New Choices – CMAs
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Case Management Agency Resources
This tab contains forms and other resources intended only for case management agencies (CMAs) that are contracted with the New Choices Waiver program. Other types of New Choices Waiver providers are not permitted to complete these forms as they are only valid and accepted when completed by CMA representatives. If other entities believe that one of these forms should be completed for a particular New Choices Waiver client, they must contact the client’s chosen CMA to request it.
Case Management Agency Forms and Documents
CMAs are permitted to print these forms for use with their New Choices Waiver clients. These are PDF copies and are not typable. Some of the forms are available in Word format, but not on this website. If a case manager would like a Word copy of a particular form, please contact the New Choices Waiver program office to request it.
This is NOT an all-inclusive list of required forms for New Choices Waiver CMA providers. There are additional forms that CMAs are required to complete for their waiver clients that will not be posted on this website. (Examples include Service Authorization Forms, Freedom of Choice of Providers Forms, SAS forms, etc). If a CMA needs to obtain any of the other forms that do not appear in this list, please contact the New Choices Waiver program office.
Documents
114AR DWS Release Form July 2016.pdf opens in a new tab
Approved CMA NOD January 2015.pdf opens in a new tab
CMA Fax Cover Sheet 10.15.2016.pdf opens in a new tab
Disenrollment Form DPF-1 10-25-2018 opens in a new tab
DPF-2 Special Circumstance Involuntary Disenrollment Request 1-1-15.pdf opens in a new tab
Health and Safety Agreement Template 2014.pdf opens in a new tab
Health Status Screening Report Effective 4.11.13.pdf opens in a new tab
LOC Determination Form NCW 1.21.2014.pdf opens in a new tab
Memory Care Checklist Effective 10-25-2018 opens in a new tab
Rental Agreement Template 7.1.15.pdf opens in a new tab
Rights and Responsibilities-Final Effective 7-1-15.pdf opens in a new tab