Medium
Medium
1915(i) Eligibility Form
Translation available - please submit requests to nd1915i@nd.gov
Request for Care Coordination Report
- HCBS Settings Assessment Guide - revised 6.24.2021
- HCBS 1915(i) Heightened Scrutiny Visit Form - revised 6.24.2021
- Initial 1915(i) HCBS Settings Review - revised 6.30.2021
- Person-centered Planning Guide
Community Transition Plan of Care - revised 1.1.2022
Individual Acknowledgement/Care Coordination Attestation/Signatures
Member Rights and Responsibilities - revised 12.01.2022
Request for Service Provider - revised 8.29.2022
Therap POC Creation Guide - revised 8/2022
Individual Provider Review Report - revised 5.25.2023