both): Provider Qualifications Provider Type: License Certificate Other Standard (specify) (specify) (specify) Certified by DSPD as Under state contract with DSPD as an an authorized provider authorized provider of services and Services of services and supports to people with disabilities in Provider supports to people accordance with 62A-5-103, UCA and with disabilities in R539-5. accordance with UCA. Completed Provider Agreement Agency-based Current business Certified by DSPD as Under state contract with DSPD as an Companion license an authorized provider authorized provider of services and Services of services and supports to people with disabilities in Provider supports to people accordance with 62A-5-103, UCA with disabilities in accordance with Enrolled as a Medicaid provider UCA. Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Division of Services for People with Disabilities Annually Services Provider Agency-based Division of Services for People with Disabilities Annually Companion Services Provider Environmental Adaptations - Home HCBS Taxonomy Category 1: Sub-Category 1: Category 2: Sub-Category 2: Category 3: Sub-Category 3: Category 4: Sub-Category 4: Service Definition (Scope):
both): Provider Qualifications Provider Type: License (specify) Certificate (specify) Other Standard (specify) Services Provider Certified by DSPD as an authorized provider of services and supports to people with disabilities in accordance with UCA. Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA and R539-5. Completed Provider Agreement Agency-based Companion Services Provider Current business license Certified by DSPD as an authorized provider of services and supports to people with disabilities in accordance with UCA. 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 Services Provider Division of Services for People with Disabilities Annually Agency-based Companion Services Provider Division of Services for People with Disabilities Annually Environmental Adaptations - Home HCBS Taxonomy Category 1: Sub-Category 1: Category 2: Sub-Category 2: Category 3: Sub-Category 3: Category 4: Sub-Category 4: Service Definition (Scope):
ABI%20Waiver%20Amendment%20-%20Final%20Draft%20for%20Public%20Comment.docx