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: 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

Entering an Application for the New Choices Waiver When Not Currently Living in a Facility for a State User

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? Identify and complete the Start Application/ Pres-screeing questions sections of NCW for a Nursing Home
? Identify and complete the Entering Applicant/Member/Authorized Rep and Emergency Contact Details sections.
? Identify and complete the Request for Evaluation for a Alf
? Identify and complete the Other Facility Details ALF
? Identify and complete the Select a Provider for an NCW
? Identify and complete the Upload/View Documents for NCW

Entering an Application for a New Choices Waiver for Currently Living in an Assisted Living Facility for a State User

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? Identify and complete the Start Application/ Pres-screeing questions sections of NCW not in a Facility
? Identify and complete the Entering Applicant/Member/Authorized Rep and Emergency Contact Details sections.
? Identify and complete the Request for Evaluation for a Alf
? Identify and complete the Other Facility Details ALF
? Identify and complete the Select a Provider for an NCW
? Identify and complete the Upload/View Documents for NCW

Entering an Application for a New Choices Waiver Not Currently Living In a Facility

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? Identify and complete the Start Application/ Pres-screeing questions sections not in a Facility
? 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 Other Facility Details
? Identify and complete the Select a Provider
? Identify and complete the Upload/View Documents

Entering an Application for the New Choices Waiver When Currently Living in a Nursing Facility

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? Identify and complete the Start Application/ Pres-screeing questions sections of NCW for an Nursing Facility
? Identify and complete the Entering Applicant/Member/Authorized Rep and Emergency Contact Details sections.
? Identify and complete the Request for Evaluation for a Alf
? Identify and complete the Other Facility Details ALF
? Identify and complete the Select a Provider for an NCW
? Identify and complete the Upload/View Documents for NCW

Entering an Application for the New Choices Waiver When Currently Living in an Assisted Living Facility

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? Identify and complete the Start Application/ Pres-screeing questions sections of NCW for an ALF
? Identify and operate the Entering Applicant/Member/Authorized Rep and Emergency Contact Details sections.
? Identify and operate the Request for Evaluation for a Alf
? Identify and operate the Other Facility Details ALF
? Identify and operate the Select a Provider for an NCW
? Identify and complete the Upload/View Documents for NCW