The following PDF downloads are the original handbook pages. You will need Adobe Acrobat Reader to view and print these pages. Learn about Acrobat Reader.

Handbook Cover - PDF (288kb).

Table of Contents - PDF (30kb).

General Information - PDF (89kb).

Covered Services and Related Limitations - PDF (109kb).

Billing Information - PDF (100kb).

Appendix

• Appendix 1: HCFA 1500 Claim Form Completion Instructions for Child Care Coordination Services - PDF (91kb).
• Appendix 2: HCFA 1500 Claim Form Completed Sample - PDF (130kb).
• Appendix 3: HCFA 1500 Claim Form Completed Sample (Risk Assessment Only) - PDF (131kb).
• Appendix 4: Medicaid-Allowable Procedure Codes and Modifiers for Child Care Coordination Services - PDF (72kb).
• Appendix 5: Medicaid-Allowable Place of Service Codes and Type of Service Code for Child Care Coordination Services - PDF (56kb).
• Appendix 6: Rounding Guidelines for Child Care Coordination Services - PDF (64kb).
• Appendix 7: Medicaid Guidelines and Performance Measurements for Child Care Coordination - PDF (119kb).
• Appendix 8: Family Questionnaire (Child Risk Assessment) - PDF (727kb).
• Appendix 9: Referral Form (Sample Format) - PDF (75kb).
• Appendix 10: Informed Consent to Release/Obtain Health Care Information Form (Sample Format) - PDF (64kb).
• Appendix 11: Care Plan (Sample Format) - PDF (86kb).
• Appendix 12: Child Care Coordination Monthly Time Long for Ongoing Care Coordination and Monitoring (Completed Sample Format) - PDF (66kb).
• Appendix 13: HealthCheck General Information - PDF (50kb).
• Appendix 14: HealthCheck Visit Schedule - PDF (86kb).
• Appendix 15: Child Care Coordination Resource Guide - PDF (107kb).
• Appendix 16: Medicaid Maximum Fee Schedule for Child Care Coordination Services - PDF (76kb).

Glossary of Common Terms - PDF (98kb).

Important Telephone Numbers - PDF (88kb).

Handbook Order Form - Word (123kb).

Index - PDF (57kb).