8606a 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the individual's name and Medicaid number at the top of the form. This information is crucial for identifying the recipient of services.
3. Next, fill in the Case Management Agency (CMA) name and vendor number. This helps in tracking and managing therapy requests efficiently.
4. In the section for requested skilled or specialized therapy, clearly specify the type of therapy needed. Be precise to ensure appropriate services are provided.
5. List any non-waiver resources that have been exhausted prior to this request. This demonstrates due diligence in seeking alternative support.
6. Provide a detailed diagnosis and a brief description of the need for services. This section should outline specific qualifying conditions requiring treatment.
7. Describe or attach planned interventions, including baseline data, goals, objectives, implementation plans, and service details such as scope, duration, amount, frequency, and location.
8. Indicate whether components of the requested service can be delivered by someone other than a therapist by selecting 'Yes' or 'No'. If 'No', provide details on what requires a licensed professional.
9. Outline a plan for transferring therapy services to a non-therapist if applicable, detailing how the therapist's role will shift to supervisory.
10. Finally, ensure that all signatures are completed by both the case manager and the professional involved before submitting your form.

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