Access Washington Home



H05-099 – Procedure

December 21, 2005

|TO: |Home and Community Services (HCS) Division Regional Administrators |

| |Area Agency on Aging (AAA) Directors |

|FROM: |Penny Black, Director, Home and Community Services Division |

|SUBJECT: |Intervention Services – Form Changes |

|Purpose: |The purpose of this management bulletin is to inform staff of the changes to the Contract Request and |

| |Approval Sheet and the Contractor Letter Example. |

|Background: |The Contract Request and Approval Sheet and the Contractor Letter Example are two forms in a packet of forms |

| |sent to potential Intervention Services contractors. |

|What’s new, changed, or |The Contract Request and Approval Sheet is updated to better identify if the request is for an independent |

|Clarified |living, psychologist, psychiatric, or other intervention services contractor. |

| |The Contractor Letter Example is updated to outline insurance requirements. |

| |This management bulletin supercedes H05-095 – Procedure. |

|ACTION: |Effective immediately, use the updated forms. |

|Related | |

|REFERENCES: | |

| |HCS - Intervention Services Forms for forms and procedures |

| |Administrative Policy No. 13.11 |

|ATTACHMENT(S): |A19-1A Sample Invoice Voucher: |

| | |

| |[pic] |

| | |

| | |

| | |

| |Instructions for Completing the A19-1A Voucher: |

| |[pic] |

| |Background Authorization Form: |

| |[pic] |

| | |

| |BCCU Account Coding: Authorization for Intervention Svc: |

| |[pic] [pic] |

| | |

| |ADSA Intervention Services Contract Request & Approval: |

| |[pic] |

| |Sample Contract Cover Letter: Background Auth. FAQ’s: |

| |[pic] [pic] |

| |Instructions for Contractor Intake: |

| |[pic] |

| |Independent Living Consultants Procedure: |

| |[pic] |

| |Procedure to Authorize Services: |

| |[pic] |

| |w-9 Form: Access to Intervention Services Website: |

| |[pic] [pic] |

|CONTACT(S): |Carol Sloan Patty McDonald |

| |Program Manager Program Manager |

| |360-725-2345 360-725-2559 |

| |sloancs@dshs. mcdonpm@dshs. |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download