance of how to document AL Service.
This tool will help you with calculating minutes/units for the CDAC Agreement.
Rights Restriction Review Template
This document is used to review rights restrictions to comply with Medicaid Elderly Waiver every 90 days.