Policy and Forms

Chapter 513 Intellectual and Developmental Disabilities Waiver Policy

Policy Clarifications
Click here to view the newest Policy Clarifications

Approved I/DD Waiver Forms
Effective December 1, 2015

PDF Version​​​                   Information              

  Instructions​

 

 ​Microsoft Word Version
Please note the file may ask for a password
just press Enter.
​IDD Waiver 2015 Manual Training Registration Form ​How to Report Abuse/Neglect Brochure ​ ​
IDD 01 Application​ ​ ​ ​IDD 01 Application​
​IDD Direct Support Services Living Arrangement Assessment ​ ​ ​​IDD Direct Support Services Living Arrangement Assessment
IDD 02 Freedom of Choice​ ​ ​ ​IDD 02 Freedom of Choice​
​IDD 03 SC HV_DV Combined ​ ​ ​IDD 03 SC HV_DV Combined
IDD 04 Initial Individualized Program Plan​ ​ ​ ​IDD 04 Initial Individualized Program Plan​
​IDD 05 Individualized Program Plan (IPP) ​ ​ ​​IDD 05 Individualized Program Plan (IPP)
​IDD 06 Certificate of Training ​ ​ ​IDD 06 Certificate of Training
​IDD 07 Direct Support Document ​ ​ ​​IDD 07 Direct Support Document
​IDD 08 Request for EAA G&S ​ ​ ​IDD 08 Request for EAA G&S
​IDD 09 Request for Nursing Services ​ ​ ​IDD 09 Request for Nursing Services
​IDD 10 Transfer Discharge ​ ​ ​IDD 10 Transfer Discharge
​IDD 11 Notification of Death Form ​ ​ Notification of Death Form ​​IDD 11 Notification of Death Form
​IDD 12 Request  to Continue Services ​ ​ ​IDD 12 Request to Continue Services
​IDD 13 Assessment Data Modification Request ​ ​ ​​IDD 13 Assessment Data Modification Request
​IDD 14 LPN Medication Admin Progress Notes ​ ​ ​IDD 14 LPN Medication Admin Progress Notes
​IDD 15 Remote Monitoring Application ​ ​ ​IDD 15 Remote Monitoring Application
​IDD 16 Remote Monitoring Equipment ​ ​ ​IDD 16 Remote Monitoring
​IDD 17 Remote Monitoring Risk Assessment ​ ​ ​IDD 17 Remote Monitoring Risk Assessment
​Self-Audit/Self-Report Form ​ ​ ​
​Standard Repayment Form ​ ​ ​
​Payment Voucher ​ ​ ​
IDDW and PC Dual Services Request Form ​IDD PC Dual Schedule Template Example ​IDDW and PC Dual Services Request Form Instructions ​IDDW and PC Dual Services Request Form
​Exceptions Request ​ ​ ​Exceptions Request

 

350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700 | Contact Us | Site Map