Prior Approval

Prior Approval A. Prior approval must be obtained from the Division of Medicaid before a beneficiary can receive services through the Assisted Living (AL) Waiver program. To obtain approval, the waiver case manager must complete and submit the current Division of Medicaid approved forms as follows: 1. Long-Term Services and Supports (LTSS) Assessment, 2. Bill of Rights, 3. Plan of Services and Supports (PSS), 4. Emergency Preparedness Plan, 5. Informed Choice, and 6. Physician or Nurse Practitioner Certification of Nursing Facility Level of Care at initial certification, readmission certification, and as required by DOM. B. All requests for increases and decreases in services must be submitted to the Division of Medicaid and must include documentation to substantiate the need for the change. Any request to add or increase services listed on the approved PSS must receive prior approval.