prescreening questionnaire

SERVICE FACILITATION
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• Personal Care, Respite Care, Companion Care 
• Initial functional assessment of needs
• Person-Centered care planning
• Maintain service authorizations to prevent lapse in service. 
• Training to individuals or their authorized representatives 
• Explain Medicaid policies, program requirements, and responsibilities
• Conduct regular home visits to monitor and ensure care is effective and safe.
• Address concerns or changes and adjust the POC
• Assist with fiscal agent enrollment with PPL or CDCN. 
• Maintaining Compliance

TO BE ELIGIBLE FOR SERVICES

HE INDIVIDUAL MUST: 

Have active Medicaid coverage.

• Be enrolled in or eligible for a Medicaid waiver program (CCC+, FIS, CL Waiver).
• Reside in a service area supported by Inspired Life Services.
• Require assistance with daily living activities, personal care, supervision, or other waiver-related supports.
• Have an Employer of Record or Designated Representative who is willing and able to manage caregiver responsibilities for consumer-directed services.

Completing the pre-screening questionnaire helps us determine eligibility and identify the next steps. 

PRESCREENING QUESTIONNAIRE

CASE MANAGEMENT
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• Collaboration with Managed Care Organizations (MCO) and Community Services Boards (CSB) 
• Service Modifications 
• Personalized Support 
• Community Resources
• Advocacy 

WAIVERS & PROGRAMS
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• CCC Plus Waiver 
• Developmental Disability Waivers (DD)
• Community Living 
• Family and Individual Support 
• Early Periodic Screening Diagnosis and Treatment Program (EPSDT)

IMPORTANT INFORMATION ABOUT

CAREGIVERS

• Paid caregivers must be at least 18 years old and pass all required background checks.
• Not all family members are eligible to serve as paid caregivers.
• Under CCC+, parents of minor children and spouses (LRIs) may only be approved as paid caregivers in limited circumstances and when supported by sufficient documentation.
• For a parent of a minor child to be approved as a paid caregiver, the child's care needs must be extraordinary and exceed typical parental responsibilities.
• EPSDT services do not allow parents to serve as paid caregivers.

​EXTRAORDINARY CARE GUIDE 

LEGALLY RESPONSIBLE INDIVIDUALS (LRIs) 

WHAT YOU WILL NEED TO GET STARTED: 

COMMON ACRONYMS 

• Medicaid card and Medicaid ID number
• Managed Care Organization (Anthem, Aetna, Sentara, Humana, etc.)
• Current waiver type (CCC+, FIS, or CL Waiver) or EPSDT
• Most recent screening: UAI or DMAS 7 (EPSDT screening form)
• Support Coordinator or Care Coordinator contact information
• Current ISP or service plan (if applicable)
• Legal guardianship paperwork (if applicable)
• Employer of Record or Designated Representative information for consumer-directed services
• Contact information for the individual and primary caregiver/family representative
• Providing this information early helps us verify eligibility, avoid delays, and move through the intake process more efficiently.

Have more questions?  CONTACT US

DD Waiver – Developmental Disabilities Waiver
FIS – Family & Individual Supports Waiver
BI – Building Independence Waiver
CL – Community Living Waiver
ISP – Individual Support Plan
UAI – Uniform Assessment Instrument
MCO – Managed Care Organization (Anthem, Aetna, Sentara, Humana, etc.)
DMAS – Department of Medical Assistance Services
EPSDT – Early, Periodic Screening, Diagnostic & Treatment
EOR – Employer of Record
DR – Designated Representative
EVV – Electronic Visit Verification
PPL – Public Partnerships LLC (Fiscal Agent)
CDCN – Consumer Direct Care Network 
FA – Fiscal Agent 
SF – Service Facilitator
CC – Care Coordinator 
SC – Support Coordinator
PCA – Personal Care Attendant