Get Application For A 1915 (c) Hcbs Waiver - Utah Department Of Health - Health Utah

This guide provides a structured approach to completing the Application For A 1915 (c) HCBS Waiver by the Utah Department Of Health. It is designed to assist individuals and families in successfully navigating the online application process by breaking down each section and providing clear instructions.

Follow the steps to complete your application efficiently.

1. Press the 'Get Form' button to access the application form and open it for editing.
2. Begin filling out the 'Request Information' section by specifying the type of request (new, renewal, or amendment). This includes selecting the appropriate waiver title and providing necessary details.
3. Complete the 'Brief Waiver Description' section with a summary of the waiver's purpose, target population, and objectives. Ensure clarity regarding the services covered.
4. In the 'Components of the Waiver Request' section, complete all applicable appendices detailing waiver administration, participant eligibility, and service planning. Pay particular attention to the roles of state and local providers.
5. Review and fill out the 'Request for Waiver(s)' section. Ensure you clarify your needs, specify any concurrent operations with other programs, and indicate dual eligibility if applicable.
6. Complete the 'Assurances' section by confirming your compliance with required regulations and providing details about participant rights, including grievance and appeal processes.
7. Finalize the form by collecting any required signatures, including that of the State Medicaid Director or their designee. Review all entries for accuracy.
8. Submit your completed application online. You have options to save changes, download, print, or share your application as needed.

Start your application online today to ensure you receive the support you need!