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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.

This document will meet the requirement of a Fee Breakdown for HCBS Waiver Providers.

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.

This tool can be used to document Assisted Living Service on a weekly basis.

This document will provide guidance of how to document AL Service.

This document is used to review rights restrictions to comply with Medicaid Elderly Waiver every 90 days.