Get Oltl Hcbs Waiver Agreement Home And Community Based Services - Dpw State Pa

The OLTL HCBS Waiver Agreement is a vital document for providers participating in Pennsylvania's Medicaid Waiver Program. This guide will help you navigate the process of completing the form online effectively.

Follow the steps to fill out the OLTL HCBS Waiver Agreement online.

1. Click ‘Get Form’ button to access the OLTL HCBS Waiver Agreement and open it in your editing tool.
2. Begin by filling in the date when the agreement is being completed. You need to provide the current date along with the name of the provider.
3. In the designated field, input the full name of the provider organization that will be participating in the Medicaid Waiver Program.
4. Review and acknowledge the responsibilities listed in the agreement. Ensure that you understand the obligations related to compliance with federal and state regulations.
5. Confirm that the individual to be served possesses a valid Medicaid Services Eligibility card by checking the relevant documentation.
6. Provide a clear commitment to maintain accurate records of services provided to waiver recipients, as outlined in the agreement.
7. Fill out the section regarding the effective date, which marks the start of the agreement based on when the Department records the provider.
8. Ensure to sign the agreement where indicated. Enter your title and the date of signing to finalize this section.
9. Complete Rider A by filling in personal assurances and confirming your compliance with the provider assurances listed.
10. After filling out the entire form, carefully review all entries for accuracy and completeness before proceeding to save, download, or print.

Begin filling out the OLTL HCBS Waiver Agreement online to ensure compliance and provide necessary services.