Home & Community Based Waiver Services

Waiver While Waiting

jwilliams — Wed, 05 Mar 2008 11:30:04 -0600

Waiver While Waiting is a benefit available to allow early access to home and community-based services while waiting for Medicaid eligibility. Anyone who is not willing to accept the uncertainty of continuing services or financial responsibility should not use this option.

H: DHHS Prior Authorization for Assisted Living Waiver Service (MC-9AD)

jwilliams — Fri, 25 Jan 2008 14:03:57 -0600

This authorization is void if client is ineligible for Medicaid.

To be completed by Service Coordinator

G: DHHS Finance and Support Manual Home and Community-Based Services Assisted Living Rates Chart (480-000-210)

jwilliams — Fri, 25 Jan 2008 14:02:55 -0600

Appendix G
Assisted Living Rates Chart
480-000-210

The following are the Assisted Living Standard Rates for individuals qualified under the Aged and Disabled Medicaid Waiver.

F: DHHS Long Term Care Facility Turnaround Billing Document (MC-4)

jwilliams — Fri, 25 Jan 2008 14:01:49 -0600

Appendix F
Authorization Notice

E: Aged and Disabled Waiver Assisted Living Services Client Consent for Multiple Occupancy (MILTC-21)

jwilliams — Fri, 25 Jan 2008 13:57:48 -0600

Appendix E
Preprinted DSS-5N

D: DHHS Assisted Living Service Provider Checklist HCB Waiver for Aged Persons, Adults or Children with Disabilities (MILTC-1AD)

jwilliams — Fri, 25 Jan 2008 13:45:29 -0600

Appendix D
Provider Authorization

C: DHHS Assisted-Living Service Provider Addendum, HCB Waiver for Aged Persons, Adults or Children with Disabilities (MILTC-1AD)

jwilliams — Fri, 25 Jan 2008 13:38:18 -0600

Appendix C
Developing Goals in
Outcome Measurement

I reserve the right to discharge any resident whose personal care needs change for more than a temporary time period to a level beyond the service capability of this facility.

B: Aged and Disabled Medicaid Waiver Plan of Services and Supports Nebraska Department of Health and Human Services (DSS-12AD)

jwilliams — Fri, 25 Jan 2008 12:58:40 -0600

Appendix B
DSS-12AD

Client's Name

Social Security Number

Page

A: Service Provider Agreement DHHS (DSS-9)

jwilliams — Fri, 25 Jan 2008 12:49:38 -0600

Appendix A
DSS-9

Agreement Number ________________

Appendices

jwilliams — Fri, 25 Jan 2008 11:31:37 -0600

List of Appendix Names and Links to Appendices