Long-Term Services and Supports Case Management Forms and Tools

CMA Forms     CCM Resources     CIRS Forms     DD Forms     NOA Forms     Program and Waiver Resources     

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
     
• Colorado Intake Screen Tool - Updated June 29, 2023 
  • 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
     
• Service Plan Signature Page - Updated January 2025 for Accessibility
  • 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.

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Care and Case Management System (CCM) Resources

• Case Management Q&A
• Care and Case Management System Page
• Case Management Home Page

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Critical Incident Report 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

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Developmental Disability Determination Forms and Resources

• Developmental Disability Determination Definition Fact Sheet - Updated January 2021
  • Spanish version - January 2021
     
• Developmental Disability and Delay Determinations FAQ - April 2020
  • Spanish version - April 2020
     
• Request for Developmental Disability Determination Form - Updated July 2019
  • Spanish Version - May 2019
     
• Developmental Disability Determination Decision Form - Updated June 2019
  • Spanish Version - April 2019
     
• Developmental Delay Determination Decision Form - Updated June 2019
  • Spanish Version - April 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
     
• Informational Memo - IM 18-49 - The Role of Psychological Testing in Accessing Medicaid Services FAQ - December 2018
  • FAQ - The Role of Psychological Testing in Accessing Medicaid Services - December 2018
     

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Notice of Action (803) Forms

• Long-Term Care Application Status Letter - Updated July 2, 2025 (auto download)
• Long-Term Care Benefits Status Letter - July 1, 2025 (auto download)
• Long-Term Care Developmental Disabilities (DD) Waiver Waitlist Letter - Updated November 26, 2024 (auto download)
• Case Status Advisement Letter - Updated August 2025 (auto download)
• Long-Term Care Notice of Action Withdrawal Letter - Updated August 2025 (auto download)

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Program and Waiver-Specific Resources

• ACF/SLP/TLP PETI Form
   
• Age Appropriate Norms and Task Definitions - August 2025
   
• Children's Extensive Support (CES) Waiver - Behavioral and Medical Supports Application - February 2020
   
• CFC Direct Care Services Calculator - Adults - Updated 8.12.2025 (auto download)
• CFC Direct Care Services Calculator - Children - Updated 8.12.2025 (auto download)
   
• CFC Health Maintenance Activities Documentation Guide - Updated July 2025
   
• CHRP SED Attestation Form - Updated February 2025
   
• 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
   
• Informed Consent for Rights Modification Template - June 2025
  • Spanish Version - June 2025
     
• OBRA Specialized Services Support Plan - Updated 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)
   
• Unit Converter for Support Planning - July 2022

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Interim Support Level Assessment (ISLA) and Supports Intensity Scale (SIS)

• 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 Process - Spanish
  • Support Level Review Panel Schedule - 2025 
     
• ISLA Report Cover Letter - June 2025 
  • ISLA Report Cover Letter - Spanish 
     
• ISLA and Support Level Information and Disclosure - June 2025
  • SIS and Support Level Information and Disclosure - Spanish
     
• ISLA Complaint Process - June 2025
  • ISLA Complaint Process - Spanish
     
• ISLA Response Options Guide - March 2025
  • ISLA Response Options Guide - Spanish
     

View SIS-A Documents

• SIS-A Respondent Resources Website
• AAIDD Website
   

SIS and Support Level Review Technical Assistance Meetings

• May 17, 2023
  • Presentation
  • Webinar Recording
     
• August 16, 2022
  • Presentation
  • Webinar Recording
     
• March 31, 2022
  • Presentation
  • Webinar Recording
     

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Other Forms and Resources

• State Supported Living Services (State SLS) Support Plan - Updated July 2025
  • Spanish version - July 2025
• Legally Responsible Person Caregiver/Attendant Options - July 2025
• Health, Safety, and Welfare Roles and Responsibilities Fact Sheet - 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
      
• LTSS Training - resource for training materials designed for Long-Term Services and Supports Case Managers
  • HCBS Waiver Charts
  • Transition from Children's to Adult Waivers Checklist
• Long-Term Services and Supports Programs Page
• Care and Case Management (CCM) Page
• PASRR - resource for information and forms for Pre-Admission Screening and Resident Review program
• State Long-Term Care Ombudsman Website

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