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Annual Plan Rate Change Request Form

 
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sanga61



Joined: 22 Oct 2005
Posts: 13

PostPosted: Sat Oct 22, 2005 4:32 pm    Post subject: Annual Plan Rate Change Request Form Reply with quote

Every waiver recipient (your son or daughter) should have received a copy of a Notice of Action form mailed to them by their case manager. This Notice of Action will have a Serial Number on it ending with "RT2". The services the waiver recipient will receive effective November 1 are listed for each month through to the end of the Plan of Care.

Ask your case manager to review this information with you, and to assist in comparing the rates per month after November 1 with the rates prior to November 1. Also review the Service Planner that was used to show the services that were required to meet the needs of your son or daughter since these services were the basis of the costs.

If there is a substantial change in the rate, please contact your residential provider. An 'Annual Plan Rate Chage Request Form' was sent to providers. This form is to identify disputed rates, meaning that the new rate is so low the provider cannot meet the needs of the waiver recipient; as reflected by the hours of support shown on the Service Planner.

The provider should submit this form as soon as possible to the Division of Disability and Rehabilitative Services in Indianapolis. If you are dissatisfied with the response from your residential provider, please contact your case manager. If your case manager cannot help, then contact David Gootee at 1-800-545-7763, or in the Indianapolis area at 233-3828.

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