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PRINTED: 10/12/2021 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION

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Home and community based services refer to a range of assistance provided to individuals in their own homes or communities to help them with activities of daily living.

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Individuals who are in need of support with daily activities or who qualify for specific programs may be required to file for home and community based services.

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To fill out home and community based forms, individuals can contact their local social services agency or health department for assistance.

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The purpose of home and community based services is to help individuals remain independent and living in their own homes or communities for as long as possible.

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Information such as medical history, daily living needs, and income may need to be reported on home and community based forms.

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