Document Library

PASRR PI-18-04 and Related Documents

Download Attachment 1 PASRR-L1 (10-16-18) - for providers

Download PASRR Issuance of LOC

Download Attachment 3 PASRR Non-Compliance Form (fillable)

Download Attachment 2 Notification of referral for PASRR II - template letter_FINAL

Download Department of Mental Health Referral l Source Fax Cover Sheet

Download Nf-141-bulletin

Download PI-18-04 Revision of PASRR Requirements

 

Consumer Directed Care Program Instruction and supporting documents

Program Instruction (PI) transmits the Executive Office of Elder Affairs guidelines for the operation of the Consumer Directed Care option within: Home Care Basic Non-Waiver Program, Home Care Over Income Program, Respite Over Income Program and Enhanced Community Option Program (ECOP).

Download PI-18-02 Consumer Directed Care without Sign-off

Download ASAP-Consumer Agreement 5-2018

Download CDC CORI Form

Download CDC Eligibility form

Download CDC Employer Service Agreement 7-2009

Download CDC handbook 5-2018

Download Consumer-Worker Agreement 5-9-18

Download CORI regulations

Home Care Program Notice of Ineligibility

Word Document: Download HCP-6_Notice of Ineligibility updated 4-26-18 PDF Document: Download HCP-6_Notice of Ineligibility updated 4-26-18

2015 Financial Eligibility Guidelines

This Program Instruction (PI) transmits the Financial Eligibility Guidelines that take effect on February 10, 2015 for the Home Care Program, and sets out the voluntary co-payment, cost sharing, and Respite Care co-payment schedules. Please click the link below for the actual guide and schedule.

Download Cost Share Table for the Home Care program 2015

Financial Worksheet

Below is a link to a Microsoft Word document of the consumer Financial Worksheet that should be used for determining program eligability.

Download Financial Worksheet 4-2014

Applicant Consent and Disclosure Form

The link below is for a Microsoft Word document to be used by ASAPs to aquire the appropriate level of consumer information consent and disclosure.

Download EOEA Applicant Consent and Disclosure Form (2)

Notification of Non-Participation

The link below is a Microsoft Word document that contains the appropriate text for a notice of non-participation in the Home and Community-Based Services Waiver Program.

Download Notification of Non-Participation revised 12-10-13

Recipient Choice Letter

The link below is a Microsoft Word document that contains the appropriate language to be included in a Recipient Choice Letter.

Download Recipient Choice Form

Medicaid Intent to Refer Letter

The link below is a Microsoft Word document with the text to be included in a letter of referral to Medicaid.

Download Intent to Refer Revised 12 11 2013

Translated Home Care Forms: Chinese Khmer Portuguese

Author: Elder Affairs

Keywords: Forms,Translated

File: Download Chinese-khmer-portuguese

Converted from ColdFusion Document Library, December 2010