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Describe specifically how this action(s) will prevent or diminish the probability of future occurrences.
 
 
 
 
 
 
 
 
 
 
<b>Adequate policy </b>- Policies and procedures are complete, meet regulatory requirements, and are consistent with established standards and accepted practice expectations. Policies and procedures are clear and concise.
<b>Assessment</b> - There are adequate policy requirements for proper assessment of member health, behavioral, and other critical support needs and preferences.
<b>Communication and awareness</b> - There is adequate communication re: new policy requirements. Staff and others are aware of changes or revisions to policy or procedure.
<b>Consistent implementation of policy</b> – Reviewed, and modified as necessary, to assure that verbal instructions are the same as procedural requirements. Policies and procedures are up to date.
<b>Documentation </b>- There are adequate policy requirements for member records – including privacy – and documentation.
<b>Employee screening</b> - There were adequate policy requirements for screening employees. Individuals with established histories of behavior that could compromise member safety/care – including abuse and neglect – are not working with members.
<b>Environment reviewed and no changes required. Describe how this adverse incident was isolated with a minimal probability of a reoccurrence.</b>
<b>Equipment and supplies reviewed and no changes required. Describe how this adverse incident was isolated with a minimal probability of a reoccurrence.</b>
<b>Fiscal control</b> - There are adequate and consistent policy requirements for the management and control of member funds.
<b>Monitoring</b> - There are adequate policy requirements for monitoring services and supports to assure safety, meeting critical needs, and providing services in accordance with member plans and agency requirements.
<b>No resolution required. Describe how this adverse incident was isolated with a minimal probability of a reoccurrence.</b>
<b>No staffing changes required. Describe how this adverse incident was isolated with a minimal probability of a reoccurrence.</b>
<b>Other, describe</b>
<b>Other, describe</b>
<b>Other, describe</b>
<b>Other, describe</b>
<b>Planning</b> - There are adequate policy requirements for proper member planning and revision of supports based on changing needs.
<b>Policy</b> - Reviewed formal written policy or procedure governing the activity, and modified as needed. Staff are able to reference agency guidelines or protocols.
<b>Resolution following equipment and supplies review. Describe specifically how this action(s) will prevent or diminish the probability of future occurrences.</b>
<b>Resolution following member review. Describe specifically how revision(s) will prevent or diminish the probability of future occurrence(s).</b>
<b>Resolution following staffing review and /or training. Describe specifically how this action(s) will prevent or diminish the probability of future occurrences.</b>
<b>Resolution of systemic factor(s). Describe specifically how these reviews and/or assurances will prevent or diminish the probability of future occurrences.</b>
<b>Training</b> - There are adequate policy requirements for training. Staff are required by policy to meet any minimum training requirements or demonstrate competencies.
<b>Treatment plan reviewed and no changes required. Describe how this adverse incident was isolated with a minimal probability of a reoccurrence.</b>
96152-Health and Behavior intervention - individual
96153-Health and Behavior intervention - group
96154-Health and Behavior intervention - family
97802-Nutritional Counseling
97803-Nutritional Counseling
abrasion
Abuse Report
Abuse report
Accident
Accidental fall
Active
Additional Information Added
Address
Address
Address
Affordable Care Act (ACA)
Age
Aggressive behavior
aggressive behavior toward another without physical injury.
Aids/HIV
ALABAMA
ALASKA
Alert
allergic reaction
AMERICAN SAMOA
Amerigroup
Amerigroup Iowa
AmeriHealth Caritas
AmeriHealth Caritas Iowa
ApplicationLevel
Approval
Approve
ARIZONA
ARKANSAS
Armed Forces Americas
Armed Forces CA AFR EUR ME
Armed Forces Pacific
arrest
as identified under physical injury
Assault
Assessments
Assisted living
attempted, unable to reach
audio file extension
Audio video interleave file extension
Behavioral
Behavioral needs
Billing / Claims
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
bit map file extension
Bit map file extension
Bit map file extention
BMC Software Patrol UNIX Icon File
Brain Injury
Breast and Cervical Cancer (BCCT)
burn
by the member to another individual
CALIFORNIA
Case Management Comprehensive Assessment
Case Manager Date Informed:
CCO Budget
CDAC Agreement
Change staff
Child Care Medical Services Documents
Children’s Mental Health
City
City
City
City:
Claim Attachment
Claimed
Claims Detail
CMH Waiver
CMH Waiver Documents
Coding
cohabitation with a registered sex offender
COLORADO
Comma Separated Values file extension
Communication with member, family and/or other staff
Community
Community Based Neurobehavioral Rehabilitation Services Documents
Community job
Community job
Completed
Completed
Completed
Completed
Completed
Completed
Completed (Investigation Completed)
concussion
Condition / situation identified under law enforcement
Condition / situation identified under physical injury
Condition / situation identified under physical injury
Conditional
Conditional
Conditional
CONNECTICUT
Consumer Choices Option (CCO)
ControlLevel
contusion / bruise
Copy of EHR invoice or contract
Copy of invoice for EHR training
Copy of invoice for hardware purchase/lease agreement
Copy of invoice for online connectivity
Correctional facility / jail
Cost Reporting
Covid-19
Criminal
Crisis stabilization
Crossover Claims
cruel punishment
Date CM contacted Member
Date Contacted
Date Contacted:
Date Informed
Date Informed
Date of Birth
Date of Report
Date of Report
Date Received
Day program
Day program
DCP
Death
Death
DELAWARE
Deleted
Delta Dental
DemographicsTab
DemographicsTab
Denial of critical care
denial of critical care
denial of critical care
Deny
Dept. of Inspection & Appeals (DIA) Date of Report:
Describe other:
Describe:
Describe:
Describe:
DHS Date of Report:
diagnosed prior to death
Dining
Disciplinary action
Discovered
discovered at time of death
dislocation
DISTRICT OF COLUMBIA
documentation error
DocumentsTab
Elderly
electric shock
Electronic Health Records (EHR)
Electronic Visit Verification (EVV)
Eligibility Diagnosis: for BI waiver members (Initial level of care for BI Diagnosis must still be uploaded through Upload document to IME)
Email
Emergency Mental Health
Emergency mental health
Emergency Needs Assessment
emergency room treatment
EPSDT / Care for Kids
Exception to Policy Documents
exclusionary timeout
Expired
Exploitation
exploitation
eXtensible markup language file extension
eye emergency
Family
Family Planning Program (FPP)/ Iowa Family Planning Network (IFPN)
Family Planning Services
Featured Functionality that are displayed in the default.aspx
FEDERATED STATES OF MICRONESIA
Female
File processing has started.
fire
First Name
First Name
First Name:
flooding
FLORIDA
Foster care/family life home
FosterCareTab
fracture
GEORGIA
Good
Group
GUAM
Guardian Date Informed:
H0004-BEHAVIORAL HEALTH CNSL&TX-15 MIN
H0018-Crisis out of home stabilization
H0023-BEHAVIORAL HEALTH OUTREACH SERVICE
H0024-BHVAL HLTH PRV INFORM DISSEMIN SRVC
H0025-Crisis intervention follow along
H0031-Behavior Programming Assessment
H0032-Behavioral Programming Development
H0036-Mental Health Outreach
H0037-Community Psychiatric Supportive Treatment Program , per diem
H0046-MENTAL HEALTH SERVICES NOS
H2001-Rehabilitation Program – per half day
H2011Crisis Intervention
H2014-Skills Training and Development
H2015-Comprehensive Community Support Services
H2015HI-COMP CMTY SUPPORT SRVC PER 15 MIN
H2016-Comp Comm Support - home based hab or SCL
H2016HI-Comp Comm Support - SCL
H2016U3-COMP CMTY SUPPORT SRVC PER DIEM
H2019-THERAPEUTIC BEHAVIORAL SRVC 15 MIN
H2021-CMTY-BASED WRAP-AROUND SRVC 15 MIN
H2023-SUPPORTED EMPLOYMENT PER 15 MINUTES
H2024UC-SUPPORTED EMPLOYMENT PER DIEM
H2025-ONGOING SUPP MNTAIN EMPLOY 15 MIN
Habilitation
Habilitation Review Information
Habilitation Services Documents
HAWAII
Hawki
HCBS QA Oversight
Health Disability (formerly Ill & Handicapped)
Health Home
Health Insurance Premium Payment (HIPP)
Health Risk Assessment
Helpful Hints that are displayed in the default.aspx
holding face down
Home- and Community-Based Services (HCBS)
Homeless/shelter/street
Homicide / violence
Hospice
Hospital / clinic
Hospital / medical clinic
Hospital Retrospective & Program Integrity Documents
html file extension
html file extension
human/animal bite
IA Health Link (managed care)
ICF / nursing facility
ICF/MR
ICF/PMI
ID, BI, EW, AIDS, PD, HD Waiver, NF, ICF/ID and PACE Documents
IDAHO
IHAWP Prior Authorization
ILLINOIS
IME ACO (Accountable Care Organization)
IME Adult Rehab
IME Adult Rehab
IME Ambulance
IME Ambulatory Surgical Center
IME Area Education Agency
IME Assertive Community Treatment (ACT)
IME Audiologist
IME Behavioral Health
IME Behavioral Health Intervention Srvcs (BHIS)
IME Birthing Center
IME Brenda Testing
IME CDAC-Consumer Directed Attendant Care
IME Certified Nurse Midwife
IME Chiropractor
IME Clinic
IME Clinical Social Worker
IME CMS 1500
IME Community Based ICF/ID
IME Community Based Neuro-Rehabilitation
IME Community MH
IME County Relief
IME Crisis Response Services
IME CRNA
IME Dental ADA
IME Dentist
IME Early Access Service Coordinator
IME Early Access Service Coordinator
IME Electronic
IME Family Planning
IME Federal Qualified Health Center
IME General Hospital
IME General IMPA Information
IME General Provider Notification
IME General Provider Notification
IME Genetic Consultation Clinic
IME Genetic Consultation Clinic
IME Habilitation Services
IME Health Home
IME Health Maintenance Organ.
IME Hearing Aid Dealer
IME HIPP
IME Home Health Agency
IME Hospice
IME ICF/ID State
IME IHAWP HMO
IME IHAWP Marketplace
IME IHAWP MarketPlace Provider
IME IMPA System
IME Independent Lab
IME Independent Speech Pathologist
IME Independent Speech Pathologist
IME Indian Health Service
IME Infant and Toddler
IME Institutional - General
IME Integrated Health Home
IME Intermediate Care Facility
IME Lead Investigation Agency
IME Lien Holder
IME Local Education Agency
IME Long Term Care
IME Maternal Health Center
IME Medical Supplies
IME Medically Needy Only
IME Medically Needy Only
IME Mental Health Substance Abuse Plan
IME Mental Hospital
IME MEP Case Manager
IME MEP Case Manager
IME NEMT Broker (Non-Emergency Transport)
IME NEMT Provider
IME Neurological Rehabilitation Facility
IME Non Provider Mail Only
IME Nurse Practitioner
IME Nursing Facility - Mental Ill
IME Occupational Therapist Independent
IME Optician
IME Optometrist
IME Orthopedic Shoe Dealer
IME Other Practitioner - General
IME PACE
IME Paper
IME Para Professional
IME Pharmacy
IME Pharmacy
IME Physical Therapist
IME Physician Assistant
IME Physician DO
IME Physician MD
IME Podiatrist
IME Prepaid Health Plan
IME Provider Information Letters - Billing Types
IME Provider Information Letters - Claim Types
IME Provider Information Letters - Provider Types
IME Psych Medical Inst Children PMIC
IME Psychologist
IME Public Health Agency
IME Public Health Agency
IME RCF Guardian
IME Rehab Agency
IME Release Notes
IME Remedial Services
IME Remedial Services
IME Residential Care Facility
IME Rural Health Clinic
IME Screening Center
IME Skilled Nursing Facility
IME Sub-acute Mental Health Services
IME Tape Intermediary
IME Targeted Case Manager
IME Therapeutic Treatment Service
IME Therapeutic Treatment Service
IME UB04
IME Waiver
IME Waiver
impair sensory capabilities
Improve team building
in-patient hospitalization (medical unit)
in-patient hospitalization (mental health unit)
Inactive
Inactive
incarceration
Incident Reporting
Increase number of staff
Increase staff hours
Increase supervision of staff
INDIANA
Individual needs
Information Letter
Informational Letters Programs List
Informational Letters Provider Topics List
Ingested / aspiration / choking
Initial (Pending Further Investigation)
Initiated
Initiated
Initiated
Initiated
Initiated
Initiated
Integrated Health Home
Intellectual Disability (formerly MR)
International Classification of Diseases, 10th Edition (ICD-10)/(ICD-9)
interRAI Child and Youth Mental Health
interRAI Community Mental Health
interRAI Home Care
interRAI Pediatric Home Care
IOWA
Iowa Health and Wellness Plan (IHAWP)
Iowa Total Care
Iowa Total Care
Is Public
Join
KANSAS
KENTUCKY
laceration
Last Name
Last Name
Last Name:
Law Enforcement
Law enforcement
License issued by Iowa Board of Physician Assistants, showing license number
Limited Emergent Services
Location Unknown/Elopement
Location Unknown/elopement
Long Term Care
loss of consciousness
loss/tearing of body part
LOUISIANA
MAINE
Male
manufacture or possession of a dangerous substance
MARSHALL ISLANDS
MARYLAND
MASSACHUSETTS
Mayo Portland Assessment (MPAI)
MCNA
mechanical restraint for behaviors
MED Exception to Policy Dental X-ray
MED Exception to Policy Digital Image
Med MDS Validation
Medicaid AR
Medical
Medical Prior Authorization
Medical Prior Authorization Dental X-ray
Medical Support for Claims Documents
Medicare Savings Program (MSP) (QMB, SLMB)
Medication Refusal
Medication Refusal
Member's physical environment evaluated and modified if necessary for safety issues
Member's physical environment evaluated and modified if necessary to increase accessibility
Member’s interpersonal relationships within their environment evaluated, and accommodated / modified if necessary, for safety reasons
Member’s legal residence
MemberTab
MemberTab
Mental Health
Mental Injury
mental injury
Message
Message file extension
Message that displays as a popup
Message that displays in webpart
MFP
MICHIGAN
Microsoft 2007 Excel file extension
Microsoft 97 - 2003 Excel file extension
Microsoft 97-2003 file extension
Microsoft Word 2007 file extension
MINNESOTA
Miscellaneous Documents
missed dosage
missed dosage
MISSISSIPPI
MISSOURI
Money Follows the Person (MFP)
MONTANA
movement / inhibited
N/A
N/A
N/A
N/A
Name
Name of Location or Facility
NEBRASKA
Necessary equipment needs to be purchased
Necessary equipment needs to be repaired
Necessary equipment needs to be replaced
Neighbor
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
no
No
no
no
No
No
No
No the Provider is accepting new medicaid clients
No Value Chosen
Non-MCO
NORTH CAROLINA
NORTH DAKOTA
NORTHERN MARIANA ISLANDS
Not verifying correct member
Notice of Action
Off-Year Assessment
Officer Name & Contact Information
OHIO
OKLAHOMA
OREGON
Other
Other
other
Other
Other (Describe)
Other (Non-Waiver)
Other Entity Contacted, specify:
Other Member
Other, describe
Other, describe
other, describe
Other, describe
Other, Describe
other, describe
other, describe
Other, describe
other, describe
Other, specify
Other; describe
Other; describe
other; describe
Out of State Facility Prior Authorization
out-patient mental health
Overdose
Overdose
PageLevel
PALAU
pc paintbrush file extension
PENNSYLVANIA
perpetrator
perpetrator
perpetrator
perpetrator
perpetrator
perpetrator
perpetrator
perpetrator
perpetrator
perpetrator
Perpetrator
Perpetrator
Personal harm
Personal harm
Phone #
Phone #
Phone #:
Phone#
Physical Disability
Physical Injury
Physical injury
Physical Injury
physical injury
physical injury
PICA behavior / Ingestion of harmful substance
PMIC Prior Authorization
poisoning / toxin ingestion
Portable Document File extension
Positive and supportive relationships
Powerpoint file extension
presence of illegal drugs
Presumptive Eligibility
Prior Authorization
Private residence/household – Living alone
Private residence/household – Living with relatives
Private residence/household – Living with unrelated persons
PRN meds for behavior
Program Integrity
ProgramServicesTab
ProgramServicesTab
prone restraint
Proof of a contract to provide services or employment agreement in support of incentive payment assignment
Proof of other costs associated with EHR implementation (such as lost productivity, or purchase of REC services)
Proof of ownership of RHC
Proof of patient volume, including location(mailing address) of service
Provider Address
Provider EFT
Provider EHR Attachment
Provider Enrollment
Provider/Agency Name
Psych Evaluation
PUERTO RICO
puncture wound
Rates
RCF
RCF/MR
RCF/PMI
Recreating
removal of mobility aids
Replaced
Report #:
Representative: POA/Guardianship
Representative: POA/Guardianship
Request
Request Form
Resolution of environmental review includes changes to the member’s existing environmental conditions
Resolution of environmental review includes long-term facility placement for member.
Resolution of environmental review includes short-term facility placement for member.
resolved by case manager
resolved by natural supports
resolved by outside entity
resolved by provider staff
RHODE ISLAND
Rich Text File extension
Rights
rights violation
Roommate
Root Cause (Describe what lead to or contributed to the incident):
S0215-NON-EMERG TRANSPORTATION PER MILE
S5100-ADULT DAY CARE SERVICES/15 MIN
S5101-Adult Day Care Services/Half Day
S5102-DAY CARE SERVICES
S5105-Center Based Adult Day Care
S5120-CHORE SERVICES PER 15 MINUTES
S5125-ATTENDANT CARE SERVICES/AGENCY
S5125U3-ATTENDANT CARE SERVICES/AGENCY
S5130-Homemaker Service, NOS
S5135-COMPANION CARE ADULT PER 15 MIN
S5150-Unskilled Respite Care - basic individual
S5150U3-UNSKLD RESPITE CARE NOT HOSPICE 15
S5160-EMERG RESPONSE SYSTEM INSTL&TST
S5161-EMERG RESPONSE SYS SRVC FEE-MONTH
S5165-Home Modification
S5170UF-HOME DEL MEALS INCL PREP MEAL
S5170UG-HOME DELIVERED MEALS
S5170UH-HOME DELIVERED MEALS
S5170UJ-HOME DELIVERED MEALS
S5199-PERSONAL CARE ITEM NOS EACH
S9122-Home Health Aid, Per Hour
S9123-Nursing Care Service - RN, Per Hour
S9124-Nursing Care Service - LPN, Per Hour
School
School
seclusion / isolation
Seizure
self injurious / self mutilation behavior without physical injury.
self-denial of critical care
Self-denial of critical care
Self-mutilation / self injurious behavior
Service Name:
Service Plan
Services were being provided.
Services were not being provided.
sexual abuse
sexual abuse
Sexual abuse
Shopping
SIS Family Friendly Long Report
SIS Family Friendly Report
SIS Long Report
SkipTCN
social environment
Social History (Social History for initial HAB must still be uploaded through Upload document to IME)
SOUTH CAROLINA
SOUTH DAKOTA
sprain
Staff
Staff distracted
Staff Reviewer
Staff trained / retrained on equipment use
State
State
State
State facility
State Innovation Model (SIM)
State MHI
State resource center
State:
suicidal ideation
Suicide
Suicide attempt
Swing Bed Documents
T1002-RN SERVICES UP TO 15 MINUTES
T1003-LPNLVN SERVICES UP TO 15 MINUTES
T1004-SERVICES OF A QUALIFIED NURSING/HH AIDE
T1004U3-SERVICES OF A QUALIFIED NURSING/HH AIDE
T1005-Respite Care Services - group
T1005U3-RESPITE CARE SERVICES TO 15 MIN
T1016-Case Management
T1017-Targeted Case Management
T1019-PERSONAL CARE SERVICES PER 15 MINS
T1019U3-PERSONAL CARE SERVICES PER 15 MINS
T1021-Home Health Aide, Per Visit
T1021U3-HOME HLTH AIDECERT NURSE ASST VST
T1030-Nursing Care Service - RN, Per Visit
T1030U3-NRS CARE HOME REGISTERED NURSE-DIEM
T1031-Nursing Care Service - LPN, Per Visit
T1031U3-NURSING CARE THE HOME LPN PER DIEM
T2003-NON-EMERG TRNSPRT ENCOUNTERTRIP
T2014-HABILITATN PREVOCATIONL WAIVRDIEM
T2015-Habilitation, Prevocational per Hour
T2018UC-HABILITATN SUPP EMPLMNT WAIVRDIEM
T2020-Day Habilitation, Waiver/Diem
T2021-Day Habilitation - 15 Minutes
T2025-Waiver Services NOS- FMS payment
T2028-SPECIALIZED SUPPLY NOS WAIVER
T2029-SPECIALIZED MEDICAL EQP NOS WAIVER
T2036-Therapy Camping Overnight
T2037-TX CAMPING DA WAIVER EA SESS
T2038-CMTY TRANSITION WAIVER PER SERVICE
T2038U3-CMTY TRANSITION WAIVER PER SERVICE
T2039-Vehicle Modification
tagged image file format extension
take down
Tax Entity
TENNESSEE
Terminal illness / natural causes
Terminate staff
Test
TEXAS
Text file extension
The file has been successfully uploaded through the File Upload web page AND all rows have been successfully processed in the nightly batch. Processed files contain rows that contain errors and no errors. Errors documented are based on IMPA eligibility.
The file has been successfully uploaded through the File Upload web page AND all rows have NOT been successfully processed in the nightly batch.
Third Party Liability (TPL) or Other Health Insurance (OHI)
This file can be deleted within 60 minutes of the Date/Time Uploaded. If you delete this file it will not be processed nor will it be retained.
This file or some of the rows did not fully process. There has been a request for this file NOT to continue processing, but has been corrected with a different file.
This file or some of the rows did not fully process. There has been a request for this file to be reprocessed through the nightly batch.See Status Matrix for available status changes.
This file or some of the rows did not process nor has the issue been corrected for a period of 3 or more days. The file will not be processed nor will it continue to hold up all other processing; it will be ignored in its entirety.
Time CM contacted Member
to the member
tornado / storm
treatment by a health care professional
Treatment plan reviewed and/or revised due to behavioral issues
Treatment plan reviewed and/or revised due to cognitive abilities
Treatment plan reviewed and/or revised due to communication needs
Treatment plan reviewed and/or revised due to level of need and support
Treatment plan reviewed and/or revised due to medical / health status, including medication review
Treatment plan reviewed and/or revised due to physical abilities
Treatment plan reviewed and/or revised due to unidentified risk or safety issues; safety plan reviewed / modified
Treatment plan reviewed and/or revised to reflect member’s goals
unauthorized administration
unauthorized administration
Under certain conditions they will take new medicaid clients.
United Healthcare
UnitedHealthcare Community Plan
Unknown
Unknown
unknown
unsafe/ unhealthy physical environment
Uploaded means that the file was successfully uploaded and is waiting for processing.
UTAH
Vehicle
Vehicular accident
VERMONT
victim
victim
victim
victim
victim
victim
victim
victim
victim
victim
Victim
Victim
VIRGIN ISLANDS
VIRGINIA
W0574-Targeted Case Management Child
W0578-Targeted Case Management Adult
W0579-TCM Adult CMI
W0580-TCM CMH Waiver
W0719-Community Living Skills Training Services Hourly
W0720-Community Living Skills Training Services Daily
W0721-Employment Related Services Hourly
W0722-Employment Related Services Daily
W0723-Day Program for Skills Training Hourly
W0724-Day Programs for Skills Training Daily
W0725-Day Program for Skills Development Hourly
W0726-Day Programs for Skills Development Daily
W0810-Targeted Case Management - Child
W0811-Targeted Case Management - Adult
W0812-Targeted Case Management - CMI
W0813-Targeted Case Management - CMH Waiver
W0814-Case Management - Habilitation
W0815-Case Management - BI Waiver
W0816-Case Management - Elderly Waiver
W0817-Targeted Case Management - Transitional
W0818-Targeted Case Management - CMI - Transitional
W1002-Adult Day Care-Full Day
W1003-Homemaker
W1004-Obsolete - Home Health Aide
W1010-Consumer Choices Option
W1021-Adult Day Care-Half Day
W1022-Personal Emergency Response-Initial
W1023-Personal Emergency Response-Ongoing
W1024-Obsolete - Home Health Aide
W1025-Homemaker
W1026-Obsolete - Nursing
W1029-Chore
W1030-Home Delivered Meals
W1031-Home and Vehicle Modifications
W1033-Transportation: RTA
W1035-Transportation
W1037-Counseling-Individual
W1038-Counseling-Group
W1039-Obsolete - Home Health Aide
W1040-Homemaker
W1041-Obsolete - Nursing
W1047-Senior Companion
W1048-Assistive Devices
W1049-Nutritional Counseling
W1060-Mental Health Outreach
W1203-Adult Day Care-Extended Day
W1204-Day Habilitation(per day)
W1205-Day Habilitation(1/2 day)
W1206-Day Habilitation(Hourly)
W1207-Home-based habilitation (hourly)
W1208-Home-based habilitation (daily)
W1250-Counseling-Individual
W1251-Counseling-Group
W1252-Obsolete - Nursing
W1258-Home Delivered Meals
W1260-Morning Meal
W1261-Noon Meal
W1262-Evening Meal
W1263-Liquid Supplement Meal
W1265-CDAC-Agency (Hourly)
W1266-CDAC-Agency (Daily)
W1267-CDAC-Individual (Hourly)
W1268-CDAC-Individual (Daily)
W1300-Supported Community Living (Daily)
W1302-Home and Vehicle Modifications
W1303-Personal Emergency Response-Initial
W1304-Personal Emergency Response-Ongoing
W1305-Obsolete - Nursing
W1306-Obsolete - Home Health Aide
W1311-Supported Community Living (Hourly)
W1320-Supported Community Living (Residential Based)
W1330-Case Management
W1401-Supported Community Living (Daily)
W1407-Personal Emergency Response - Ongoing
W1408-Personal Emergency Response-Initial
W1409-Case Management
W1410-Case Management
W1414-Transportation
W1417-Home and Vehicle Modifications
W1418-Specialized Medical Equipment
W1419-Behavioral Programming
W1420-Family Counseling and Training
W1421-Supported Community Living (Hourly)
W1425-Pre-Vocational Services
W1426-Pre-Vocational Services (1/2 day)
W1430-Supported Employment, obtain a job
W1431-Supported Employment, maintain employment/job coaching
W1432-Supported Employment, maintain employment/personal care
W1433-Supported Employment, maintain employment/enclave
W1518-Interim Medical Monitoring & Treatment - SCL
W2500-Respite-HHA specialized
W2501-Respite-HHA basic individual
W2502-Respite-HHA group
W2503-Respite-Home Care Agcy & Non-Facility, Specialized
W2504-Respite-Home Care Agcy & Non-Facility, Basic Individual
W2505-Respite- Home Care Agcy & Non-Facility, Group
W2506-Respite-hospital or nursing facility/skilled
W2507-Respite-nursing facility
W2508-Respite-ICF/MR
W2509-Respite-foster group care
W2510-Respite-camps
W2511-Respite- adult day care
W2512-Respite- child care center
W2513-Interim Medical Monitoring & Treatment-HHA
W2514-Interim Medical Monitoring & Treatment-Nurse
W2515-Interim Medical Monitoring & Treatment-Registered/Licensed Child Care
W2516-Respite-RCF/MR
W2517-CDAC-Assisted Living
W2518-Interim Medical Monitoring & Treatment-HHA
W2519-Interim Medical Monitoring & Treatment-Nurse
W2520-Interim Medical Monitoring & Treatment- registered/licensed child care
W2521-Respite Resident Camp - Weeklong overnight recreational respite
W2522-Group Summer Day Camp - Group recreational respite camp
W2523-Group Specialized Summer Day Camp - Group Recreational respite camp for individuals requiring additional support
W2524-Teen Day Camp - Day Camp providing recreational activities for teens age 13 to 21 years old
W2525-Weekend On-site Respite - Camp based recreational overnight respite
W3245-Environmental Modifications, Adaptive Devices, and Theraputic Resources
W3246-Family & Community Supports
W3247-In-Home Family Therapy
W4021-Adult Day Care (Hourly)
W4414-Transportation – Trip
W4425-Pre-Vocational Services (Hourly)
W5001-Crisis Intervention-In home technical assistance
W5002-Crisis Intervention-out of home crisis stabilization
W5003-Crisis Intervention-Follow-along
W5004-Nurse Delegation
W5005-Transition Services-Individual Budget
W5006-Money Follows Person
W5007-Community Provider Participation
W5008-ICF MR Staff Participation
W5019-Supported Employment - Job Development
W5020-Supported Employment - Employer Development
W5021-Supported Employment - Enhanced Job Search
Waiver Prior Authorization
WASHINGTON
Welfare Check
WEST VIRGINIA
WISCONSIN
Witnessed
word perfect graphic file extension
Work activity
Work activity
Worksheets 1 and 2 for Payment Justification
Wraparound Payment Request
Wraparound Payments
wrong dosage
wrong dosage
wrong medication
wrong medication
wrong time
wrong time
WYOMING
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
yes
yes
Yes
Yes
Yes
Yes the Provider is accepting new medicaid clients
Zip
Zip
Zip
Zip:


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