My ODP

Intake Eligibility / Level of Care

Attachment 3: Level of Care Re-Evaluation Tool

Attachment 4: Re-evaluation Instructions

DP 250 - User Friendly

DP 251 - User Friendly

DP 1090

Level of Care Evaluation - Eligible for ICF-ID or ICF-ORC – Results of Review Letter

Level of Care Evaluation - Not Eligible – Results of Review Letter

Level of Care Re-evaluation - Eligible for ICF-ID or ICF-ORC – Results of Review Letter

Level of Care Re-evaluation - Not Eligible – Results of Review Letter

Waiver ICF-ID  LOC letter – Initial (waiver capacity available)

Waiver ICF-ID LOC documentation – Initial (no waiver capacity)

Waiver ICF-ORC LOC for children prior to age 9 with Developmental Disabilities documentation – Initial (waiver capacity available)

Waiver ICF-ORC LOC for children prior to age 9 with Developmental Disabilities documentation – Initial (no waiver capacity)

Waiver ICF-ORC LOC for children prior to age 9 with Developmental Disabilities documentation – Additional information Required

Waiver ICF-ORC LOC for people with ASD documentation – Initial (waiver capacity available)

Waiver ICF-ORC LOC for people with ASD documentation – Initial (no waiver capacity)

Waiver ICF-ORC LOC for people with ASD documentation – Additional Information Required

Examples of Billable TSM Transition Activities