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Library: Policy

317:35-9-26. Application procedures for private ICF/MR

Revised 6-26-00

     A request for payment for private ICF/MR is made to the local office in the county where the applicant lives. A written application is not required for an individual who has an active Medicaid case. The DHS Notification Regarding Patient in a Nursing Facility, Intermediate Care Facility for the Mentally Retarded or Hospice form (ABCDM-83) (.pdf, 2 pp, 84 KB) (new Form 08MA083E), when received in the county office, also constitutes an application request and is handled the same as an oral request. The local county office will send the ICF/MR DHS form ABDCM-37D, Notice to Nursing Care Facility or LTCA, within three working days of receipt of DHS forms ABCDM-83 (.pdf, 2 pp, 84 KB) (new Form 08MA083E) and 08MA084E  (.doc, 2 pp, 530 KB) (new Form 08MA084E), Management of Recipient’s Funds, indicating actions that are needed or have been taken regarding the client.

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