Age 21, meets medical financial eligibility, and meets MN to level of meeting institutional requirements.
What are the eligibility requirements for Waiver Services?
100
720 hours or 30 days per year.
What is yearly limit on respite services?
100
This form is documented in a PDF format and a Trucare format.
What is the 1700-1?
100
2065D.
What is the form that comes from TMHP and approves waiver svs, includes the RUG level, and the SOC date?
100
Upgrade trigger note.
What is the note the SC does in Trucare when a member is noted to have a MNLOC trigger?
200
PAS and DAHS and some DME.
What are the non -waiver services available to Waiver members?
200
This is only available if the member lives with someone.
What is Protective Supervision?
200
This form is signed to acknowledge Freedom of Choice and agreement with the ISP thus requiring 2 signatures from the member.
What is 1700-2?
200
ISP.
What is other name used for the 1700-1 form?
200
RN and RUG certified.
What is the requirement for an SC to do the MNLOC documentation ?
300
Only this member is provided PAS as a Waiver benefit.
What is MAO's PAS benefit ?
300
This service requires three BIDS and must be necessary due to a medical condition.
What is MHM?
300
This form lists the information on the MD, DME, HHA, and any community resources being utilized.
What is 1700-B?
300
8001.
What is form number for MERP?
300
This is determined by the TMHP.
What is MNLOC approval?
400
It is the difference between a surgical incision and a complicated pressure ulcer.
What is long term nursing vs. acute nursing care.
400
This waiver benefit is only available one time to assist the member to move back into the community.
What is TAS?
400
The member cannot sign this form on the day of assessment - only after services have been delivered.
What is 1700A-1?
400
MNLOC.
What is the assessment that determines Medical Necessity to the level of institutional care?
400
The member is removed from Star Plus benefits.
What is consequence when an MAO member loses waiver?
500
A copay is usually required.
What is a MAO member's additional requirement when receiving AL or AFC waiver services?
500
These are the 2 waiver benefits that provide 24 hour care.
What is AL and AFC?
500
1700-A documents this information.
What is the form that documents the unmet waiver need and the rationale for that service?
500
2067.
What is the communication form used by providers and MCO's?
500
This form is always presented at the initial assessment for NMNLOC and at the annual reassessment if not found in Trucare documentation. It only has 4 questions on it.