Get Personal Care Program Addendum To Title Xix ... - Provider Manuals

Filling out the Personal Care Program Addendum to Title XIX is an essential task for providers wishing to participate in the MO HealthNet Personal Care Services. This guide will provide you with clear, step-by-step instructions to facilitate the online completion of this important document.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. In the first section, enter the provider or agency name in the designated field. Ensure that the name matches the official documentation.
3. Provide your provider identifier in the specified space. This number is crucial for identifying your agency within the MO HealthNet system.
4. Acknowledge compliance with MO HealthNet standards by reviewing the conditions mentioned; this may involve procedures or standards from the MO HealthNet Personal Care Provider Manual.
5. Indicate your commitment to delivering and billing for approved Advanced Personal Care services only. This can be done by appropriately marking or confirming the statement in the form.
6. If applicable, attach verification of your valid RCF license or current contract with the Division of Senior and Disability Services in the provided section. Make sure these documents are current and valid.
7. Fill in the details for the owner’s signature, including their original signature, printed name, and title. This step is vital for the authenticity of the form.
8. Finally, confirm the date the form is signed, ensuring it reflects the current date of submission.
9. Decide where to submit the completed form: if providing Advanced Personal Care in your RCF only, send it to the MO HealthNet Division Provider Enrollment Unit; if providing services in the community, send it to the Division of Senior and Disability Services.
10. After completing your form, you may choose to save changes, download, print, or share the form as needed.

Start filling out the Personal Care Program Addendum to Title XIX online to ensure compliance and continue providing vital services.