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AFL Update Form

  • ATTENTION:
    If the provider agency adds a new AFL site or if the member placed in an AFL home should change at any time, the provider must contact Vaya Health immediately to inform the Network Performance Unit of this change.
  • Unlicensed supervised living homes (AFLs) may only serve one adult based on 10A NCAC 27 G.5601 (b) (1) (2). In accordance with the above regulation, provider attests that no other adult or child is receiving mental health, intellectual/developmental disability, and/or substance use services in the home.
  • Regarding HCBS self assessments



    Providers of N.C. Innovations – Residential Supports, Day Supports and Supported Employment or CAP/DA/CAP CHOICE – Adult Day Health Services

    The HCBS Provider Self-Assessment must be completed in full on the N.C. Department of Health and Human Services website.

    Failure to complete the form and answer all questions could result in a delay of approval. If you have any questions, contact HCBS@vayahealth.com.




    Providers of Long-Term Community Support Services

    Please download the HCBS Form here, complete and submit to HCBS@vayahealth.com. Failure to complete the form and answer all questions could result in a delay of approval.

    For additional support, contact HCBS@vayahealth.com.

    .


    ' QUESTIONS? Email questions to afl.info@vayahealth.com. REMINDER: Any emails containing protected health information and/or member identifiers must be sent through SSL securely either via secure electronic mail, hand delivery, U.S. mail or courier.
  • This date must be after the date HCBS self-assessment meets full compliance.
  • Needs to be the site name used when submitting the HCBS Self Assessment.
  • If you checked: Member moving to a new or vacant unlicensed AFL to another unlicensed AFL; or AFL provider and member are moving to a new address this should be the NEW address to be reviewed.
  • Please complete if changing an address

    The member is no longer living in this address.
  • Comments

  • QUESTIONS? Email all questions to afl.info@vayahealth.com. REMINDER: Any emails containing protected health information and/or member identifiers must be sent through SSL securely either via secure electronic mail, hand delivery, U.S. mail or courier.

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