Get Clinic-based Intensive Outpatient Treatment Module Guidance

This guide is designed to assist users in successfully completing the Clinic-Based Intensive Outpatient Treatment Module Guidance online. Following this comprehensive structure will ensure accurate submission and promote effective provision of intensive outpatient services.

Follow the steps to complete the guidance online effectively.

1. Press the ‘Get Form’ button to access the form and open it in your editing interface.
2. Begin with the section that requires your clinic's information. Enter the name of the clinic, its address, and contact details accurately. Ensure that all information is current to avoid any delays in processing.
3. Proceed to the next section which requests details about the Intensive Outpatient Program being proposed. Describe the services offered, including the frequency of visits and types of therapies provided.
4. Fill in the required fields regarding the waiver request for 14 NYCRR Part 501. Include specific information about the requested exceptions for service delivery beyond the standard limits.
5. In the staffing resources section, outline the current staffing levels and any additional staffing needed to meet the increased demand for services. Be clear and detailed in your descriptions.
6. Complete any information relating to contracting arrangements with plans, making sure to provide accurate details that correspond with the payment structure outlined in the guidance.
7. Review your entries for accuracy and make any necessary adjustments. Confirm that you have included all required documentation and details.
8. Once all fields are filled and verified, you have the option to save your changes, download a copy of the form, print it for your records, or share it with relevant stakeholders.

Complete the required documents online today to ensure the effective implementation of intensive outpatient services.