Long-Term Services and Supports Case Management Forms and Tools
CMA Forms CCM Resources CIRS Forms DD Forms NOA Forms Program and Waiver Resources
HCBS State Review and Exceptions Requests ISLA/SIS Resources Other Forms and Resources
Forms and resources used primarily by Case Management Agencies (CMA):
Case Management Agency Forms (Offline)
- Care Plan Form - July 2023
- LTC Assessments for IADLs Form - July 2023
- Service Plan Form - July 2023
- Assessment/Support Plans: LTC Level of Care Eligibility Assessment (Legacy ULTC 100.2) - June 2023
- This form replaces the ULTC 100.2 Initial Screening and Intake Form
- This form replaces the ULTC 100.2 Initial Screening and Intake Form
- Colorado Intake Screen Tool - Updated June 29, 2023
- This form replaces the ULTC 100.2 Initial Screening and Intake Form
- This form replaces the ULTC 100.2 Initial Screening and Intake Form
- Case Management Agency and Eligibility Information Sharing Form - January 2024
- This form replaces the Case Management Agency and Eligibility Information Sharing Form - 2018 and June 2023
- This form replaces the Case Management Agency and Eligibility Information Sharing Form - 2018 and June 2023
- Service Plan Signature Page - Updated January 2025 for Accessibility
- No changes to this form - continue to use this form per regulatory and contractual requirements.
- No changes to this form - continue to use this form per regulatory and contractual requirements.
- Professional Medical Information Page (PMIP)
- No changes to this form - continue to use this form per regulatory and contractual requirements.
Care and Case Management System (CCM) Resources
Critical Incident Report (CIRS) Forms (Offline)
- Critical Incident Form - Criminal Activity - June 2023
- Critical Incident Form - Damage to Consumer's Property or Theft - June 2023
- Critical Incident Form - Death - June 2023
- Critical Incident Form - Injury or Illness to Client - June 2023
- Critical Incident Form - Medication Management - June 2023
- Critical Incident Form - Missing Person - June 2023
- Critical Incident Form - Mistreatment, Abuse, Neglect, Exploitation - June 2023
- Critical Incident Form - Unsafe Housing - June 2023
- Critical Incident Form - Other High-Risk Issues - June 2023
Reminder - Case Managers please refer to the CCM job aid for Critical Incident Reports
CIRS Resources for Participants
- Critical Incident and Mistreatment Reporting - Participant Quick Guide - July 2019
- Critical Incident and Mistreatment Reporting - Participant Education and Contacts - July 2019
Developmental Disability Determination Forms and Resources
- Developmental Disability Determination Definition Fact Sheet - Updated January 2021
- Spanish version - January 2021
- Spanish version - January 2021
- Developmental Disability and Delay Determinations FAQ - April 2020
- Spanish version - April 2020
- Spanish version - April 2020
- Request for Developmental Disability Determination Form - Updated July 2019
- Spanish Version - May 2019
- Spanish Version - May 2019
- Informational Memo - IM 19-054 - Developmental Disability and Delay Determinations Frequently Asked Questions - September 2019
- Developmental Disability and Delay Determinations FAQ Sheet - September 2019
- Developmental Disability and Delay Determinations FAQ Sheet - September 2019
- Informational Memo - IM 18-49 - The Role of Psychological Testing in Accessing Medicaid Services FAQ - December 2018
Notice of Action (803) Forms
- Long-Term Care Application Status Letter - Updated September 9, 2025 (auto download)
- Long-Term Care Benefits Status Letter - Updated September 9, 2025 (auto download)
- Long-Term Care Developmental Disabilities (DD) Waiver Waitlist Letter - Updated September 9, 2025 (auto download)
- Long-Term Care Medicaid Sustainability Service Plan Revision Letter - January 2026 (auto download) - New!
- Case Status Advisement Letter - Updated August 2025 (auto download)
- Long-Term Care Notice of Action Withdrawal Letter - Updated October 2025 (auto download)
Program and Waiver-Specific Resources
- ACF/SLP/TLP PETI Form
- Age-Appropriate Guidelines for ULTC 100.2 - January 2026
- Children's Extensive Support (CES) Waiver - Behavioral and Medical Supports Application - February 2020 (auto download)
- CFC Direct Care Services Calculator - Adults - Updated January 2026 (auto download)
- CFC Direct Care Services Calculator - Children - Updated January 2026 (auto download)
- Age-Appropriate Task Standards and Task Definitions for Homemaker and Personal Care - Updated January 2026
- Age-Appropriate Task Standards and Task Definitions for Homemaker and Personal Care - Updated January 2026
- CFC Health Maintenance Activities Documentation Guide - Updated January 2026
- Health Maintenance Activities Member Documentation Checklist - Updated January 2026
- CHRP SED Attestation Form - Updated January 2026
- CwCHN Attestation Form and Case Manager Decision Tree - July 2025 (auto download)
- Home and Community-Based Services (HCBS) Settings Final Rule Ongoing Monitoring Guide - December 2024
- HCBS State Review and Exceptions Requests Site
- This site will connect you to Exception Requests for:
- Community Connector
- CFC Direct Care Services
- Day Habilitation
- Home Modification
- Protective Oversight within CFC Personal Care
- Supported Living Services (SLS)
- Respite
- This site will connect you to State Review Requests for:
- Assistive Technology
- Home Modifications under $2,500
- Vehicle Modification
- This site will connect you to Exception Requests for:
- Informed Consent for Rights Modification Template - June 2025
- Spanish Version - June 2025
- Spanish Version - June 2025
- OBRA Specialized Services Support Plan - Updated April 2025
- Spanish version - April 2025
- Spanish version - April 2025
- Over-Threshold Respite Request Form - Updated April 2025
- Physician Statement of Life-Limiting Illness - Updated September 2020
- Pre-Admission Screening and Resident Review Level I form (PASRR)
- Protective Oversight and Accompanying Tasks Service Guide - January 2026 - New!
- Unit Converter for Support Planning - July 2022
Interim Support Level Assessment (ISLA)
- Risk Factor Training - May 2024
- Support Level Review Request Form - Updated May 2023
- Level 7 Rate Request Form - March 2022
- Desk Guide - August 2022
- Support Level Review Process - June 2025
- Support Level Review Panel Schedule - 2026
- ISLA Report Cover Letter - June 2025
- ISLA and Support Level Information and Disclosure - June 2025
- ISLA Complaint Process - June 2025
- ISLA Response Options Guide - March 2025
SIS Assessment Retired - Replaced by ISLA
- As of July 1, 2025, Colorado no longer uses the Supports Intensity Scale (SIS) assessment because the version of the SIS Colorado used has been discontinued by its author, the American Association on Intellectual and Developmental Disabilities (AAIDD).
- Historical SIS Resources
More information about ISLA and SIS
Other Forms and Resources
- Legally Responsible Person Caregiver/Attendant Options - Updated January 2026
- Health, Safety, and Welfare Roles and Responsibilities Fact Sheet - Updated August 29, 2025
- Human Rights Committee (HRC) Review Notification Letter - July 2024
- HRC Cover Sheet and Summary Review - July 2024
- State Supported Living Services (State SLS) Support Plan - Updated July 2025
- Spanish version - July 2025
- Spanish version - July 2025
- LTSS Level of Care Referral Form - Updated May 2025
- Formal Discontinuation Notice for Providers - Updated May 2025 (auto download)
- LTSS Case Management Agency Roles and Responsibilities - November 2024
- LTSS Case Manager Roles and Responsibilities - November 2024
- LTSS Member Preference Guide - August 2024
- Spanish version - August 2024
- Spanish version - August 2024
- Assessment and Support Planning Preparation Guide for Applicants - November 2025
Helpful Websites
- Case Management Page
- LTSS Programs Page
- LTSS Training - resource for training materials designed for Long-Term Services and Supports Case Managers
- PASRR - resource for information and forms for Pre-Admission Screening and Resident Review program
- State Long-Term Care Ombudsman Website