Operating Agreement Terms and Conditions Definition of Terms. The following capitalized terms as used in this Agreement are defined as set forth below: Administrative Entity: AE (AE) – A county/joinder or non-governmental entity that enters into and maintains a signed current agreement with the Department to perform administrative functions delegated by the Department, as the Department’s designee, in compliance with the Department’s approved Consolidated and P/FDS Waivers, Written Policies and Procedures and Departmental Decisions. Agency With Choice (AWC) – A type of Financial Management Services (FMS) where a provider supports a Participant or Participant’s Surrogate acting as the Managing Employer in the management of the Participant’s Support Service Workers (SSW’s) and supports and services authorized in the Participant’s Individual Support Plan (ISP). Annual Review Update – The category field in the Home and Community Services Information System (HCSIS) used to document the results of an ISP annual review meeting. The annual review update date is the end date of the current ISP. Approved Program Capacity (APC) – The individual capacity established by the Department for each Waiver-funded licensed service location. Assessed Needs – Needs of Waiver Participants identified through a valid assessment (SIS, PT, OT, Speech, etc.) that have been conducted based on the Participant’s unique circumstances, documented in writing including frequency and duration, when applicable prescribed by a licensed medical professional, and identified as a required need by the Participant’s team responsible for developing the ISP. Auto Approval and Authorization – web-based process that allows ISPs that meet criteria to be auto approved and services authorized automatically. Bureau of Hearings and Appeals (BHA) – The Departmental entity charged with conducting administrative hearings and adjudication of appeals which are filed in accordance with state and federal regulations. Centers for Medicare & Medicaid Services (CMS) – The agency in the federal Department of Health and Human Services that is responsible for federal administration for Medicaid, Medicare, and State Children’s Health Insurance programs. Claim – A bill for a service(s) or a line item of service within a bill for a service(s) provided to a Waiver Participant that is submitted through the Provider Reimbursement and Operations Management Information System in electronic format (PROMISe™) Common-Law Employer – The participant or his/her designee that is the legal employ...
