Provider Forms and Materials

Nursing Homes

Nursing Home Bed Hold Request (Electronic)

Nursing Home Bed Hold Request (Paper)

Instructions For Member HIPPS Notification Form

Member HIPPS Notification Form

Current Contract Addenda

Adult Day Care

Assistive Technology

Community Support Program

Community Supported Living

Competitive Integrated Employment (CIE) Exploration

Consultative Clinical and Therapeutic Services for Caregivers

Consumer Directed Support Broker Services

Consumer Education and Training

Counseling and Therapeutic Resources

Daily Living Skills Training

Day Habilitation Services (Day Services)

Environmental Accessibility Adaptations (Home Modifications)

Financial Management Services – Representative Payee

Financial Management Services (SDS)

Home Delivered Meals

Home Health Agency

Housing Counseling

Mental Health & Alcohol and Drug Abuse Services

Nursing Home

Personal Emergency Response System (PERS)

Prevocational Services

Private Duty Nursing

Remote Monitoring

Residential Services – Certified Adult Family Home

Residential Services – Community-Based Residential Facility

Residential Services – Licensed Adult Family Home

Residential Services – Residential Care Apartment Complex

Respite

Supported Employment – Individual

Supported Employment – Small Group

Supportive Home Care

Training Services for Unpaid Caregivers

Transportation

Vehicle Modifications

Vocational Futures Planning and Support

Provider Portal

DataClarity User Guide

Service Contract

LCI Service Provider Contract

LCI Encryption User Guide

Attachment 1: Rates and Service Code Chart

Attachment 2: Appeals and Grievance Policy

Attachment 3: Member Use of Personal Resources

Attachment 4: HIPAA

Attachment 5: Insurance Minimum Requirements

Restrictive Measures

Restrictive Measures Policy and Procedure

DHS Restrictive Measures Guidelines and Standards

Member Rights and Responsibilities

Member Rights and Responsibilities Policy

Health and Wellness

Annual Wellness Handbook

WPS Forms and Claims Information

FAMC CLTS General Claim Submission Requirements

WPS Electronic Data Services External Access Request Form

WPS Corrected Claim Form

Corrected Claim Form Tip Sheet

Family Care Claim Submission Tips

Family Care Claim Form Outline