Community choices waiver provider manual - Lamedicaid 2026

1. Click ‘Get Form’ to open the community choices waiver provider manual in the editor.
2. Begin by filling out the Company or Doing Business As (DBA) field, followed by the Federal Employer Identification Number (FEIN). Ensure accuracy as this information is crucial for your application.
3. Next, provide details for the Legally Authorized Representative, including their name and phone number. This section is vital for communication regarding your application.
4. Complete the Agency Address section with both physical and mailing addresses. Double-check that all addresses are correct to avoid any delays in processing.
5. In the Program(s) and Services sections, select all applicable options that your agency will provide. This helps clarify your offerings to Medicaid.
6. List all counties served and ensure you include all relevant areas where services will be provided.
7. For Provider Staff, enter each staff member's name, position, contact information, and type of case management they will provide. Attach necessary licenses or diplomas as required.
8. Finally, review the certification statement at the end of the form. Ensure it is signed and dated by the Legally Authorized Representative before submission.

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