Part II, Question 4 Complete the following table for each LTSS contract you entered into within the last five (5) years. Limit your response to two (2) pages inclusive of the table. Contract No. of Services Performed State: Performance Call Program Parent Organization: Telephonic Face Development Plan/Service Monitoring Service Affiliates: Center for Assessments Subsidiaries: Appeals Specify: Other. Eligibility Eligibility Plan Trade Name: Planning Operations Screening Duration: of Delivery of of Number of Individuals Served: Face Care Care Populations Served (describe): and for to Contract Monitor Name: Contract Monitor Contact Information: Name and Contact Information for other reference: Brief description of work including the name(s) and role of any major subcontractor(s):
Part II, Question 4 Complete the following table for each LTSS contract you entered into within the last five (5) years. Limit your response to two (2) pages inclusive of the table. Contract No. of Services Performed State: Parent Organization: Affiliates: Subsidiaries: Trade Name: Duration: Number of Individuals Served: Populations Served (describe): Contract Monitor Name: Contract Monitor Contact Information: Name and Contact Information for other reference: Call Center Operations Telephonic Screening for Eligibility Performance of Face to Face Assessments for Program Eligibility and Service Planning Development of Care Plan Monitoring of Care Plan/Service Delivery Appeals Other. Specify: Brief description of work including the name(s) and role of any major subcontractor(s):