FAIR
- FAIR Policy Manual (updated 4/1/19)
- Attachment 1 — Confidentiality Agreement–Board Member, Instructions
- Attachment 2 — Confidentiality Agreement–Employees and Volunteers, Instructions
- Attachment 3 — SAEF (updated 9/14/21), Instructions (3/15/18)
- Attachment 4 — Rights and Responsibilities Form (updated 4/1/19), Instructions
- Attachment 5 — Rights and Responsibilities Posting (updated 4/1/19), Instructions
- Attachment 6 — Denial/Reduction on Services Letter (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 7 — Grievance Procedures Form (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 8 — Grievance Procedures Posting (updated 4/1/19), Instructions
- Attachment 9 — Personal Conduct Policy Form and Posting (updated 4/1/19); Form with Signature (updated 4/1/19), Instructions
- Attachment 10 — Board Certification, Instructions
- Attachment 11 — State Cost Share Chart (updated 2/1/24)
- Attachment 12 — FAIR State Cost Share Invoice, Instructions
- Attachment 13 — FAIR Cost Share Accountability Form (updated 7/6/21), Instructions
- Attachment 14 — Activity Plan (updated 11/5/15), Instructions
- Attachment 15 — FAIR Congregate Respite Guidelines (updated 12/3/15)
- Attachment 16 — FAIR Sample Letter to Physician (updated 11/23/15), Instructions
- Attachment 17 — FAIR Job Description Congregate
- Attachment 18 — FAIR Job Description In-Home
- Attachment 19 — Personal History (updated 11/9/15), Instructions
- Attachment 20 — FAIR Service Recipient Responsibility Agreement–Congregate, Instructions
- Attachment 21 — FAIRService Recipient Responsibility Agreement–In-Home, Instructions
- Attachment 22 — FAIR Worker Notes (updated 11/23/15), Instructions (updated 11/23/15)
- Attachment 23 — FAIR Supplemental Service Recording Log (added 11/23/15), Instructions (added 11/23/15)
In-Home Fiscal Forms
Lighthouse
- Lighthouse Policy Manual (updated 1/5/21)
- Attachment 1 — Confidentiality Agreement–Board Member, Instructions
- Attachment 2 — Confidentiality Agreement–Employees and Volunteers, Instructions
- Attachment 3 — SAEF (updated 9/14/21), Instructions (3/15/18)
- Attachment 4 — Rights and Responsibilities Form (updated 4/1/19), Instructions
- Attachment 5 — Rights and Responsibilities Posting (updated 4/1/19), Instructions
- Attachment 6 — Denial/Reduction of Services Letter (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 7 — Grievance Procedures Form (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 8 — Grievance Procedures Posting (updated 4/1/19), Instructions
- Attachment 9 — Personal Conduct Policy Form and Posting (updated 4/1/19); Form with Signature (updated 4/1/19), Instructions
- Attachment 10 — Board Certification, Instructions
- Attachment 11 — State Cost Share Chart (updated 2/1/24)
- Attachment 12 — Lighthouse State Cost Share Invoice, Instructions
- Attachment 13 — Lighthouse Cost Share Accountability Form (updated 7/6/21), Instructions
- Attachment 14 — Lighthouse RN Assessment (updated 11/5/15), Instructions
- Attachment 15 — Lighthouse Plan of Care (updated 11/13/18), Instructions
- Attachment 16 — Lighthouse Eligibility Determination Form (updated 11/13/18), Instructions
- Attachment 17 — Lighthouse Six-Month Call Log, Instructions
- Attachment 18 — Lighthouse Direct Care Worker Log, Instructions
- Billing Worksheet (added 12/29/15)
- Direct Care Worker Monitoring Tool (updated 8/15/17)
- Program Monitoring Tool (updated 8/15/17)
- Desktop Review Forms (updated 11/13/18)
Medicaid Aged and Disabled Waiver
- Incident Management – managing risk or potential of risk of health and safety of Aged and Disabled Waiver clients
- Monitoring Tools - for use by the Bureau's nurse monitors
- Quality Assurance Documents
- Risk Management
- Certification Affidavit and Continuing Certification Review
Medicaid Personal Care
Older Americans Act
- Older Americans Act – 2020 Authorization
- Recommended and Approved Nutrition Education Resources for AAA Meal Programs (added 1/28/16)
- Older Americans Act Title III Services Policy Manual (effective 10/1/2015; updated 11/1/19)
- Attachment 1 — Confidentiality Agreement–Board Member, Instructions
- Attachment 2 — Confidentiality Agreement–Employees and Volunteers, Instructions
- Attachment 3 — SAEF (updated 9/14/21), Instructions (3/15/18)
- Attachment 4 — Rights and Responsibilities Form (updated 4/1/19), Instructions
- Attachment 5 — Rights and Responsibilities Posting (updated 4/1/19), Instruction
- Attachment 6 — Denial/Reduction of Services Letter (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 7 — Grievance Procedures Form (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 8 — Grievance Procedures Posting (updated 4/1/19), Instructions
- Attachment 9 — Personal Conduct Policy Form and Posting (updated 4/1/19); Form with Signature (updated 4/1/19), Instructions
- Attachment 10 — Board Certification, Instructions
- Attachment 11 — Federal Cost Share Chart (updated 2/1/24)
- Attachment 12 — Federal State Cost Share Initial Notification (updated 1/9/17), Instructions
- Attachment 13 — Federal Cost Share Monthly Statement (updated 1/9/17), Instructions
- Attachment 14 — Federal Cost Share Accountability Form (updated 4/1/16), Instructions
- Attachment 15 — Personal History (updated 11/9/15), Instructions
- Attachment 16 — Activity Plan (updated 11/5/15), Instructions
- Attachment 17 — Homemaker Plan of Care and Service Worksheet, Instructions
- Attachment 18 — Chore Plan of Care and Service Worksheet, Instructions
- Attachment 19 — Personal Care Plan of Care and Service Worksheet, Instructions
- Attachment 20 — Initial/Annual Home-Delivered Meals Assessment (updated 4/1/19), Instructions (updated 4/1/19)
- Attachment 21 — Title III-E Worker Notes (added 11/23/15), Instructions (added 11/23/15)
- Attachment 22 — Title III-E Supplemental Service Reporting Log (added 11/23/15), Instructions (added 11/23/15)
- III-D COVID-19 Remote Programs Policy (12/4/20)
- Title III Monitoring Tools (added 6/16/16)
SAMS Assistance
Updated 2/15/24