Get the free Attachment 4.19-D Addendum ICF-MR - ncdhhs
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This document outlines the payment and reimbursement plan for intermediate care facilities serving individuals with mental retardation (ICF-MR) under the North Carolina Medicaid Program, detailing
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How to fill out Attachment 4.19-D Addendum ICF-MR
01
Review the guidelines provided by the relevant authority regarding Attachment 4.19-D.
02
Gather necessary documentation that supports the information you will fill in the form.
03
Start with the personal information section, ensuring all details are accurate and up to date.
04
Clearly fill out the financial information section by providing all required financial data.
05
Provide detailed information about services being requested, including any specific needs.
06
Review the eligibility criteria and ensure that all information aligns with these requirements.
07
Double-check all sections for completeness and accuracy before submission.
08
Submit the completed form along with any supporting documentation as per the submission guidelines.
Who needs Attachment 4.19-D Addendum ICF-MR?
01
Individuals seeking funding or services covered under ICF-MR.
02
Service providers working with individuals eligible for ICF-MR services.
03
Administrative personnel responsible for managing ICF-MR funding and services.
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What is Attachment 4.19-D Addendum ICF-MR?
Attachment 4.19-D Addendum ICF-MR is a specific document that outlines the requirements and information necessary for Intermediate Care Facilities for Individuals with Mental Retardation (ICF-MR) to ensure compliance with federal and state regulations.
Who is required to file Attachment 4.19-D Addendum ICF-MR?
Providers of Intermediate Care Facilities for Individuals with Mental Retardation (ICF-MR) are required to file Attachment 4.19-D Addendum ICF-MR as part of their compliance and funding applications.
How to fill out Attachment 4.19-D Addendum ICF-MR?
To fill out Attachment 4.19-D Addendum ICF-MR, providers must carefully review the instructions provided in the attachment, gather relevant data, and accurately complete each section as per the guidelines outlined for reporting financial and service information.
What is the purpose of Attachment 4.19-D Addendum ICF-MR?
The purpose of Attachment 4.19-D Addendum ICF-MR is to collect essential data needed for financial reimbursement, ensure accountability, and monitor the quality of care provided to individuals with intellectual disabilities in ICF-MR facilities.
What information must be reported on Attachment 4.19-D Addendum ICF-MR?
Attachment 4.19-D Addendum ICF-MR requires the reporting of various financial information, cost data, service utilization metrics, staffing details, and other relevant operational data necessary for compliance and reimbursement purposes.
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