Assertive community treatment program 2026

1. Click ‘Get Form’ to open the Assertive Community Treatment Program Guidelines Waiver for Psychiatric Coverage Request Form in the editor.
2. Begin by entering the 'Date Request Submitted' and the 'Name of ACT Team Agency' at the top of the form. This establishes your agency's identity and timeline.
3. Fill in the 'Contact Person Name and Title', along with their phone number and email address. This information is crucial for communication regarding your waiver request.
4. In Section 1, provide details on current psychiatric coverage, including staffing levels. Be specific about how many hours are covered by both PNPs and psychiatrists.
5. For Section 2, articulate a detailed reason for needing a waiver. Clearly outline any challenges faced in meeting existing guidelines.
6. In Section 3, describe efforts made to comply with ACT Program Guidelines, including time frames for any psychiatric vacancies.
7. Section 4 requires you to outline future hiring plans for psychiatrists. Be proactive in detailing your strategy.
8. Finally, in Section 5, explain how your agency will meet complex psychopharmacology needs if the waiver is granted.
9. Review all sections carefully, check relevant boxes affirming compliance with requirements, and ensure that all necessary attachments are included before submission.

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