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
Program Instruction – 2013 Home Care Program Cost Sharing Tables
Document Abstract: This Program Instruction (PI) transmits the Financial Eligibility Guidelines that took effect February 1, 2013, for the Home Care Program and sets out the voluntary co-payment, cost sharing, and the Respite Care co-payment schedules. Revised Co-payment and Cost Sharing Schedule: Elder Affairs implemented co-payment and cost share increases effective February 1, 2013. This […]
Revised Cost Share Table for the Home Care Program
This Program Instruction (PI) transmits the Financial Eligability Guidelines that take effect on Februry 1, 2014 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 PI-14-02 Revised Cost Share Table for the Home Care […]
Clinical Assessment and Eligibility Program: Best Practices Guide and Appendix
The information contained within the guide is the be used by professionals working within the ASAP and is to serve as a guide and reference only. The information contained within the guide is only current as of November 2014. The most current regulations, program instructions, and information memorandums should be adhered to at all times Click […]
Requirements for Comprehensive Screening and Service Model Activities (CSSM)
The purpose of this Program Instruction is to issue requirements for Aging Services Access Points (ASAPs) in the performance of Comprhensive Screening and Services Model (CSSM) program related activities. This Program Instruction requires all ASAPs to adopt a specified management and staffing model and protocols to perform CSSM-related activities.
Review of Pre-Admission Screen & Record Review – PASRR Requirements prior to Authorization of MAssHealth Pmt. of NF Services
The purpose of this Program Instruction is to clearly delineate the practice for PASRR documentation review by ASAP Clinical Assessment Eligability (CAE) staff when approving pre-admission and post admission assessments in NF. This is being presented in order to improve NF compliance with PASRR to prevent inappropriate NF admissions for those indivduals with a diagnosis […]