Entering an Application for the Technology Dependent Waiver Program for a State User

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? Identify and complete the Start Application/ Pres-screeing questions Technology Dependent Waiver
? Identify and complete the Entering Applicant/Member/Authorized Rep and Emergency Contact Details sections.
? Identify and complete the Request for Evaluation
? Identify and complete the Select a Provider
? Identify and complete the Upload/View Documents for

Entering an Application for a Technology Dependent Waiver

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? How to start application and answer pre-screeing questiosn
? How to Enter Details Application for TechnolgyWaiver not in a Facility
? How to enter data and compelte the Request of Evaluation section
? How to enter and complete the Select a Provider for a Technology Dependent Waiver
? How to tenter and complete the Upload/View Documents N
? How to sumbit your application for a Technology Dependent Waiver

Overview: Technology Dependent Waiver

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? Identify and complete the Start Application/ Pres-screeing questions Technology Dependent Waiver
? Identify and complete the Entering Applicant/Member/Authorized Rep and Emergency Contact Details sections.
? Identify and complete the Request for Evaluation
? Identify and complete the Select a Provider
? Identify and complete the Upload/View Documents for

Overview: Utilizing the Application Referral Page for Various Waivers

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Introduced to:
? Acces points to Application Referral page through external links in PRISM and Utah Medicaid Webisite
? Aging Waiver
? New Choices Waiver (ALF) (NF) and (Not in a Facility)
? Technolody Dependent Waiver
? Employment-Related Personal Assistant abberviated as EPAS