COMPREHENSIVE SUPPORTS WAIVER PROGRAM (COMP)

CHAPTER 600 SPECIAL CONDITIONS OF PARTICIPATION VI

Section 601 General
Section 602 Organization and Administration
Section 603 Other Provider Information
Section 604 Provider Enrollment
Section 605 Changes in Enrollment Data
Section 606 Staffing Requirements
Section 607 Waivers to Standards

CHAPTER 700 SPECIAL ELIGIBILITY CONDITIONS VII
Section 701 Eligibility Criteria
Section 702 Notification of Participant
Approval/Disapproval
Section 703 Denial of Eligibility
Section 704 Grounds for Appeal
Section 705 Screening for Services
Section 706 Initial Level of Care Determination
Section 707 Level of Care Reevaluation
Section 708 Level of Care Approval Requirements (DMA-6/ DMA-6A/DMA-7)
Section 709 Reevaluation of Participants
Section 710 Participant Assurances
Section 711 Eligibility Determination for Medical Assistance Only (MAO)
Section 712 Eligibility Determination for TEFRA/Katie Beckett
Section 713 Georgia Pediatric Program (GAPP)

CHAPTER 800 PRIOR APPROVAL VIII
Section 801 General
Section 802 Obtaining Prior Approval
Rev. 04 2014
January 1, 2015 Comprehensive Supports Waiver Program 1

CHAPTER 900 GENERAL SERVICES REQUIREMENTS IX
Section 901 Services Overview
Section 902 Exclusions and Special Conditions
Section 903 Duplication of Services
Section 904 Hospice Services
Section 905 Transportation Requirements
Section 906 Day Services Requirements
Rev. 10 2010 Section 907 Developmental Disability Professional Requirement
Section 908 Termination of Participant Services Requirement
Section 909 Proxy Caregivers and Health Maintenance Activities

CHAPTER 1000 BASIS FOR REIMBURSEMENT X
Section 1001 General
Section 1002 Reimbursement Methodology
Section 1003 General Claims Submission Policy for Ordering, Prescribing, or Referring (OPR) Providers
Section 1004 Limitations on Billing of Case Management
Section 1005 CMS 1500 Claim Form Overview

CHAPTER 1100 DOCUMENTATION AND RECORDS XI
Section 1101 General
Section 1102 Individualized Service Planning and Implementation
Section 1103 Provider Intake
Section 1104 Individual Service Plan (ISP) Goal
Progress Documentation
Section 1105 Maintenance of Records
Section 1106 Management and Protection of Participant
Funds
Section 1107 Monitoring
Section 1108 Multi-Purpose Information Consumer Profile

CHAPTER 1200 PARTICIPANT-DIRECTION XII
Section 1201 General
Section 1202 Participant Eligibility
Section 1203 Participant-Direction by a Representative
Section 1204 Eligibility Criteria
Section 1205 Special Consideration for Eligibility for
Participant-Direction
January 1, 2015 Comprehensive Supports Waiver Program 2
Section 1206 Notification of Participant
Approval/Disapproval
Section 1207 Denial of Eligibility
Section 1208 Grounds for Appeal
Section 1209 Requirements for Enrollment in
Participant-Direction
Section 1210 Eligible Waiver Services
Section 1211 Participant-Direction Opportunities
Section 1212 Supports for Participant-Direction
Section 1213 Employee Eligibility
Section 1214 Hiring Family/Relatives to Provide
Participant-Directed Waiver Services
Section 1215 Special Requirements and Conditions of
Participation of Employees
Section 1216 Participant-Directed Services Documentation and Other Requirements
Section 1217 Maintenance of Records
Section 1218 Exclusions and Special Conditions
Section 1219 Termination of Participant-Direction

APPENDIX A Regional Office of DBHDD Contact List

APPENDIX B Application for Developmental Disabilities/Mental
Retardation Services

APPENDIX C Physician’s Recommendation Concerning Nursing Facility Care or Intermediate Care for the Mentally Retarded
(DMA-6)
Physician’s Recommendation Concerning Nursing Facility Care or Intermediate Care for Pediatric Care (Pediatric DMA 6(A)
Level of Care Re-Evaluation for ICF/ID (DMA-7)

APPENDIX D I & E Screening Tool for Chronic Medical Conditions

APPENDIX E Freedom of Choice (Statement of Informed Consent)

APPENDIX F MAO Communicator

APPENDIX G Prior Authorization Form

APPENDIX H Documentation for Exceptional Rate Request

APPENDIX I Glossary of Terms

APPENDIX J Georgia Health Partnership (GHP)

APPENDIX K Medical Assistance Eligibility Certification

APPENDIX L Medicaid Provider Application Process for DBHDDServices (Flow Chart)

APPENDIX M Georgia Families

APPENDIX N Non-Emergency Transportation Broker System

APPENDIX O Person Centered Planning

APPENDIX P Letter of Intent to Provide Services Form

APPENDIX Q MR/DD New Site Inspection Checklist

APPENDIX R Antipsychotic and Mood Stabilizer Medications

APPENDIX S Documentation Progress Note and Summary Examples

APPENDIX T ICD-10 Overview

APPENDIX U Georgia Families 3600 SM,

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