Support (Personal Care) (b)(3) Waiver Peer Support (b)(3) Waiver Respite I/DD Supported Employment Services Long-term Vocational Supports MH/SA Supported Employment Services (non-Medicaid-funded) I/DD Non-Medicaid-funded Personal Care Services I/DD Non-Medicaid-funded Respite Community Services I/DD Non-Medicaid-funded Respite Hourly Services not in a licensed facility Developmental Therapies (non-Medicaid-funded) Medicaid-funded services exceptions Are exceptions for any Medicaid-funded community/mobile service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes _______, please list. No ________ If the access and choice data is not at 100% for any Medicaid-funded community/mobile service, are exception requests included with the 2017 gaps report? Yes _______, please list. No _______, please explain. Non-Medicaid-funded services exceptions Are exceptions for any non-Medicaid-funded community/mobile service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes _______, please list. No ________ If the access and choice data is not at 100% for any non-Medicaid-funded community/mobile service, are exception requests included with the 2017 gaps report? Yes _______, please list. No _______, please explain. Crisis Services Crisis services access and choice data Medicaid-funded services standard 100% of eligible individuals must have access within the LME/MCO catchment area to at least one provider agency for each crisis service. Medicaid-funded services instructions
Support (Personal Care) (b)(3) Waiver Peer Support (b)(3) Waiver Respite I/DD Supported Employment Services Long-term Vocational Supports MH/SA Supported Employment Services (non-Medicaid-funded) I/DD Non-Medicaid-funded Personal Care Services I/DD Non-Medicaid-funded Respite Community Services I/DD Non-Medicaid-funded Respite Hourly Services not in a licensed facility Developmental Therapies (non-Medicaid-funded) Medicaid-funded services exceptions Are exceptions for any Medicaid-funded community/mobile service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes _______, please list. No ________ If the access and choice data is not at 100% for any Medicaid-funded community/mobile service, are exception requests included with the 2017 gaps report? Yes _______, please list. No _______, please explain. Non-Medicaid-funded services exceptions Are exceptions for any non-Medicaid-funded community/mobile service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes _______, please list. No ________ If the access and choice data is not at 100% for any non-Medicaid-funded community/mobile service, are exception requests included with the 2017 gaps report? Yes _______, please list. No _______, please explain. Crisis Services Crisis services access and choice data Medicaid-funded services standard 100% of eligible individuals must have access within the LME/MCO catchment area to at least one provider agency for each crisis service. Medicaid-funded services instructions
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