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Publications and Documents

Brochures

Title Type Posted Date
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
HCBS-Support Services Phone List PDF 05/08/2016
DAAS Let’s Go Transportation Directory 2014 PDF
Money Follows the Person Provider List PDF
Social Security Administration District Offices PDF

Forms

Title Type Posted Date
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
Personal Care Referral Form PDF

Frequently Asked Questions

Title Type Posted Date
ARChoices Provider Workshop Q & A PDF 11/30/2015

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

Newsletter

Title Type Posted Date
January-March 2017 PDF 02/05/2017

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

Proposal

Title Type Posted Date
Recommendations to Balance Arkansas’ Long-Term Care System PDF

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 Guide to Services for Children with Disabilities PDF 06/03/2007
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
Your Guide to Medicaid Estate Recovery in Arkansas 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
HCBS RN County Cross Reference Chart PDF 06/01/2016

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
HCBS Waiver Quality Assurance Reports - 2009 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
title here 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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