Service Delivery Method Participant-directed as specified in Appendix E X Provider managed (check each that applies): Specify whether the service may Legally Relative Legal Guardian be provided by Responsible (check each that Person applies): Provider Specifications Provider Individual. List types: X Agency. List the types of agencies: Category(s) Living Start-up Costs Provider (check one or both): Provider Qualifications Provider Type: License Certificate Other Standard (specify) (specify) (specify) Living Start-up Under state contract with DSPD as an Costs Provider authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA. Enrolled as a Medicaid provider Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Living Start-up Costs Division of Services for People with Disabilities Annually Provider Personal Budget Assistance HCBS Taxonomy Category 1: Sub-Category 1: Category 2: Sub-Category 2: Category 3: Sub-Category 3: Category 4: Sub-Category 4:
Service Delivery Method (check each that applies): Participant-directed as specified in Appendix E X 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: X Agency. List the types of agencies: Living Start-up Costs Provider Provider Qualifications Provider Type: License (specify) Certificate (specify) Other Standard (specify) Living Start-up Costs Provider Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA. Enrolled as a Medicaid provider Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Living Start-up Costs Provider Division of Services for People with Disabilities Annually Personal Budget Assistance HCBS Taxonomy Category 1: Sub-Category 1: Category 2: Sub-Category 2: Category 3: Sub-Category 3: Category 4: Sub-Category 4:
ABI%20Waiver%20Amendment%20-%20Final%20Draft%20for%20Public%20Comment.docx