Application and Referral Process for Admission to Services
CSBs/Behavior Health and other referring agencies referring Individuals for services should submit to Cabaniss the following to be considered for admission: (email to dcabaniss@cabanisshomes.com or fax to 434-846-2190)
- DMAS 20 Consent to Exchange Information
- Application Referral form
- Medicaid Waiver Slot approval letter or documentation of other funding source
- Social Assessment (PCP/ISP Parts I-IV)
- Supports Intensity Scale (SIS) or other similar assessment results
- ICF/MR LOF checklist
- Psychological
- Medical History
Upon receipt of the above, Cabaniss Consultants, LLC representatives will call to schedule a visit & interview the individual;
Complete the Skills Behavior Checklist;
Schedule a visit to the group home (need copies of Rx, medications, money, picture ID, emergency contact)
During the visit, review Skills Checklist, write detailed activity notes;
Make recommendations for transitioning if considered to meet criteria for admission
Prior to beginning services the referring agency should submit to Cabaniss the following;
- DMAS-225 (Notice of Action on Medicaid and FAMIS Programs)
- Physical exam including TB test completed less than 30 days prior to admission
- Copy of all prescriptions including prescriptions for over the counter medications
- Statement of Income from SSA
- Copy of SSN card
- Copies of Medicaid and other insurance cards
- Photo ID card
- Proof of Citizenship (Birth Certificate)