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) Individual Medicaid Provider (check one or both): Provider Qualifications Provider Type: License Certificate Other Standard (specify) (specify) (specify) Individual Certified by DSPD as Under state contract with DSPD as an Medicaid an Acquired Brain authorized provider of services and Provider Injury Support supports to people with disabilities in Coordinator (ABISC). accordance with 62A-5-103, UCA. The ABISC certification process is Qualified support coordinators shall an internal process possess at least a Bachelor's degree in offered through nursing, behavioral science or a human DSPD. services related field such as social work, sociology, special education, rehabilitation counseling, or psychology and demonstrate competency relating to the planning and delivery of health services to the Acquired Brain Injury population through successful completion of a core curriculum and testing program approved by the State Medicaid Agency, leading towards certification of an Acquired Brain Injury Support Coordinator (ABISC). The certification process is an internal process offered through DSPD. Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Individual Medicaid Division of Services for People with Disabilities: Annually Provider ABI Support Coordinators are monitored and evaluated on an ongoing basis by: A) their DSPD Supervisors,
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: Individual Medicaid Provider Provider Qualifications Provider Type: License (specify) Certificate (specify) Other Standard (specify) Individual Medicaid Provider Certified by DSPD as an Acquired Brain Injury Support Coordinator (ABISC). The ABISC certification process is an internal process offered through DSPD. Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA. Qualified support coordinators shall possess at least a Bachelor's degree in nursing, behavioral science or a human services related field such as social work, sociology, special education, rehabilitation counseling, or psychology and demonstrate competency relating to the planning and delivery of health services to the Acquired Brain Injury population through successful completion of a core curriculum and testing program approved by the State Medicaid Agency, leading towards certification of an Acquired Brain Injury Support Coordinator (ABISC). The certification process is an internal process offered through DSPD. Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Individual Medicaid Provider Division of Services for People with Disabilities: ABI Support Coordinators are monitored and evaluated on an ongoing basis by: A) their DSPD Supervisors, Annually
ABI_Amendment_11.3.17.docx