Date No. and Title Change
June 4, 2018 Form 3052, Practitioner’s Statement of Medical Need, and Instructions Changes were made to the format to make it easier for doctors and providers to complete the form, including moving the diagnosis of mental illness statement to the second page, removing a duplicate functional limitation and Part IV, Medical Diagnosis(es) and ICD-10 Codes to the second page, and adding language regarding temporary medical need.
March 5, 2018 Form 2307-A, Family Care, Community Attendant Services and Primary Home Care Rights and Responsibilities, and Form 2307-AS (Spanish) Updates the eligibility monthly income amounts in Section II to reflect the 2018 Social Security Cost of Living Adjustment (COLA), changes case “manager” to “worker,” and removes In-Home and Family Support.
March 5, 2018 Form 2307, Rights and Responsibilities, and Form 2307-S (Spanish) Changes Item 10, Dignity and Respect, and the process an individual follows to file a complaint.
December 11, 2017 Form 1032, Residential Care Copayment Worksheet Changes the Residential Care Apartment rate to $15.60 and the Non-Apartment rate to $13.91 in Step 2.
September 11, 2017 Form 3052,  Practitioner’s Statement of Medical Need Adds a box on Page 2 for Individual Name and Individual No.
June 23, 2017 Form 3050, DAHS Health Assessment/Individual Service Plan, and Instructions Revises form and instructions to include members in STAR+PLUS.
June 23, 2017 Form 3055, Physician's Orders (DAHS), and Instructions Revises form and instructions to include members in STAR+PLUS.