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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. |
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