APD CDC+ Purchasing Plan Quick Update Form



Quick Update to My Purchasing Plan that was Effective:      

|Participant’s Name: |      |Participant’s ID #: |      |

A. Reason for this Quick Update: (You MUST Check one of the following and complete any blanks.)

| Replace current authorized provider with new provider. Current provider’s last day:      . New provider starts:      . |(B-C) |

| Change vendor in Savings, OTE or STE to authorize participant/representative reimbursement starting      . |(B-C) |

| Change the Estimated Date of Purchase for a Savings item, or the End Date for an OTE or STE. |(B-C) |

| Add or replace a service or support in the Savings section of the Purchasing Plan section starting      . |(B-D or D) |

| Add a provider ONLY AS an additional emergency backup provider starting      . |(D ONLY) |

B. Current Entry to be Replaced/Changed (You MUST Circle One: R E S T[1] ):

|Service Code |Descrip|Provider’s Name: | |Provider Type |

| |tion: | |Crit| |

| | | |ical| |

| | | |[2] | |

|PARTICIPANT/REPRESENTATIVE SIGNATURE | |PARTICIPANT/REPRESENTATIVE (PRINT/TYPE NAME) | |DATE |

| | |      | |      |

|CONSULTANT SIGNATURE | |CONSULTANT (PRINT/TYPE NAME) | |DATE |

| | |      | |      |

|APD AREA LIAISON SIGNATURE | |AREA LIAISON (PRINT/TYPE NAME) | |DATE |

Instructions for Quick Update Form (Version 3.0, 6/01/09)

This Form may be used for the following five specific purposes. At the top of the form, check the ONE purpose for which you are completing the Quick Update Form and follow the completion rules for each purpose, as shown below:

1. To replace a current authorized provider (employee, vendor or independent contractor) in any section of the Purchasing Plan with a new provider who needs to start providing services within seven to ten days. When using the Quick Update form to change a provider in SERVICES, OTE or STE Sections, the rate of pay, number of units, employer tax status, and the previously approved budget amount for the item cannot be changed. When changing a provider in SAVINGS, if anything has been paid to the first provider, the amount associated with the new provider should reflect only the amount to be saved to pay for services provided by the new provider.

◊ Enter the current service line exactly as it is shown on your most recently approved Purchasing Plan. Circle the section of the plan where the current approved item appears on the Purchasing Plan. Circle whether current service/provider is critical (Y=Yes, N=No, E=EBU).

◊ For SERVICES, OTE and STE, the replacement line must be exactly the same as the current service line in all respects except the name of the provider. That means if the current provider is NOT exempt from employer taxes, your new provider must also be a DHE who is NOT exempt from employer taxes – because you cannot change any budget line item amounts during the month. NOTE: You can replace a DHE who is exempt from employer taxes with an A/V or IC and vice-versa because the original approved budget for the service will not change. For SAVINGS, the provider type or employer tax status of the replacement provider can be different from the current provider because that will not appreciably increase the amount originally approved.

◊ Complete the last block entitled “DATE” only to change the estimated date of purchase for a SAVINGS item or the end date for an OTE or STE.

2. To change the provider of an approved Savings item, OTE or STE to enable the participant or representative to be reimbursed for the service/purchase because the participant or representative will be purchasing the item or service using his or her own money. NOTE: The participant or representative cannot be reimbursed for paying a directly hired employee OR an independent contractor with his or her own funds; the F/EA must be able to report all earnings of these provider types to the IRS and cannot do so through reimbursement.

◊ Follow the rules for purpose #1, above.

◊ The effective date must be the first of the month in which services being submitted for reimbursement were provided.

◊ The participant or representative may be reimbursed for only those purchases made at a local point-of-sale store or to vendors such as a dentist who requires payment at the time the service is rendered. All other vendors must be paid directly to the provider from CDC+.

◊ In the Provider’s/Payee’s section of the replacement line, enter the name of the provider, then “Partic/Rep Reimb”. Leave all other items blank.

3. To change only the estimated date of purchase for an approved Savings item or the “end date” of an approved One Time or Short Term Expenditure.

◊ Enter the current service line exactly as it is shown on your most recently approved Purchasing Plan.

◊ In the Date section of the replacement line, enter ONLY the new estimated date of purchase or end date, depending on whether the change is for Savings or OTE/STE. Leave all other items blank.

4. To add or replace a complete line item in the Savings section of the Purchasing Plan.

◊ Use rows B and D for a replacement; use only row D for an addition. Rows B and C are used only to replace providers or change est date of purchase.

5. To add an Emergency Back Up provider for a service in the Services Section of the current approved plan.

Note: This form may be used instead of completing a full Purchasing Plan for one of these five purposes. This form amends the most recently submitted Purchasing Plan, the effective date of which must be entered at the top of the form. Each signer is to attach a copy to the current approved full Purchasing Plan and then forward the original Quick Update form to the next signer. The APD Area Liaison is to send a copy of the approved form back to the Consultant. The next time the participant submits a new Purchasing Plan, the item on the Quick Update Form must appear on that plan or it will be removed from the participant’s authorized services. If the reason for using the Quick Update Form is to change the Provider, and the new provider will start working on the first of the following month, do not use this form unless you have missed the due date to submit a full purchasing plan. If the ONLY revision you need to make to a Purchasing Plan is to request a new savings item or change the estimated purchase date of a Savings item or the end date of an OTE or STE, you may use this form instead of completing a full Purchasing Plan, even if the change is effective on the first of a month. All Purchasing Plan rules apply to this document, as it is, in fact, an amendment to the Plan.

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[1] R = Services; E = One Time Expenditure; S = Savings; T = Short Term Expenditure

[2] Circle one: If the current provider is the primary provider, circle Y for yes, N for no; if the current provider is an emergency backup provider, circle E. Applies only to Services Section.

[3] Date = estimated date of purchase or end date; complete only if the current item is in the Savings, One Time or Short Term Expenditure section.

[4] Date = estimated date of purchase or end date; complete only when replacing the provider of a Savings, One Time or Short Term Expenditure.

[5] R = Services; S = Savings. These are the only sections of the Purchasing Plan to which additions may be made using this form.

[6] Date = estimated date of purchase; complete only if the item is being added to the Savings section

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