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Attachment B Forms for New Chocies Waiver Provider Enrollment

Instructions:

Providers must complete the Attachment B that corresponds to the New Choices Waiver service that the provider is qualified to provide and intends to offer.  If the provider has selected and plans to offer more than one New Choices Waiver service, the provider must complete a separate Attachment B for each of the distinct services.  If you need to verify which service(s) your agency has signed up to offer through New Choices Waiver, please return to your provider file within the PRISM Portal and review this information in the section labeled "HCBS Waiver and EPAS."

When the provider has reviewed and signed the document(s), the final page of each Attachment B must be uploaded to the provider's file within the PRISM portal. If you have questions about the Attachment B content or anything else related to New Choices Waiver provider enrollment, please call (800)662-9651, option 6 and ask to speak with the NCW Provider Enrollment Specialist.

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Provider Training
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