|
HCSP 3047 MLTC Cover Sheet
HCSP 3047 1-26-2015.pdf
This is the cover sheet to be used for MLTC cases
|
|
13 Apr, 2015
44 kb
Downloads: 3868
|
|
|
HSCP-3047b MLTC Nursing Home Eligibility Determination Cover Sheet
HCSP-3047b 1-26-2015.pdf
This is the cover sheet to used for MLTC NHED
|
|
13 Apr, 2015
55 kb
Downloads: 5614
|
|
|
HCSP-3047a MLTC/PRU
HCSP-3047a MLTC-PRU 1-26-15.pdf
This is the MLTC Provider Relations Unit cover sheet to be used
|
|
13 Apr, 2015
47 kb
Downloads: 3691
|
|
|
HCSP 3026 ALP Medicaid Cover Sheet
HCSP-3026 HCSP Cover Sheet for ALP-MLTC 1-26-2015.pdf
This is the cover sheet for HRA-ALP Medicaid Cover Sheet
|
|
13 Apr, 2015
44 kb
Downloads: 3788
|
|
|
Notice of Admission/Discharge for the Assisted Living Program
HCSP 3027 1-26-2015.pdf
This form is to be mailed to Home Care Services Program once a client is admitted or discharged from Assisted Living Programs
|
|
13 Apr, 2015
44 kb
Downloads: 4016
|
|
|
MAP-58u List of Medicaid Offices
MAP-58u Where To Apply.pdf
This is a list of Medicaid Offices throughout NYC's 5 boroughs, along with a list of MICSA/MAP sites with certified application counselotrs
|
|
13 Apr, 2015
377 kb
Downloads: 4851
|
|
|
HIPAA Compliant Authorization Form 1-2013
HIPAA Compliant Authorization Form 1-2013.pdf
HIPAA form
|
|
13 Apr, 2015
47 kb
Downloads: 10824
|
|
|
MAP-259H Consumer Intent to Return/Not Return Home
MAP-259H Intent to Return Home 2008-06-20.pdf
This form is used when a client enters a residential facility and makes a determination that he/she will either return or not return home.
|
|
13 Apr, 2015
236 kb
Downloads: 5123
|
|
|
Agreement to Participate in the Medicaid Pay-In Program
MAP-931B Agreement to Participate in Pay-In Program searchable pdf.pdf
This is the form in both English & Spanish agreeing to participate in the Medicaid Pay-In Program
|
|
13 Apr, 2015
86 kb
Downloads: 3594
|
|
|
Optional Pay-In Program for Individuals with Excess Income
MAP-931A Optional Pay-In Program searchable pdf.pdf
This explains the Excess Income Program for clients whose incomes exceeds the Medical Assistance income limits
|
|
13 Apr, 2015
142 kb
Downloads: 3299
|
|
