IA 470-2917 2019 free printable template

O. Box 36450 Des Moines IA 50315 For questions contact Tel. 800 338-7909 option 2 or 515 256-4609 option 2 local Individual applicants applying to provide Consumer-Directed Attendant Care CDAC must complete and submit the following forms Form 470-2917 - Medicaid HCBS Waiver Provider Application Sections I and II Form 470-2965 - Provider Agreement Form 470-4202 - EFT IRS Form W9 Form 470-4612 - Individual CDAC Disclosure Form 470-4457 - Atypical Provider Declaration Form 470-4227 - Record...

How to fill out IA 470-2917

How to fill out Iowa Medicaid Universal HCBS:

1. Gather all necessary documents and information, such as personal identification, income information, medical records, and any supporting documentation for disabilities or medical conditions.
2. Visit the Iowa Medicaid website or contact the Medicaid office to obtain the necessary application forms for the Universal HCBS program.
3. Carefully fill out the application forms, providing accurate and detailed information regarding your personal and financial situation, as well as any medical conditions or disabilities that may qualify you for the program.
4. Compile any additional documentation required by the application, such as proof of income, medical records, or disability certifications.
5. Double-check all the information provided on the application forms to ensure accuracy and completeness.
6. Submit the completed application along with all necessary supporting documentation to the Iowa Medicaid office either electronically or by mail, following the instructions provided.

Who needs Iowa Medicaid Universal HCBS:

1. Individuals who have a disability or a medical condition that requires assistance with daily activities and could benefit from home and community-based services.
2. Individuals who meet the income and asset eligibility requirements set by the Iowa Medicaid program.
3. People who prefer to receive long-term care services in their own homes or community settings instead of institutional care facilities.

People Also Ask about

How do I report changes to Medicaid in Iowa?

For problems or concerns regarding your local DHS office contact the Central Office at 1-800-972-2017 or by email at contactdhs@dhs.state.ia.us.

What is the authorized representative form for Medicaid in Iowa?

Clients may use Form 470-3948 when there is a need to designate a personal representative. A "personal representative" is someone designated by another as standing in the other's place or representing the other's interest for one or more purposes. Record of Disclosure of Health Information, Form 470-4015.

What are the Medicaid guidelines for 2023 in Iowa?

In 2023, the Medically Needy Income Limit (MNIL) for individuals is the same as for married couples and is $483 / month. The amount one must “spend down” can be thought of as a deductible. It is the difference between one's monthly income and the MNIL. In IA, the spend down is calculated for a 2-month period.

What is the form for Medicaid reconsideration in Iowa?

Form 470-5526 shall be completed by the Medicaid member or their parent, if the member is a minor. The member and the authorized representative must both sign the form. Once completed, the form should be submitted to the Medicaid member's MCO, if for a managed care appeal, or to HHS, if for a state fair hearing.

How do I become a Medicaid provider in Iowa?

Providers wanting to enroll as an Iowa Medicaid provider must submit an enrollment application to the Iowa Medicaid Enterprise (IME) Provider Enrollment Unit. No payment will be made to a provider for services prior to the effective date of the department's approval of an application.

How do I appeal Medicaid denial in Iowa?

You also may call the Appeals Section at (515) 281-3094 or send us an email at appeals@dhs.state.ia.us if you have questions. We accept collect phone calls.

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What is IA 470-2917?

IA 470-2917 is a form used by taxpayers in Iowa to report certain types of income and claim specific tax credits.

Who is required to file IA 470-2917?

Individuals or entities who have received non-employee compensation, certain tax credits, or other specific types of income that fall under Iowa tax regulations are required to file this form.

How to fill out IA 470-2917?

To fill out IA 470-2917, you must provide your personal information, specify the type of income or credits being reported, and include necessary supporting documentation as indicated on the form.

What is the purpose of IA 470-2917?

The purpose of IA 470-2917 is to ensure that taxpayers report all applicable income and claim any eligible tax credits, aiding in proper tax assessment and compliance.

What information must be reported on IA 470-2917?

Information that must be reported on IA 470-2917 includes taxpayer identification details, the nature of the income received, the amount of income, and any credits being claimed.