The operational protocol manual describing the eligibility criteria, services and program procedures to assist individuals, case managers and service providers in planning and managing services for the highest and high needs individuals.

Highest & High Needs Manual

Choices for Care 1115 Highest & High Needs Manual - Cover Page

• Cover Page

Choices for Care 1115 Highest & High Needs Manual - Preface

• Preface

Choices for Care 1115 Highest & High Needs Manual - Glossary of Terms

• Glossary of Terms

Choices for Care 1115 Highest & High Needs Manual - Table of Content

• Section I: General Policies
• Section II: Eligibility
• Section III: Universal Provider Qualifications & Standards
• Section IV: Services
• Section IV: Services - 1. Case Management Services
• Section IV: Services - 2. Adult Day Services
• Section IV: Services - 3. Personal Care Services
• Section IV: Services - 4. Respite Care Services
• Section IV: Services - 5. Companion Services
• Section IV: Services - 6. Assistive Devices & Home Modifications
• Section IV: Services - 7. Personal Emergency Response System
• Section IV: Services - 8. Enhanced Residential Care
• Section IV: Services - 9. Nursing Facility
• Section IV: Services - 10. Live-in Care
• Section IV: Services - 11. Program for all-inclusive Care for the Elderly (PACE)
• Section IV: Services - 12. Flexible Choices Pilot
• Section V: Procedures
• Section V: Procedures - 1. Application & Eligibility Determination Procedures
• Section V: Procedures - 2. Waiting List Procedures
• Section V: Procedures - 3. Initial Assessment & Reassessment Procedures
• Section V: Procedures - 4. Monitoring Procedures
• Section V: Procedures - 5. Changes & Start Date Procedures
• Section V: Procedures - 6. Initiating Services Procedures
• Section V: Procedures - 7. Denial & Termination Procedures
• Section V: Procedures - 8. Notices, Variances & Appeals Procedures
• Section V: Procedures - 9. Utilization Review Procedures
• Section V: Procedures - 10. Enrollment & Billing Procedures
• Section V: Procedures - 11. Informed Consent & Negotiated Risk Procedures
• Section V: Procedures - 12. Medicare Advocacy Project (MAP) Procedures
• Section V: Procedures - 13. Complaints
• Section VI: Assessment Tools
• Section VII: Forms