Application and Contracting Reference
Application Forms
- Provider Application
- W-9 Form
- Background Information Disclosure (BID)
- Owner Occupied Adult Family Home (AFH) Certification Application
- AFH Certification Application Community Care Home
- Residential Provider Service Form
- Provider Application-Service Location Form
Contract Appendix C: Provider Insurance Coverage Minimums
Contract Appendix N: Scope of Service
- Adaptive Aids – Service Dogs
- Adult Day Care
- Assistive Technology
- Communication Assistance
- Community Support Program (CSP)
- Community Supported Living (CSL)
- Competitive Integrated Employment Exploration
- Consultative Clinical and Therapeutic Services
for Caregivers - Consumer Directed Supports (SDS) Broker
- Consumer Education and Training
(includes Mental Health Peer Specialists) - Counseling & Therapeutic Resources (Non-MA)
- Daily Living Skills Training
- Day Habilitation Services (Adult Day Services)
- Environmental Accessibility Adaptations
(Home Modifications) - Financial Management Services – Representative Payee
- Financial Management Services for Self-Directed Supports
- Home Delivered Meals
- Home Health
- Housing Counseling
- Independent Nursing
- Mental Health-AODA
- Personal Emergency Response System (PERS)
- Physical and Occupational Therapy, Speech & Language Pathology
- Prevocational Services
- Relocation Services
- Remote Monitoring
- Respite Services
- Residential Services – Adult Family Home (AFH)
- Residential Services – Community Based Residential Facility (CBRF) 5-8 bed
- Residential Services – Community Based Residential Facility (CBRF) greater than 8 bed
- Residential Services – Residential Care Apartment Complex (RCAC)
- Supported Employment Group
- Supported Employment Individual
- Supportive Home Care
- Supportive Home Care – Chore Services
- Training for Unpaid Caregivers
- Transportation (Specialized Transportation)
- Vehicle Modifications
- Vocational Futures Planning & Support (VFPS)