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Frequently Asked Questions

What forms do I need to apply for CDAC?

Individual applicants applying to provide Consumer-Directed Attendant Care (CDAC) must complete and submit the following forms for IME: Form 470-2917 – Medicaid HCBS Waiver Provider Application (Sections: I and II) Form 470-2965 –Provider Agreement Form 470-4202 –EFT

What is a CDAC agreement?

CDAC agreement is completed in a collaboration between the member, provider and case manager. The CDAC agreement is part of the member’s Person Centered Service Plan and must be approved by Iowa Total Care prior to beginning services. This agreement needs to be completed at least annually or whenever there is a change in the member’s needs.

What are the different types of CDAC waivers?

Consumer-Directed Attendant Care (CDAC) waiver types include: H&D, AH, E, ID, and PD.  Individual Applicant (Attach a photocopy of birth certificate or driver’s license.

How to complete the Iowa total care Medicaid HCBS waiver provider enrollment application?

Instructions for Completing the Iowa Total Care Medicaid HCBS Waiver Provider Enrollment Application Reason for Application: Check one box. Managed Care Organization (MCO): Check the box next to each MCO plan that you want your enrollment application submitted to. I. General Section: Important Reminders 1 National Provider Identifier (NPI)


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