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Publications and Documents

Brochures

Title Type Posted Date
Adult Protective Services Brochure PDF 03/27/2018
PUB-417 Living Choices Assisted Living Brochure PDF 03/16/2018
The Arkansas Lifespan Respite Coalition Brochure PDF 02/05/2017
MDS Section Q Brochure PDF

Directories

Title Type Posted Date
2017 Senior Benefits Resource Guide PDF 02/12/2017
Money Follows the Person Provider List PDF

Forms

Title Type Posted Date
PC Referral Form PDF 03/21/2018
LTSS Application Packet PDF 02/23/2017
LTSS Application Packet - Spanish Version PDF 02/23/2017
LTSS Application Packet - Spanish Version PDF 02/09/2017
Arkansas Lifespan Respite Coalition Membership Agreement Form PDF 02/07/2017
LTSS Application Packet PDF 02/07/2017
APS-0001 Request for Adult Maltreatment Registry Information DOC 09/12/2016
DHS-0777 Long term Care Medicaid Application Educational Wrap PDF 12/31/2015
DHS-0777 Spanish, Long Term Care Medicaid Application for Assistance with Voter Registration PDF 12/31/2015
DHS-0777 Long Term Care Medicaid Application for Assistance with Voter Registration PDF 12/31/2015
DHS-4000 Authorization to Disclose Health Info-Release of Info Form DOC 10/31/2005
24 Hour Contact Informaton Form DOC
ARChoices in Homecare Provider Application PDF
Potential MFP Satisfaction Survey Questions DOC
DHS-8504 DAAS Home and Community Based Waiver Programs -  Start Services Form DOC
DHS-8505 Informed Consent Form DOC
DHS-8506 MFP Assessment and Personal History Form DOC
DHS-8507 Checklist of Clients Rights DOC
DHS-8508 Statement of Rights of MFP Participants DOC
DHS-8509 Provider Freedom of Choice Referral Form DOC
DHS-8510 Demonstration Services Freedom of Choice DOC
DHS-8511 Transition Risk Form DOC
DHS-8512 Risk Mitigation Monthly DOC
DHS-8520 General Professional Recommendation DOC
DHS-8521 Demonstration Services Plan of Care DOC
DHS-8523 Housing Info Checklist DOC
Helping Hands Respite Programs form PDF
MFP Emergency Dental Form DOC
MFP Form (Consent to Discuss ) DOC
MFP ITM Checklist DOC
Goods N Services Form DOC
Transition Services Form DOC

General Information

Title Type Posted Date
Arkansas Money Follows the Person Demonstration Operational Protocol PDF 01/30/2014

HCBS Materials

Title Type Posted Date
AR Home and Community-Based Services - Statewide Transition Plan PDF 12/05/2016
CMS feedback and initial approval letter PDF 11/17/2016

Letters

Title Type Posted Date
CMS STP Feedback Letter PDF 09/12/2016

News

Title Type Posted Date
Small Group TA Week 3 PDF 01/23/2017

Policy Crosswalk

Title Type Posted Date
DAAS Non-Residential Settings Policy Crosswalk PDF 09/12/2016
DAAS Residential Settings Policy Crosswalk PDF 09/12/2016
DDS Provider Owned-Controlled Residential Settings Policy Crosswalk PDF 09/12/2016

Program Overview

Title Type Posted Date
AR HCBS STP Narrative PDF 09/12/2016

Publications

Title Type Posted Date
LTSS PUB-350 - Spanish Version PDF 02/09/2017
Arkansas Lifespan Respite Coalition Day Proclamation PDF 02/07/2017
LONG-TERM SERVICES AND SUPPORTS (LTSS) INFORMATION PDF 02/02/2017
Medicare Protection Toolkit PDF 01/23/2017
AR HCBS STP Summary of Public Comments and State Responses PDF 09/12/2016
PUB-351 ARChoices In Homecare Brochure - Spanish PDF 03/31/2016
PUB-351 ARChoices In Homecare Brochure PDF 02/29/2016
Arkansas Nursing Home Consumer Guide PDF
BH-Brief-WanderingExit-Seeking PDF
BH-Brief-WanderingExit-Seeking PDF
Diabetes Brochure - Spanish PDF
Diabetes Brochure PDF
FAQs HCBS General PDF
FAQs Planned Construction and Person Centered Planning PDF
FAQs Unsafe Wandering and Exit Seeking Behavior PDF
HCBS Heightened Scrutiny Q and A PDF
Information on Heighted Scrutiny Process PDF
Settings that Isolate PDF
Update on HCBS Settings-timeline and heightened scrutiny PDF

Reference Chart

Title Type Posted Date
Quick Reference Medicaid Chart for 2017 PDF 01/25/2017
AR HCBS STP Timeline Chart PDF 09/12/2016

Reports

Title Type Posted Date
Assessment of Arkansas HCBS Non-Residential Settings report PDF 09/12/2016
Assessment of Arkansas HCBS Residential Settings report PDF 09/12/2016
State of the States in Aging and Disability:2015 Survey of State Agencies PDF 06/30/2015
Adult Protective Services (APS) Taskforce Report PDF

Resources

Title Type Posted Date
Arkansas HCBS Non-Residential Beneficiary Survey (draft) PDF 06/16/2016
Arkansas HCBS Non-Residential Site Review Survey tool (draft) PDF 06/16/2016
Arkansas HCBS Residential Beneficiary Survey PDF 03/16/2016
Arkansas HCBS Residential Site Review Survey Tool with Regs PDF 03/15/2016
HCBS Non-Residential Provider Self-Assessment Survey PDF
HCBS Residential Provider Self-Assessment Survey PDF
HCBS Excluded Settings and Heightened Scrutiny 10-26-2015 PDF
HCBS Settings Statewide Transition Plan REVISED 12-6-2016 PDF

Rules

Title Type Posted Date
Overview of the HCBS Setting Rule PDF 09/12/2016
Summary of HCBS Settings final rule PDF 09/12/2016

State Plan

Title Type Posted Date
Aging State Plan - Fiscal 2016 - 2019 PDF 05/08/2016

Arkansas Department
of Human Services
(501) 682-1001

TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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