Common Contracts
1 similar Provider Agreement contracts
ADULT FOSTER CARE or HOME FOR THE AGED PROVIDER AGREEMENTProvider Agreement • April 18th, 2003
Attached is an Adult Foster Care Facility or Home for the Aged Provider Agreement form and instructions for completing this form. This form must be completed by all Adult Foster Care (AFC) or Home for the Aged (HA) providers in order to receive payment for Personal Care Services provided to eligible Medical Assistance (Medicaid) Program beneficiaries. A separate agreement is required for EACH facility. The agreement may be initiated by contacting either a local Family Independence Agency or Community Mental Health Agency.
