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Assessment
Request Form0000000000RLFor Medicaid health plan members requiring noncovered community based long term services and supports. SECTION 1. MEDICAID HEALTH PLAN INFORMATION
Current Medicaid
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How to fill out managed long term services
How to fill out managed long term services
01
Contact the managed long term services provider to inquire about eligibility and the application process.
02
Complete the necessary paperwork and provide any required documentation to support your application.
03
Attend any required assessments by healthcare professionals to determine the level of care needed.
04
Work with the managed long term services provider to create a care plan that meets your specific needs and preferences.
05
Regularly review and update your care plan as needed to ensure it continues to meet your needs.
Who needs managed long term services?
01
Individuals who require ongoing assistance with daily activities such as bathing, dressing, and meal preparation due to a chronic illness or disability.
02
Elderly individuals who need help with managing multiple medications, transportation to appointments, and other daily tasks.
03
Individuals with cognitive impairments such as dementia who require specialized care and supervision.
04
People with physical disabilities who need assistance with mobility, transferring, and other activities of daily living.
05
Individuals who are at risk of nursing home placement but prefer to receive care in their own homes or community settings.
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What is managed long term services?
Managed long term services are services provided to individuals who require assistance with daily activities due to a chronic illness, disability or aging.
Who is required to file managed long term services?
Healthcare providers or organizations that offer managed long term services are required to file these services.
How to fill out managed long term services?
Managed long term services can be filled out online or through the appropriate forms provided by the healthcare provider or organization.
What is the purpose of managed long term services?
The purpose of managed long term services is to ensure that individuals who require assistance with daily activities receive the necessary care and support.
What information must be reported on managed long term services?
Information such as the type of services provided, the duration of services, the cost of services, and the individual receiving the services must be reported on managed long term services.
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