Get Oa-ap Waiver Services Overview (pdf)

Filling out the OA-AP Waiver Services Overview form is an essential step for individuals seeking waiver services under the Medicaid program. This guide provides a clear, step-by-step approach to ensure accurate completion of the form online.

Follow the steps to complete the OA-AP Waiver Services Overview form effectively

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling in your Medicaid number and the participant's full name. Ensure all information is accurate to avoid delays.
3. Enter the current address, including city, state, and zip code. Double-check for typos to maintain a professional presentation.
4. Fill in the participant’s date of birth, ensuring the format aligns with the requirements of the form.
5. List the name of the qualified Home and Community-Based (HCB) agency along with the healthcare billing number.
6. Indicate the start date of the Plan of Care (POC) and the renewal date for the Level of Care (LOC). These dates are crucial for tracking service timelines.
7. In the Provider & Waiver Services Overview section, specify the type of services you are applying for by checking the appropriate boxes for each service type.
8. Next, enter the service start and end dates for each selected service. Accuracy in these dates is vital for service scheduling.
9. Provide the name and contact number of the care coordinator, along with the care coordination agency’s number.
10. In the TYPE OF SERVICE section, select from the list of available services and include any relevant codes. Be sure to reference the services outlined in the MRDD/CCMC Waiver Services Overview as needed.
11. Once all sections are filled out, review the document for any errors or omissions. Ensure all fields have been completed appropriately.
12. Finally, save any changes made to the form. You can also download, print, or share the completed document as required.

Complete your OA-AP Waiver Services Overview form online today to ensure timely processing of your waiver services.