PURPOSE: The Long Term Care Medical Assessment Abstract form (MAD 378 or “Abstract”) is used in the Medicaid program to assess and issue prior authorizations (PA) for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC).
Current Manual Revision Memoranda for MAD - New Mexico …
Implementation of MAD 748 and MAD 749 Recipient Notices for Disabilities Waiver and Medically Fragile Waiver MAD: Manual Revision Memoranda (MRs) – 2018 Revision
The MAD 378 must be sent to the MAD/ESPB via fax at (505) 827-3138 or by secure email to the ESPB ICF/IID Program Coordinator within 24 hours of the transfer to the waiver.
Supplements to MAD NMAC Program Rules - 2021 - New Mexico …
2017年1月1日 · Uniform New Mexico Hepatitis C Virus Checklist – Repeal and Replace MAD 634 Form. See Updated Supplement 24-06 . August 30, 2021
What Is Form MAD378? - TemplateRoller
2021年7月1日 · Download a printable version of Form MAD378 by clicking the link below or browse more documents and templates provided by the New Mexico Human Services Department. Download Printable Form Mad378 In Pdf - The Latest Version Applicable For 2025.
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Current Manual Revision Memoranda for ISD and MAD
Revisions to MAD 378 ICF/IID and Developmental Disabilities Home and Community Based Services Waiver Long Term Care Assessment Abstract Form: 16-09: Revisions to MAD 307 EMSA Denial of Claims Form: 16-07: Revisions to MAD 303 Prior Approval Request Form: 16-06: REVISED 2016 MAD 222 and MAD 399; DELETE and REMOVE OBSOLETE MAD 214: 16-04
New Mexico Health Care Authority | Comagine Health
Due to COVID-19, the 1915(c) Waiver Level of Care (LOC) Reminder Letters will not be sent out. Instead, a reminder call will be placed to the waiver participants. The necessary forms (MAD 378 and History and Physical forms) to submit an LOC request can be …
Manuals, Forms and Resources - Western Sky Community Care
The Long Term Care Medical Assessment form (MAD 378 or “Abstract”) is used in the Medicaid program to assess and issue prior authorizations for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC).
2019年7月31日 · The TPA will accept the 2019 MAD 378 and/or H&P up to ninety (90) calendar days following the lifting of the Public Health Emergency. Should you have any questions regarding this Supplement, please contact Claudia Duran, ICF/IID
PURPOSE: The Long Term Care Medical Assessment Abstract form (MAD 378 or "Abstract") is used in the Medicaid program to assess and issue prior authorizations (PA) for Intermediate care Facility Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC).