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How do I fill this out?
To fill out the IDD Qualifying Diagnosis Certification form, follow these instructions. You must secure the necessary forms from the SDS website and ensure they are completed by a qualified professional. Submit the completed forms and supporting documents to SDS.
How to fill out the IDD Qualifying Diagnosis Certification Guidelines?
1
Download the QDC and Request for Qualifying Diagnosis Certification forms from the SDS website.
2
Attach the Request form to the QDC and send to a qualified professional for completion.
3
Ensure the form is completed within the previous 12 months by a licensed professional.
4
Submit the completed QDC form to SDS.
5
Assist the applicant or guardian in submitting comprehensive evaluation and testing documents.
Who needs the IDD Qualifying Diagnosis Certification Guidelines?
1
Care coordinators need this file to verify the diagnosis of individuals applying for IDD waiver services.
2
Applicants need this file to provide necessary documentation for the IDD waiver program.
3
Qualified professionals need this file to certify the diagnosis required for program eligibility.
4
Parents or guardians of applicants need this file to support their child's application for IDD services.
5
SDS staff need this file to assess and approve IDD waiver service eligibility.
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What are the instructions for submitting this form?
To submit the IDD Qualifying Diagnosis Certification form, email the completed form to sds@alaska.gov or fax it to (907) 269-3639. You can also submit the form through the SDS online submission portal available on their website. Alternatively, mail the document to: Division of Senior and Disabilities Services, P.O. Box 110680, Juneau, AK 99811-0680. Ensure all supporting documents are included for a complete submission. For any questions or further assistance, contact SDS at (907) 269-3666.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, the form must be completed within the previous 12 months of submission. Ensure timely submission to avoid delays in eligibility reviews.
What is the purpose of this form?
The IDD Qualifying Diagnosis Certification form is used to verify the diagnosis of individuals applying for the intellectual or developmental disabilities waiver program. It ensures that applicants meet the necessary medical criteria for home and community-based Medicaid waiver services. The form must be completed by a licensed professional and submitted to the Division of Senior and Disabilities Services (SDS) to determine program eligibility.
Tell me about this form and its components and fields line-by-line.
- 1. Applicant Information: Contains personal details such as name, date of birth, and contact information of the applicant.
- 2. Qualified Professional Information: Includes the name, credentials, and contact information of the licensed professional completing the form.
- 3. Diagnosis Details: Provides specific information about the diagnosed intellectual or developmental disability.
- 4. Evaluation and Testing: Details the comprehensive evaluation and testing conducted to support the diagnosis.
- 5. Submission Details: Includes the date and signature of the qualified professional certifying the diagnosis.
What happens if I fail to submit this form?
Failure to submit the IDD Qualifying Diagnosis Certification form can result in delays or denial of waiver service eligibility.
- Delayed Eligibility Reviews: Without timely submission, eligibility for services may be delayed.
- Denial of Services: Incomplete or missing documentation can lead to denial of IDD waiver services.
- Additional Documentation Requests: SDS may request further documentation if the form is not properly completed, causing further delays.
How do I know when to use this form?
- 1. Initial Application: Submit the form when applying for the first time for IDD waiver services.
- 2. Periodic Review: Use the form for annual reviews of eligibility for continued waiver services.
- 3. Change in Diagnosis: Submit an updated form if there are changes in the diagnosed condition.
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