The caseworker completes Form 2101. This renews the prior approval process for all ongoing Primary Home Care people, including transfer cases, not certified as Community Attendant Services (CAS) people. Instructions for items other than numbers 4 and 5, are covered in the instructions for Form 2101 in the Forms and Reports section.
Renewals
Item 4 Begin date
Item 5 End date
Renewal — no service plan change
NA — Do not send Form 2101.
NA — Do not send Form 2101.
Renewal with increase
Seven calendar days from date mailed or negotiated date.
Leave blank — date remains the same as current authorization.
Renewal with decrease
12 calendar days from the Form 2101 date unless appealed.
Leave blank — date remains the same as current authorization.
Service plan change between assessments
Item 4 Begin date
Item 5 End date
Increase
Seven calendar days from the Form 2101 date or negotiated date.
Leave blank — date remains the same as current authorization.
Decrease
12 calendar days from the Form 2101 date unless appealed.
Leave blank — date remains the same as current authorization.
Terminations
Item 4 Begin date
Item 5 End date
Loss of Medicaid eligibility
Remains unchanged.
Last day of month that person is determined ineligible for Medicaid.
Other eligibility criteria change such as type of residence, functional eligibility, unmet need
Remains unchanged.
12 calendar days from the Form 2065 date, unless appealed.
Person or someone in home threatens health or safety of provider
