File a variance

Submit an over-cap variance request to MQD · Aguilar, Phillip · auth MQD-G809-4421

+12u over April cap due by Apr 30 · 1d remaining

Reason

Justification

Attachments

Sign & submit

Variance required by Apr 30, 2026 Without an approved variance MQD will deny 12 units ($84.00) and reduce next month's cap. Submitted variances are reviewed within 5 business days.

1 · Reason for over-cap visits

Pick the primary reason. MQD requires one classification per variance request.

Medical event requiring extended care Acute illness, post-discharge, fall risk, behavioral crisis — care needs exceeded the authorized cap.

MED-01

Caregiver / family unavailable Primary caregiver illness, emergency travel, hospitalization left no informal support.

FAM-02

Schedule disruption · weather, transit Visit shifted to a different DSW or extended due to transportation or weather.

SCH-03

Documentation correction · prior month Visits previously dropped from billing are being recaptured this period.

DOC-04

Service-plan change pending Care plan update or auth increase has been requested but not yet approved.

PLN-05

Other · explain in justification Reason doesn't fit MQD's standard codes — provide detail in step 2.

OTH-99

2 · Justification narrative

Required. Be specific about the medical / situational facts. MQD reviewers reject vague narratives.

What happened? *min. 100 chars · 750 chars max

Care plan reviewed with

Discharge date / event date

Will visits continue at elevated level? *

3 · Supporting documents

Discharge summary, MD order, or care-plan amendment. PDF / JPEG / PNG · 20MB max each.

⎘

Add supporting document Drop a file or click to browse · we'll redact PHI on submission

Choose file

PDF

queens-discharge-aguilar-2026-04-22.pdf

432 KB · uploaded 2m ago

PDF

md-order-wound-care-mehta.pdf

128 KB · uploaded just now

4 · Sign & submit

Your supervisor will be CC'd. Once submitted, MQD assigns a case number — track in Notifications.

Submitted by

Supervisor sign-off *

I attest that the information provided is accurate, complete, and supported by the attached documentation. Submission becomes part of the participant's permanent record.

Press ⌘Enter to submit · all submissions logged to audit trail Cancel

Participant

NameAguilar, Phillip

Medicaid IDM-22831

Care planG809 · I/DD Waiver

Primary DSWKalei Pō

SupervisorLehua Kahale

Authorization

Auth #MQD-G809-4421

Service codeT2021 · Day Habilitation

PeriodApr 1 – Apr 30, 2026

Monthly cap120 units

Logged · MTD132 units (+12)

Rate$7.00/unit · $84.00 at risk

April cap132 / 120u

● within cap ▨ over cap · 12u

Over-cap visits

Apr 22Wound care · post-discharge8u

Apr 25Wound care · evening+4u

Apr 27Supervision · evening+4u

Apr 28Wound care · evening+4u

Past variances

Jan 2026 · approved (+8u)

No others in last 12 months

File a variance

1 · Reason for over-cap visits

2 · Justification narrative

3 · Supporting documents

4 · Sign & submit

Variance submitted