Fillable nebraska medicaid dm5 form

Description
REV. MARCH 1, 2012 MANUAL LETTER # 31-2012 NEBRASKA DEPARTMENT OF MEDICAID SERVICES HEALTH AND HUMAN SERVICES 471-000-203 Page 1 of 4 471-000-203 Instructions for Completing Form MC-9-NF, "Authorization for Facility Care" Use: Form MC-9-NF is used to authorize Medicaid payment for Nursing Facility (including Special Needs), ICF/MR-ID, Swing-bed and Hospice-in-facility care. It may be initiated by the provider,...
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