Staggered Roll Out Plans of Care Moving to a Fee for Service Sharon Weber
|
|
- Jordan Wright
- 6 years ago
- Views:
Transcription
1 Staggered Roll Out Plans of Care Moving to a Fee for Service Sharon Weber
2 Staggered Roll Out To transition to a fee for service rather then a bundled rate the POC s will need to be discharged and re-entered This will be done in 4 stages Round 1: May 7 May 21, 2018 Plans of Care with a last covered day in May and June 2018 Round 2: May 22 June 5, 2018 Plans of Care with a last covered day in July 2018 Round 3: June 6 June 20, 2018 Plans of Care with a last covered day in August 2018 Round 4: June 20 June 30, 2018 POC s submitted outside the timeframes 2
3 Round 1 May 7 May 21, 2018 Last covered day in May, June 2018 Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page, only the FCC s signature is required (this is an administrative change and not an actual reauthorization request). 3
4 Round 2 May 22 June 5, 2018 Last covered day in July 2018 Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page, only the FCC s signature is required (this is an administrative change and not an actual reauthorization request). 4
5 Round 3 June 6 June 20, 2018 Last covered day in August 2018 Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page: Guardian s signature and FCC s this is an administrative change and a reauthorization 5
6 Round 4, June 20 June 30, 2018 All POC s submitted outside the designated timeframes. All late submissions risk temporary non-auth status and will be processed last. Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page: Guardian s signature and FCC s this is an administrative change and a reauthorization You may submit an Update Reassessment Plan of Care after July 1, 2018 to document any changes to objectives and strategies, as needed. 6
7 Coordination of Units per Month Providers will request units ( 15 minutes) and manage those units Unit requests for all roles will need to be specified in the Plan of Care. The units for each role are independent of the other roles Authorized units will be provided in a manner to support a family Refer to the Timelines and Requirements to see national standards of contact. We will look at the need of each family and youth. Both the State and Magellan recognize that we will have youth that need more and youth that need less. We will continue to have open dialogue regarding this. All needs must be clearly documented in Plans of Care. If more units are needed to serve a family within the specified time span, the POC update with the justification will be needed, Update Corrected Service Addition and must identify this need before the current units are expired 7
8 Service Additions If your Child and Family Team would like to request a new service before July 1, 2018, it will occur as a delayed process. WYClinical@magellanhealth.com a Choice of Provider form. Make sure the Choice of Provider form also indicates the start date of the new service. After July 1, 2018, the Clinical team will review all Choice of Provider forms The team will backdate the start date of new service authorizations to the date on the Choice of Provider form, as long as the Choice of Provider form was submitted on or before the start date of the new service. If the Choice of Provider form was submitted after the start date of the new service, the Clinical team will backdate the start date of the new service to the date the Choice of Provider form was submitted. 8
9 Case Reviews Clinical team will have limited availability for case review between May 1, 2018 and July 30, The primary focus of the Clinical team during this timeframe is to ensure all HFWA enrolled youth have Update Corrected Reassessment Plans of Care uploaded to MagellanProvider.com. If you have an urgent matter that requires immediate attention, please outreach Sharon Weber via text or . Sharon will consult with the internal CME team to determine whether a case review will be scheduled, or if the matter will need to be discussed via 9
10 Answers to Questions
11 If you are watching this after the Learning Opportunity, please Sharon your name and agency so you get credit for watching it!
12 Confidentiality statement for providers The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. *If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors. 12
Adverse Outcome Reporting Requirements. July 19, 2016
Adverse Outcome Reporting Requirements July 19, 2016 Magellan of Virginia (Magellan) serves as the contracted Behavioral Health Services Administrator for the Department of Medical Assistance Services
More informationHigh Fidelity Wraparound High Fidelity Wraparound principles
High Fidelity Wraparound High Fidelity Wraparound principles Family voice and choice Team-based Natural supports Collaboration Community-based Culturally competent Individualized Strengths-based Unconditional
More informationIndependent Assessment, Certification and Coordination Team: Process Overview. Magellan of Virginia May 15, 2018
Independent Assessment, Certification and Coordination Team: Process Overview Magellan of Virginia May 15, 2018 Training Objectives Identify and describe important roles in the Independent Assessment,
More informationTreatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter
Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter 1 2016 After today s training you will be able to: Determine DMAS Medical Necessity Criteria (MNC)
More informationTherapeutic Day Treatment: Service Request Authorization Updates. Presented by Clinical November 1, 2016
Therapeutic Day Treatment: Service Request Authorization Updates Presented by Clinical November 1, 2016 The Purpose of This Training To highlight the changes on the new Service Request Authorization (SRA)
More informationMagellan Healthcare, Inc.
Magellan Healthcare, Inc. 2018 Handbook for Care Management Entity Standard operating procedures for High Fidelity Wraparound (HFWA) in Wyoming Table of Contents SECTION 1: INTRODUCTION...4 Welcome...
More informationDischarge and Follow-Up Planning. Presented by the Clinical and Quality Team
Discharge and Follow-Up Planning Presented by the Clinical and Quality Team After today s training you will be able to: Identify and summarize important information about discharge planning Have adequate
More informationProvider Contracting and Re-credentialing. Third Thursday Provider Call (August 20, 2015) Gail Fowler, Network Development Administrator
Provider Contracting and Re-credentialing Third Thursday Provider Call (August 20, 2015) Gail Fowler, Network Development Administrator New Provider Contracting - In the Louisiana Behavioral Health Partnership
More informationDean Health Plan Physical Medicine Overview
Dean Health Plan Physical Medicine Overview Provider Training / Presented by: Leta Genasci Above and throughout this document, NIA Magellan refers to National Imaging Associates, Inc. Dean Health Plan
More informationNIA Magellan 1 Medical Specialty Solutions
NIA Magellan 1 Medical Specialty Solutions CeltiCare of Massachusetts Health Provider Training 1 - NIA Magellan refers to National Imaging Associates, Inc. NIA Magellan Training Program 2 NIA Magellan
More informationNational Imaging Associates, Inc. (NIA) 1 Medical Specialty Solutions
National Imaging Associates, Inc. (NIA) 1 Medical Specialty Solutions Provider Training/Presented by: Name: Kevin Apgar 1 National Imaging Associates, Inc. (NIA) is a subsidiary of Magellan Healthcare,
More informationPsychosocial Rehabilitation (PSR) H2017. Presented by the Clinical and Quality Teams September 2016
Psychosocial Rehabilitation (PSR) H2017 Presented by the Clinical and Quality Teams After today s training you will be able to: Determine Department of Medical Assistance (DMAS) Medical Necessity Criteria
More informationMagellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program
Magellan Healthcare 1 Magellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program 1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc. Magellan Healthcare
More informationSleep Solution for Magellan Complete Care of Virginia Members. Provider Training Program for Sleep Management Presented By:
Sleep Solution for Magellan Complete Care of Virginia Members Provider Training Program for Sleep Management Presented By: Magellan Healthcare 1 Program Agenda Sleep Disorders Our Program 1. Magellan Healthcare
More informationNIA Magellan 1 Medical Specialty Solutions
NIA Magellan 1 Medical Specialty Solutions Provider Training 1 NIA Magellan refers to National Imaging Associates, Inc. NIA Magellan Training Program 2 NIA Magellan Program Agenda Introduction to NIA Magellan
More informationMagellan Healthcare 1 Medical Specialty Solutions
Magellan Healthcare 1 Medical Specialty Solutions Horizon NJ Health 1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc. Magellan Healthcare Training 2 Magellan Healthcare Agenda
More informationNational Imaging Associates, Inc. (NIA) Medical Specialty Solutions
National Imaging Associates, Inc. (NIA) Medical Specialty Solutions NIA Program Agenda Introduction Our Program 1. Expanded Program 2. Authorization Process 3. Clinical Validation of Records 4. Other Program
More informationHMSA s Interventional Pain Management and Spine Surgery Program
HMSA s Interventional Pain Management and Spine Surgery Program Presented by: Laurie Kim, Director, Provider Relations and Account Management Hawai i Magellan Healthcare 1 Training Program 1 National Imaging
More informationAn Orientation to Your Employee Assistance Program (EAP)
An Orientation to Your Employee Assistance Program (EAP) Presented by Linda Kushel-Hernandez Magellan Senior Account Executive 2015 Magellan Health, Inc Objectives Describe your EAP benefits. Identify
More informationOverview: Mental Health Case Management and 1915(i) Chapter I
Overview: Mental Health Case Management and 1915(i) Chapter I 1 Home And Community-Based Services: Intensive Behavioral Health Services For Children, Youth and Families Beacon Health Options Maryland began
More informationAetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers
Aetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers Aetna Physical Medicine Overview What: When: Who: Aetna will initiate a Utilization Management Prior Authorization
More informationWyoming CME Clinical Eligibility Criteria
Wyoming CME Clinical Eligibility Criteria Version 1.0 Effective Date: Nov. 16, 2016 Wyoming CME Clinical Eligibility Criteria 2016 Magellan Health, Inc. Table of Contents Wyoming CME Clinical Eligibility
More informationQualified Evaluator Network (QEN)
Qualified Evaluator Network (QEN) Cassandra Watson, MSW Quality Manager, QEN Program Magellan Medicaid Administration Missy Gibson, LMHC Sr. Manager, Clinical Care Services Magellan Medicaid Administration
More informationCHILDREN S RECORD AUDIT TOOL
Date of Audit: Netsmart ID #: Date of enrollment: Agency: Auditor: Score: STANDARD Yes No NA Located In: Recommendations Additional Comments ELIGIBILITY Chart EHR Recent claims and clinical data document
More informationWe Energies Renewable Energy Workforce and Economic Development Grant Program
We Energies Renewable Energy Workforce and Economic Development Grant Program - 2011 Introduction During the 2011 program year, We Energies will offer grants and financial assistance under its Workforce
More informationPATIENT NOTICE. If you are already taking any of the above medications, your provider may want to talk to you about alternative treatments.
PATIENT NOTICE Our goal at is to provide quality medical care. Because of our concern for your health and well-being, there are certain types of medications we may not be able to prescribe to you. Examples
More information******************************************************************** Policy Expectation:
HIPAA Privacy Procedure #8 Effective Date: April 14, 2003 Reviewed Date: February, 2011 Use or Disclosure of Protected Health Revised Date: February, 2011 Information on Fundraising Scope: Radiation Oncology
More informationRyan White Part A. Quality Management
Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant
More informationHIPAA & Research Overview for the Privacy Board March 22, UAMS HIPAA Office Vera M. Chenault, JD
HIPAA & Research Overview for the Privacy Board March 22, 2011 UAMS HIPAA Office Vera M. Chenault, JD The Privacy Board - YOU HIPAA Privacy Rule establishes the requirements for membership and role of
More informationCompliance with Selective Service Registration Policy Determination of Knowing and Willful Failure to Register Military Selective Service Act (MSSA)
WorkSource Atlanta Regional Policies and Procedures Manual Compliance with Selective Service Registration Policy Determination of Knowing and Willful Failure to Register Military Selective Service Act
More informationO'YEAH)- Vendor References: #045- Day Treatment Prior Authorization POLICY
Current Status: Active PolicyStat ID: 4289422 Date Issued: 5/31/2003 Last Approved Date: 12/5/2017 Last Revised Date: 12/5/2017 Next Review: 12/4/2020 Owner: Policy Area: Dana James: 21011004-Quality Assurance
More informationI. Preamble: II. Parties:
I. Preamble: MEMORANDUM OF UNDERSTANDING BETWEEN THE FEDERAL COMMUNICATIONS COMMISSION AND THE FOOD AND DRUG ADMINISTRATION CENTER FOR DEVICES AND RADIOLOGICAL HEALTH The Food and Drug Administration (FDA)
More information14. PCA PROVIDER WRITTEN AGREEMENT (PCA CHOICE OR TRADITIONAL PCA)
14. PCA PROVIDER WRITTEN AGREEMENT (PCA CHOICE OR TRADITIONAL PCA) Agreement between (hereinafter ); Best Home Care, an enrolled PCA provider with the State of Minnesota Roles and Responsibilities As a
More informationProvider Handbook Supplement for the Louisiana Coordinated System of Care
Magellan Healthcare, Inc. Provider Handbook Supplement for the Louisiana Coordinated System of Care Revised March 2017 2016-2017 Magellan Health, Inc. 3/17v2 Magellan Healthcare, Inc. Provider Handbook
More informationApplication Guidelines. Small Business
Application Guidelines Small Business 2013 Community Membership Stream The intention of this funding stream is to support Mississauga First Nation Band members regardless of residency. Who can apply..
More informationLifeBridge Health HIPAA Policy 4. Uses of Protected Health Information for Research
LifeBridge Health HIPAA Policy 4 Uses of Protected Health Information for Research This Policy contains the following Sections: I. Policy II. III. IV. Definitions Applicability Procedures A. Individual
More informationKickStart Venture Services Commercialization Award Program
KickStart Venture Services Commercialization Award Program Request for Applications Description The KickStart Venture Services Commercialization Award Program will provide up to $50K in non-dilutive funding
More informationWritten Financial Policy
2316 South Mason Road Katy, TX 77450 Written Financial Policy Thank you for choosing Cinco Ranch Dental. Our primary mission is to deliver the best and most comprehensive dental care available. An important
More informationCommunity Based Adult Services (CBAS) Manual
Community Based Adult Services (CBAS) Manual Revised October 2016 TABLE OF CONTENTS Policies and Procedures CBAS Initial Assessment and Reassessment... 3 CBAS Authorization Requests... 5 CBAS Claim Procedures...
More informationThe Children's Clinic Patient Information Form
The Children's Clinic Patient Information Form Patient Name: Patient Demographics of Birth: Social Security #: Mother's Name: Parent Demographics Maiden Name: Address: City/Zip: Home Phone #: Alternate
More informationQuality Improvement Work Plan
NEVADA County Behavioral Health Quality Improvement Work Plan Mental Health and Substance Use Disorder Services Fiscal Year 2017-2018 Table of Contents I. Quality Improvement Program Overview...1 A. QI
More informationAn Innovative Approach to Residential Treatment: Shorter Stays & Better Outcomes!
An Innovative Approach to Residential Treatment: Shorter Stays & Better Outcomes! Presented by John Lees, LSW, Child and Adolescent Care Management Supervisor and Pat Hunt, National Director, Child and
More informationQuality Improvement Work Plan
NEVADA County Behavioral Health Quality Improvement Work Plan Fiscal Year 2016-2017 Table of Contents I. Quality Improvement Program Overview...1 A. Quality Improvement Program Characteristics...1 B. Annual
More informationUse And Disclosure Of Protected Health Information (PHI) For Research
Current Status: Pending PolicyStat ID: 2558954 Origination: Last Approved: Last Revised: Next Review: Owner: Policy Area: References: Applicability: N/A N/A N/A 1 year after approval PAIGE ENGLISH: ASSOCIATE
More informationPage 1 CHAPTER 31 SCREENING OUTREACH PROGRAM. 10: Screening process and procedures
Page 1 CHAPTER 31 SCREENING OUTREACH PROGRAM 10:31-2.3 Screening process and procedures (a) The screening process shall involve a thorough assessment of the client and his or her current situation to determine
More informationProvider Frequently Asked Questions (FAQ)
1. What behavioral health services does Magellan of Virginia manage for Virginia Medicaid? Covered Services Magellan is responsible for management of the behavioral health services for the fee-for-service
More informationAPPLICATION FOR REINSTATEMENT OF AN EDUCATOR S LICENSE (PRINT OR TYPE ALL INFORMATION)
FORM 1R REINSTATEMENT MISSISSIPPI DEPARTMENT OF EDUCATION Office of Educator Licensure P. O. Box 771 Jackson, MS 39205-0771 TELEPHONE (601) 359-3483 OFFICE USE ONLY Application Complete / / APPLICATION
More informationIllinois Grant Accountability and Transparency Act Programmatic Risk Assessment Questionnaire
Illinois Grant Accountability and Transparency Act Programmatic Risk Assessment Questionnaire In response to the requirements of 2 CFR 200.205, the awarding agency is required to review the programmatic
More informationRyan White Part A Quality Management
Quality Management Mental Health Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part A grant
More informationMR #: Patient Name: Page: 1 of 4 PROGRESSIVE PHYSICAL THERAPY PATIENT DATA SHEET. May we send you text messages relating to your care with us?
MR #: Patient Name: Page: 1 of 4 PROGRESSIVE PHYSICAL THERAPY PATIENT DATA SHEET First: MI: Last: of Birth: Age: Gender: Male Female Mailing Address: Physical Address: May we send you text messages relating
More informationPlanned Respite Referral Application
Planned Respite Referral Application White Plains, NY 10605 (914) 948-4993 or (914) 564-3749 FAX: (914) 813-4364 Dear Applicant: Thank you for your interest in Planned Respite. Planned Respite is a short-term
More informationUndergraduate Research Support Grant Guidelines
Grant Guidelines Overview The research grant program is intended to support the undertaking of research projects and creative activities performed by undergraduates at Westminster College. Eligibility
More information1/18/2012. SBIRT Protocol: for School Nurses and Other School Staff to Identify Students at Risk for Substance Use Related Problems.
SBIRT Protocol: for School Nurses and Other School Staff to Identify Students at Risk for Substance Use Related Problems. January 2012 INTRODUCTION The Screening, Brief Intervention, and Referral to Treatment
More informationMedical and Scientific Research Grant Policies Eating Disorders Research Grants Program
Medical and Scientific Research Grant Policies 2017 Eating Disorders Research Grants Program The aim of the Klarman Family Foundation s (the Foundation ) Eating Disorders Research Grants Program is to
More informationScholarship Program for Indigenous Students 2018 Application Form. Applicant Information. First Name: Last Name: Prefix: Permanent Address: City:
Applicant Information First Name: Last Name: Prefix: Permanent Address: City: Province / State: Postal Code / Zip Code: Country: Telephone: Email: * How did you hear about this scholarship program? Email
More informationStudy Management PP STANDARD OPERATING PROCEDURE FOR Safeguarding Protected Health Information
PP-501.00 SOP For Safeguarding Protected Health Information Effective date of version: 01 April 2012 Study Management PP 501.00 STANDARD OPERATING PROCEDURE FOR Safeguarding Protected Health Information
More informationModule: Research and HIPAA Privacy Protections ( )
Module: Research and HIPAA Privacy Protections (7-18-11) HIPAA's protections focus on individually identifiable health information HIPAA defines identifiable health information as (1) any form or medium"
More informationMaryland Department of Health and Mental Hygiene Center for Healthy Homes and Community Services Youth Camps. Health Program
Maryland Department of Health and Mental Hygiene Center for Healthy Homes and Community Services Youth Camps Health Program Purpose The purpose of a written health program is to inform camp staff and volunteers
More information2016 Curriculum Innovation Grants
2016 Curriculum Innovation Grants PURPOSE AND SCOPE OF PROGRAM This program supports the creation of new courses needed to keep our disciplinary, interdisciplinary and general education programs current
More informationParental Consent For Minors to Receive Services
Parental Consent For Minors to Receive Services Welcome to the University of San Diego s Wellness Area! We appreciate your coming our way, and look forward to working with you. The following provides important
More informationChild and Family Development and Support Services
Child and Services DEFINITION Child and Services address the needs of the family as a whole and are based in the homes, neighbourhoods, and communities of families who need help promoting positive development,
More informationJump Starters Grant Application Getting Started PROJECT INFORMATION SHEET
Jump Starters Grant Application Getting Started PROJECT INFORMATION SHEET Please answer the following questions about your project. Be honest and complete. You may not know all the answers yet, but we
More informationSUBMITTING A REQUEST FOR REIMBURSEMENT
SUBMITTING A REQUEST FOR REIMBURSEMENT This guide is the property of Strategies to End Homelessness, Inc. and contains confidential and proprietary information. It may not be reproduced, in whole or in
More informationThe Gulf Coast Center IDD SERVICES HANDBOOK. The goal of this book is to provide individuals and their families with information on:
The Gulf Coast Center IDD SERVICES HANDBOOK The goal of this book is to provide individuals and their families with information on: 1. The services we offer 2. The responsibilities of a. Individuals and/or
More informationTHE JOURNEY FROM PHI TO RHI: USING CLINICAL DATA IN RESEARCH
THE JOURNEY FROM PHI TO RHI: USING CLINICAL DATA IN RESEARCH Helenemarie Blake, Esq. Chief Privacy Officer, Interim Office of HIPAA & Privacy Security August 2016 SCENARIO You are putting a study together
More informationA SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS
A SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS This tool is intended to provide a broad overview of common Medicaid (MA) requirements in relation to COA s Standards. While there are specific
More informationPCA CHOICE TRATIIONAL PCA
11. PCA PROVIDER WRITTEN AGREEMENT PCA CHOICE TRATIIONAL PCA Agreement between Best Home Care, an enrolled PCA provider with the State of Minnesota (hereinafter Consumer ); Consumer Roles and Responsibilities
More informationInstitutional Review Board (previously referred to as Human Participants Research Board) Updated January 2004
Institutional Review Board (previously referred to as Human Participants Research Board) Updated January 2004 All research requests meeting the following conditions must be reviewed by the Institutional
More informationNew York Notice Form Notice of Psychologists Policies and Practices to Protect the Privacy of Your Health Information
New York Notice Form Notice of Psychologists Policies and Practices to Protect the Privacy of Your Health Information THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
More informationFederal Occupational Health (FOH) Employee Assistance Program
Federal Occupational Health (FOH) Employee Assistance Program Introduction Federal Occupational Health (FOH), an agency within the Department of Health and Human Services (HHS), contracts with Magellan
More informationPatient Name: Date of Birth:
: Patient Agreement Welcome to Community Psychiatry Community Psychiatry s dedicated providers and staff are committed to ensuring that each and every patient receives the highest quality psychiatry services
More informationMACOMB COUNTY COMMUNITY MENTAL HEALTH ACKNOWLEDGMENT AND CONSENT FORM
MACOMB COUNTY COMMUNITY MENTAL HEALTH ACKNOWLEDGMENT AND CONSENT FORM IDENTIFYING INFORMATION PROVIDED INFORMATION Consumer was provided with the following information: Membership Information 1. MCCMH
More informationARTIST MENTOR GRANT FUNDED BY: LRAC GRANT PROGRAM (FY19) GRANT GUIDELINES AND APPLICATION INSTRUCTIONS
1 2017-2018 LRAC GRANT PROGRAM (FY19) GRANT GUIDELINES AND APPLICATION INSTRUCTIONS ARTIST MENTOR GRANT LRAC4.org LRAC welcomes your questions about eligibility, grant programs, and application support
More informationGreen Fund Application
2011-2012 Green Fund Application Office of Sustainability Stanford University 2011-2012 Green Fund Application for Grant Cycle 2011-2012 (4 th year) An initiative of Office of Sustainability and Sustainable
More informationAcknowledgement of Receipt of Notice of Privacy Practices
HIPAA PRIVACY FORM 2 Acknowledgement of Receipt of Notice of Privacy Practices Purpose: This form is used to obtain acknowledgement of receipt of our Notice of Privacy Practices or to document our good
More informationDISCLOSURE AND POLICY STATEMENT
ERIN A. BEASLEY, Ph.D. Licensed Child & Adolescent Psychologist (206) 661-3199 DISCLOSURE AND POLICY STATEMENT PLEASE READ AND SIGN Welcome to my practice. I am pleased to have the opportunity to work
More informationGUIDELINES FOR THE IMPERIAL COUNTY COMMUNITY BENEFIT PROGRAM
GUIDELINES FOR THE IMPERIAL COUNTY COMMUNITY BENEFIT PROGRAM The following are general rules for the Community Benefit. The Board of Supervisors reserves the right to reject any or all Applications, waive
More informationAdvantages of Southeast AR, Inc. Job Description
Title: Waiver Program Specialist Management Team Member Department: Administration Reports To: Assistant Director FLSA Status: Salaried/Exempt Annuity Class: Administrative Supervises: Waiver Direct Support
More information12057 Jefferson Blvd LA, CA (323)
Playa Vista Mental Health General Adult and Women s Psychiatry 12057 Jefferson Blvd LA, CA 90230 (323) 813-6218 Please read and complete each of the sections listed below as completely as possible. NEW
More informationHOME CARE PACKAGES. INFORMATION BOOKLET Consumer Directed Care. To be read in conjunction with the Home Care Agreement
HOME CARE PACKAGES INFORMATION BOOKLET Consumer Directed Care To be read in conjunction with the Home Care Agreement TABLE OF CONTENTS Prahran Mission Home Care Package... 3 Budget & Statement, Fees...
More informationINFORMED CONSENT FOR TREATMENT
INFORMED CONSENT FOR TREATMENT I (name of patient), agree and consent to participate in behavioral health care services offered and provided at/by Children s Respite Care Center, a behavioral health care
More informationHIPAA Policies and Procedures Manual
UNIVERSITY of NORTH CAROLINA at CHAPEL HILL SCHOOL of NURSING HIPAA Policies and Procedures Manual November 2015 1 Table of Contents I. INTRODUCTION... 3 A. GENERAL POLICY... 3 B. SCOPE... 3 II. DEFINITIONS...
More informationProvider Orientation to Williams Class Reporting
Provider Orientation to Williams Class Reporting Registration Assertive Community Treatment (ACT) Permanent Supportive Housing (PSH) Transition Coordination Comprehensive Service Planning 09-29-2014 1
More informationPRESCRIBED PEDIATRIC EXTENDED CARE CENTERS CSHCN SERVICES PROGRAM PROVIDER MANUAL
PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS CSHCN SERVICES PROGRAM PROVIDER MANUAL SEPTEMBER 2018 CSHCN PROVIDER PROCEDURES MANUAL SEPTEMBER 2018 PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS Table of Contents
More informationCCF RESEARCH GRANT APPLICATION 2017 REQUIREMENTS & GUIDELINES
CCF RESEARCH GRANT APPLICATION 2017 REQUIREMENTS & GUIDELINES The Children s Cardiomyopathy Foundation (CCF) s Research Grant Program has a two- step application process. A letter of intent is required
More informationFlorida Medicaid. Home Health Visit Services Coverage Policy
Florida Medicaid Home Health Visit Services Coverage Policy Agency for Health Care Administration November 2016 Table of Contents Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions...
More informationAPPLICATION FORM CONOCOPHILLIPS CANADA CENTENNIAL SCHOLARSHIP PROGRAM
APPLICATION FORM Administered by Universities Canada 1. APPLICANT INFORMATION Name Mr. Ms. Address Street Apt. 2. GUIDELINES City Province Postal Code Email* * Mandatory: Universities Canada will use your
More informationDESCRIPTION OF THE AWARD ELIGIBILITY AWARD EXPENDITURES AND START DATE
Call for Applications Center for Educational Innovation and Scholarship Medical Education Pilot Grant Awards Due monthly: by the first Wednesday of the month DESCRIPTION OF THE AWARD The Center for Educational
More informationAcknowledgement of Notice of Privacy Practices
OMEGA HEIGHTS FAMILY MEDICINE CLINIC Acknowledgement of Notice of Privacy Practices I have been presented with a copy of the Notice of Privacy Practices for Omega Heights Family Medicine Clinic, detailing
More informationFirst Nation Member s Recreation Grant. Application deadline: October 31, 2017
2017 Photo courtesy of the Northern Sport, Culture & Recreation District Application deadline: October 31, 2017 First Nation Member s The SPRA First Nation Member s Recreation Grant assists First Nation
More informationWeber Family Chiropractic PC Patient Right to Request Restrictions on Use and Disclosure of Health Information
Weber Family Chiropractic PC Patient Right to Request Restrictions on Use and Disclosure of Health Information Policy No.: 6 Issue Date: 04/14/03 Revision Date: 10/01/2013 Approvals: Dr. Scott Weber Title:
More informationMasonic Support - Grants Appeal & Complaints Policy and Process
Masonic Support - Grants Appeal & Complaints Policy and Process Contents 1. Overview... 3 2. Complaints and Appeals Policy... 3 2.1 Policy on Rights... 4 2.2 Data Protection... 4 2.3 Supporting Freemasons
More informationIowa Family Support Standards Presented by the Iowa Department of Public Health, Bureau of Family Health
Iowa Family Support Standards Presented by the Iowa Department of Public Health, Bureau of Family Health In partnership with: Early Childhood Iowa Early Childhood Comprehensive Systems Grant, Quality Services
More informationAPPLICATION FORM FESSENDEN-TROTT SCHOLARSHIPS
Administered by Universities Canada 1. APPLICANT INFORMATION Name Mr. Ms. Permanent Address Street Apt. City Province Postal Code Email* * Mandatory: Universities Canada will use your email as point of
More informationState of Montana. Department of Public Health and Human Services CHILDREN S MENTAL HEALTH BUREAU PROVIDER MANUAL AND CLINICAL GUIDELINES
State of Montana Department of Public Health and Human Services CHILDREN S MENTAL HEALTH BUREAU PROVIDER MANUAL AND CLINICAL GUIDELINES FOR UTILIZATION MANAGEMENT October 1, 2012 Children s Mental Health
More informationRequest for Expression of Ideas for Resource Mobilization for Education in Emergencies and Protracted Crises
ECW Resource Mobilization Challenge Submit your idea at educationcannotwait.org/challenge Request for Expression of Ideas for Resource Mobilization for Education in Emergencies and Protracted Crises A.
More informationCombined federal Campaign (CFC) Adventure Works: The ultimate source for outdoor equipment
Combined federal Campaign (CFC) Adventure Works: The ultimate source for outdoor equipment 1 What are AIM-IRS CFC operating guidelines? National AIM-IRS Combined Federal Campaign (CFC) Operating Guidelines
More informationState of Alaska Department of Health and Social Services. Behavioral Health Inpatient Psychiatric Review Provider Manual
State of Alaska Department of Health and Social Services Behavioral Health Inpatient Psychiatric Review Provider Manual Revised October 2015 Alaska Medicaid Inpatient Psychiatric Review Provider ManualTable
More informationAssociated Pediatric Dentistry Belleville, Edwardsville, O Fallon, IL
Associated Pediatric Dentistry Belleville, Edwardsville, O Fallon, IL Patient Name: DOB: ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES AND CONSENT **You May Refuse to Sign This Consent Acknowledgement**
More informationJune 23, Dear Ms. Moreland:
June 23, 2016 Ms. Kim Moreland Director of Research and Sponsored Programs University of Wisconsin, Madison 21 N. Park Street, Suite 6401 Madison, WI 53715-1218 Dear Ms. Moreland: The Damon Runyon Cancer
More information