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This document is an attestation form for providers of 100% community-based non-residential adult day services, prevocational services, and children’s long-term support day services in Wisconsin. It ensures compliance with the exemption from the HCBS settings rule by requiring providers to confirm that they do not operate a physical service location or utilize such a location for Medicaid waiver recipients.
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How to fill out hcbs community-based non-residential provider

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How to fill out hcbs community-based non-residential provider

01
Begin by gathering all necessary documentation that verifies eligibility for HCBS services.
02
Download or obtain the HCBS community-based non-residential provider application form.
03
Fill out the personal information section, including your name, address, and contact details.
04
Provide information about your service offerings and how they align with community-based non-residential support.
05
Include any relevant qualifications, certifications, or training that support your capability to provide these services.
06
Outline your proposed plan for service delivery, including hours of operation and location.
07
Ensure compliance with local, state, and federal regulations by referencing relevant guidelines.
08
Review the application for completeness and accuracy before submission.
09
Submit the application to the appropriate local state agency or department overseeing HCBS programs.

Who needs hcbs community-based non-residential provider?

01
Individuals with disabilities who require support to participate in community activities.
02
Caregivers who need additional assistance to help individuals achieve their personal goals.
03
Elderly individuals who require non-residential support services to maintain independence.
04
Social service providers looking for quality services to assist their clients.

What is Hcbs Community-based Non-residential Provider Attestation Form?

The Hcbs Community-based Non-residential Provider Attestation is a writable document which can be filled-out and signed for specified reasons. In that case, it is provided to the exact addressee to provide certain info of any kinds. The completion and signing is available in hard copy by hand or via a suitable tool e. g. PDFfiller. These applications help to fill out any PDF or Word file online. While doing that, you can customize it according to your needs and put a valid e-signature. Once done, you send the Hcbs Community-based Non-residential Provider Attestation to the recipient or several ones by mail and even fax. PDFfiller has got a feature and options that make your blank printable. It provides a number of settings for printing out appearance. No matter, how you'll distribute a form after filling it out - in hard copy or by email - it will always look well-designed and clear. In order not to create a new editable template from the beginning over and over, turn the original form as a template. After that, you will have a customizable sample.

Template Hcbs Community-based Non-residential Provider Attestation instructions

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HCBS community-based non-residential providers are organizations or entities that offer home and community-based services to individuals with disabilities or special needs, enabling them to live independently within their communities.
Providers that offer HCBS services and receive funding or reimbursement through Medicaid or other public programs are typically required to file as HCBS community-based non-residential providers.
To fill out the HCBS community-based non-residential provider form, complete the required sections with accurate information regarding the services provided, organizational details, and compliance with relevant regulations and standards.
The purpose of HCBS community-based non-residential providers is to facilitate access to necessary services and support for individuals with disabilities, promoting their independence and integration into the community.
The information that must be reported typically includes provider details, service descriptions, compliance with regulations, service delivery outcomes, and financial details related to funding sources.
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