EPSDT Policy Instructions (80 KB)
Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years of Age (42 KB)
Health Check Coordinators (177 KB)
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| Appendix | Content |
|---|---|
| 1 | Health Check Program Overview |
| 2 | Health Check Contact List |
| 3 | Managed Care Consultants |
| 4 | Health Check Project Agreements - DMA Agreements; DPH Agreements; DMA Collaboration Agreements |
| 5 | Health Check Coordinator Job Description |
| 6 | Suggested Local Orientation Guide for New Health Check Coordinators |
| 7 | Health Check Outreach Project Annual Plan Form |
| 8 | Health Check Outreach Project Site Visit, Evaluation Form |
| 9 | Automated Information and Notification System Overview |
| 10 | County Options Change Request - Instructions; COCR Form |
| 11 | Monthly Accounting of Activities Report - Instructions ; MAAR Form |
| 12 | Health Check Implementation Plan |
| 13 | Funding & Budgetary Guidance for Health Check Outreach Projects |
| 14 | Letter of Intent |
| 15 | Abbreviations |
| 16 | Technical Visit Form |
| 17 | Standard Letters (English) |
| 17 | Standard Letters (Spanish) |
| 17 | Standard Letters (Hmong) |
| 18 | Dental Lawsuit Settlement Agreement |
| 19 | ER Letters (English) |
| 19 | ER Letters (Spanish) |
| 20 | HIPAA Memo to HCC's & Local Care Manager |