RFP, RFV, at mga OPP

ATTACHMENT A - HCBS PROPOSAL TITLE PAGE FY 24 25 ATTACHMENT B - STATEMENT OF OBLIGATION ATTACHMENT C - DS 1891 Medicaid Integrity Form

Project 1- Socialization Training Program (028) Project 2- Social Recreational Programs (525) Project 3- Specialized Recreational Therapy (106) Project 4- Art Therapist (691) Project 5- Dance Therapist (692) Project 6- Music Therapist (693) Project 7- Recreation Therapist (694) Project 8- Camping Services (850) Project 9- Sports Club (008) Attachment A: Pahina ng Pamagat Attachment B: Pahayag ng Obligasyon Attachment C: Statement of Equity and Diversity Guide

SDP Standardized Vendorization Packet para sa Pre-Enrollment Services Person Centered Planning at Self-Directed Supports Guidance Attachment A: Vendor Packet Checklist Attachment B: General Self-Directed Supports Qualifications and Agreement Form Attachment C: Mga Serbisyo sa Pamamahala ng Pinansyal na Self-Directed Supports Qualifications and Agreement Form Attachment D: DS 1890 Vendor Application Attachment E: DS 1891 Applicant/Vendor Disclosure Statement Attachment F: Conflict of Interest Form Attachment G: Business Associate Agreement/HIPAA Form Attachment H: Home at Community Based Services Provider Agreement Form Attachment I: Kahilingan ng W9 para sa Taxpayer Identification Number at Certification

Kalakip A: Pahina ng Pamagat ng Panukala Attachment B: Pahayag ng Obligasyon Attachment C: Statement of Equity and Diversity Attachment D: Pahayag ng Gastos Attachment E: Mga Kinakailangan sa Pagsulat ng Panukala Attachment F: Direktiba ng DDS Attachment G: Business Plan Attachment H: CFS Service Code Attachment I: CFS Fact Sheet Attachment J: CFS Referral at Service Need form Attachment K: CFS Provider Quarterly Reporting Tool

Kalakip A: Pahina ng Pamagat ng Panukala Attachment B: Pahayag ng Obligasyon Attachment C: Business Plan Attachment D: Statement of Equity and Diversity Attachment E: Pahayag ng Gastos ng NLACRC

Kalakip A: Pahina ng Pamagat ng Panukala Attachment B: Pahayag ng Obligasyon Enclosure C: CCP Referral at Service Need Evaluation Form Attachment F: CCP Program Design Guidance Enclosure A: Paglalarawan ng Code ng Serbisyo ng CCP Enclosure B: Person Centered Career Plan Service Provider Fact Sheet Enclosure C: CCP Referral at Service Need Evaluation Form Enclosure D: Fact Sheet ng CCP para sa Mga Potensyal na Tagabigay ng Serbisyo Enclosure E: CCP Fact Sheet para sa mga Indibidwal at Pamilya

Kalakip A: Pahina ng Pamagat ng Panukala Attachment B: Pahayag ng Obligasyon Attachment C: Mga Kinakailangan sa Pagsulat ng Panukala Attachment D: Mga Kinakailangan sa Disenyo ng Programa Attachment E: DS1890 Attachment F: DS1891 Attachment G: Kasunduan sa Provider ng HCBS Attachment H: Halimbawang Kontrata sa Transportasyon Attachment I: Patakaran sa Seguro ng Tagabigay ng Serbisyo ng NLACRC Board of Trustees Attachment J: Pahayag ng Gastos Attachment K: Mga Batas at Regulasyon Kalakip L: W-9