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This letter notifies individuals or their surrogates about the re-determination decision regarding the need for an Intermediate Care Facility for the Mentally Retarded (ICF/MR) level of care, including
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How to fill out Re-Determination of ICF/MR LOC

01
Gather all required personal and medical information.
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Obtain the Re-Determination of ICF/MR LOC form from the appropriate authority.
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Carefully read the instructions provided with the form.
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Fill out the personal information section completely and accurately.
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Provide relevant medical history and documentation as requested.
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Include information on current services and support being received.
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Submit the form to the designated agency or authority by the specified deadline.

Who needs Re-Determination of ICF/MR LOC?

01
Individuals currently receiving ICF/MR LOC services who are due for a review.
02
New applicants seeking to establish eligibility for ICF/MR LOC services.
03
Patients transitioning from other care settings where ICF/MR LOC services are applicable.
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Re-Determination of ICF/MR Level of Care (LOC) is the process of reassessing an individual's need for services in an Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR) to ensure they continue to meet eligibility requirements.
The facility administrator or designated representative is required to file the Re-Determination of ICF/MR LOC for residents who are receiving services in the facility and need ongoing assessment.
To fill out the Re-Determination of ICF/MR LOC, one must complete the designated form by providing information regarding the individual's current status, medical history, and any changes in their condition since the last determination.
The purpose of the Re-Determination of ICF/MR LOC is to ensure that individuals continue to receive appropriate care and services based on their current needs and to verify eligibility for funding and support.
The information that must be reported includes the individual's demographic details, current functional status, medical assessments, any new diagnoses, and a summary of the individual's progress and needs.
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ICF/MR Mental Retardation Waiver Level of Care Re-determination Medicaid Appeal Rights Qualified Mental Retardation Professional Support Coordinator County Assistance Office

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