Document Library and Checklists

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Document Library and Checklists

Agency Application
Agency with Choice Assurance Form
Agency with Choice FAQs
Agency with Choice Memo
Assurance Agreement-Agency
Assurance Agreement-IHS 2 and IHS 3
Assurance Agreement-Individual Practitioner Clinical Behavioral Consultant
Assurance Agreement-Individual Practitioner Healthcare Coordination
Assurance Agreement-Remote Supports
Assurance Agreement-Subcontracted Nursing Agency
Clinical Behavioral Consultant Requirements
Connecticut Criminal History Record Request Form
Connecticut State Police website
Confidentiality and HIPAA Assurance Agreement
Criminal Background Verification Certificate for a Change in Principal of the Entity, Connecticut Administrator, Partnership or LLC

DDS Policy and Procedures
False Claims Act Acknowledgement of Receipt
False Claims Act FAQ Attachment A
False Claims Act Policy
False Claims Act Procedure
False Claims Act Report Form
HCBS Waiver Manual
Healthcare Coordination Requirements
Individual Practitioner Application
Parenting Support Service Requirements Checklist
Peer to Peer Support

Policy Requirements Based on Support Level

Provider Agreement

Provider Minimum Qualifications

Provider Profile Correction Form

Provider Profile Correction Form - Towns
Qualifications for Agencies to Subcontract for Nursing Services

Similarities and Differences in services through Individual Budgets and POS Contract

Waiver Services Home Page

Checklists

Agency Qualified Provider Checklist
Clinical Behavioral Consultant Checklist
Healthcare Coordination Checklist
Individual Qualified Provider Checklist
Subcontracting for Nursing Supports Checklist

Training Materials

Provider Orientation Overview (PowerPoint Presentation)

Videos:
Review Processes

Quality Improvement - Continuous Quality Improvement Plans - Enhanced Monitoring

Resource Administration

** Video Sign-off Sheet**