confidentiality; adapt to a variety of situations; and respect and accept different values, nationalities, races, religions, cultures and standards of living. Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Grocery Shopping ASAPs Every 3 years and Delivery Provider Agencies Service Specification Service Type: ☐ Statutory ☐ Extended State Plan Other Service Name: Home Based Wandering Response Systems ☐ Service is included in approved waiver. There is no change in service specifications. Service is included in approved waiver. The service specifications have been modified. ☐ Service is not included in approved waiver. Service Definition (Scope): Home Based Wandering Response Systems are communication alert systems for participants at risk for wandering. Participants are outfitted with a device that transmits signals using technology such as GPS or radio frequency. The service includes 24/7 emergency response and location assistance in the event the participant wanders. Specify applicable (if any) limits on the amount, frequency, or duration of this service: Service Delivery Participant-directed as specified in Appendix E Provider Method managed (check each that applies): Specify whether the service may be Legally Responsible Relative Legal Guardian provided by Person (check each that applies): Provider Specifications Provider Individual. List types: Agency. List the types of agencies: Category(s) Home Based Wandering Response Provider (check one or Agencies both): Provider Qualifications Provider Type: License Certificate Other Standard (specify) (specify) (specify) Home Based Education, Training, Supervision: Wandering Providers must ensure effective training of Response staff members in all aspects of their job
confidentiality; adapt to a variety of situations; and respect and accept different values, nationalities, races, religions, cultures and standards of living. Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Grocery Shopping and Delivery Provider Agencies ASAPs Every 3 years Service Specification Service Type: ☐ Statutory ☐ Extended State Plan Other Service Name: Home Based Wandering Response Systems ☐ Service is included in approved waiver. There is no change in service specifications. Service is included in approved waiver. The service specifications have been modified. ☐ Service is not included in approved waiver. Service Definition (Scope): Home Based Wandering Response Systems are communication alert systems for participants at risk for wandering. Participants are outfitted with a device that transmits signals using technology such as GPS or radio frequency. The service includes 24/7 emergency response and location assistance in the event the participant wanders. Specify applicable (if any) limits on the amount, frequency, or duration of this service: Service Delivery Method (check each that applies): Participant-directed as specified in Appendix E Provider managed Specify whether the service may be provided by (check each that applies): Legally Responsible Person Relative Legal Guardian Provider Specifications Provider Category(s) (check one or both): Individual. List types: Agency. List the types of agencies: Home Based Wandering Response Provider Agencies Provider Qualifications Provider Type: License (specify) Certificate (specify) Other Standard (specify) Home Based Wandering Response Education, Training, Supervision: Providers must ensure effective training of staff members in all aspects of their job
few-renewal-application-draft-2018.docx