The Office of Developmental Programs (ODP) issued Bulletin 00-18-02 to disseminate an updated PA 1768 Home and Community-Based Services (HCBS) Eligibility/Ineligibility/Change Form, and to provide guidance for completion of the form. The intent of the updated form is to improve communication between the County Assistance Office (CAO) and the designated ODP entities that must inform the CAO of eligibility status of waiver recipients.

Notable changes include:

• The addition of Part I, “Complete for New HCBS Applicants”;
• The addition of Part II, “Complete for HCBS Recipients reporting an Update, Change, Transfer or Termination”;
• The addition of the Community Living Waiver in the Eligibility/Coding Section; and
• Revised terminology throughout the PA 1768 form to accommodate several programs’ needs.

The electronic version of PA 1768 may be completed in HCSIS by the individual’s supports coordinator. Provider agencies, families, and individuals may not complete and submit the PA 1768 directly to the CAO. All must work with the SC for any changes where the form must be completed and submitted to the CAO.

The term “HCBS Provider” as an enrolling agency in the “PA 1768 Originator” section includes Supports Coordinator Organizations.

The Money Follows the Person (MFP) code must be entered on the PA 1768 when applicable. The CAO will not enter an MFP code in its information system if it is not on this form.

The PA 1768 form does not eliminate the requirement for the Administrative Entity or County MH/ID program to document program eligibility for a waiver on ODP – approved forms. A service plan will be completed and will include specific services that will be received once the individual is enrolled in the waiver and the date that services will begin.