CMA & AMH+ Survey Question Title * 1. Provider Name: OK Question Title * 2. Are you planning to apply for certification as a Care Management Agency (CMA)? Yes No OK Question Title * 3. Are you planning to apply for certification as an Advanced Medical Home Plus (AMH+) Yes No OK Question Title * 4. If yes. Please indicate the population(s) for which they are applying to be certified. 1) Behavioral Health (BH) – both Mental Health Substance Use Disorder (SUD) Adult and/or Child/Adolescent 2) I/DD and TBI (populations that are not enrolled in the Innovations or TBI waiver) Adult and/or Child/Adolescent 3) Innovations Waiver and/or TBI Waiver Adult and/or Child/Adolescent OK Question Title * 5. What region(s) are you applying to be a CMA? OK Question Title * 6. What counties are you applying to be a CMA? OK Question Title * 7. Are you planning to work with a Clinically Integrated Network? Yes No OK Question Title * 8. Do you anticipate needing a platform or system to meet the Health Information Technology requirements? Yes No OK Question Title * 9. Provider Contact for CMA or AMH+: OK THANK YOU FOR COMPLETING THIS SURVEY!