Get (new 714, Rev - Dphhs Mt

The (New 714, Rev - Dphhs Mt form is crucial for the recertification of community first choice and personal assistance services in Montana. This guide provides clear steps and instructions to help you complete this form efficiently and accurately.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin filling out the member name field by entering the full name of the individual receiving services.
3. Input the Medicaid ID number in the provided space. This is crucial for identification.
4. If applicable, fill in the contact person’s name who is responsible for communication regarding the member.
5. Record the date of the visit. This date is important for tracking service delivery.
6. Enter the member's average biweekly utilization in units, noting that one unit equals 15 minutes of service over the previous two months.
7. Fill in the current authorization status for the services being recertified.
8. Review the responses required for ‘No’ answers and ensure an action plan is noted if applicable.
9. Indicate whether the member overview, profile, and service plan have been reviewed with the member or their representative by checking ‘Yes’ or ‘No’.
10. Confirm if the service delivery records accurately reflect the service plan and provide comments if needed.
11. Assess whether the current profile and service plan meet the member’s needs, indicating your answer and adding comments as necessary.
12. In the agency action plan section, address any issues identified and ensure compliance requirements are met.
13. Evaluate the attendants. Fill out whether they display competence and safety, perform tasks according to guidelines, and whether their interaction performance is satisfactory.
14. Indicate whether the attendant was present at the visit, and if so, provide the attendant's name. Note any additional training needs if identified.
15. Include the agency signature, agency name, and date of completion in the designated fields.
16. Finally, the member or their representative should sign to indicate that they have been offered voluntary training on managing personal care attendants.
17. Once all fields are completed, save your changes, and determine if you wish to download, print, or share the form.

Complete your documents online to ensure timely processing.