DD Waiver
CADI Waiver
Waiver Misc.
Forms
Benton County
100

Case Management rate per unit

What is $23.19?

100

Case Management rate per unit

What is 24.47?

100

The function button that gets you the heck outta there

What is F6?

100

The form we complete when a person moves

What is My Move Plan?

100

Mailing Address

What is P.O. Box 740, Foley, MN 56329?

200

Devices or equipment to improve a persons ability to communicate, perform ADL's or access their environment

What is Assistive Technology? 

200

Service that includes pest control

What is chore service?

200

The waiver Bible

What is the CBSM?

200

The form that needs to filled out when clients move into a GRH setting

What is the Combined Application Form? 

200

Fraud Prevention Specialist at Benton County

Who is Andrew Toenjes?

300

Largest service provider for day supports in Central MN

What is Wacosa? 

300

Maximum amount for supplies and equipment per day

What is $10,000?

300

Number of days before an initial Mn Choice assessment expires

What is 60 days?

300

Form used to communicate with the financial unit 

What is the DHS 5181?

300

Benton County Sherriff 

Who is Troy Heck? 

400

This screening must happen prior to a MN certified Nursing Facility if a person has a developmental disability

What is OBRA Level 1 Screening? 

400

4 word acronym for CADI waiver

What is Community Access for Disability Inclusion? 

400

Stearns County CFR Number

What is 073?

400

Form 2828B Name 

What is the Notice of Action?

400

Benton County Human Services intake phone number 

What is 320-968-5087?

500

Diagnosis code for Unspecified DD for kids under 5 (Rule 185 Eligibility)  

What is F79?

500

Assessment results for a death

What is 24?

500

The year Home and Community Based waiver services started 

What is 1981?

500

Form used for MCOS Recommendation for state plan home care services 

What is the DHS 5841?

500

Infection Diseases, Birth Defects/Hearing Loss, Immunization Records and WIC public health nurse

Who is Marnie Hanratty?

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