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Long Term Services and Supports : Long Term Care Forms

Medicaid Nursing Home Program


During the 2008 Legislative Session, the legislature passed Senate Bill 682 requiring the Department of Health and Mental Hygiene (DHMH) and the Department of Human Resources (DHR) to create uniform procedures, guidelines, and forms to be used by all employees in the determination of long-term care (LTC) Medical Assistance eligibility and to streamline regulations, policies, and procedures related to the application for LTC Medical Assistance Program services.

The LTC forms on this webpage are to be used consistently by all case managers in all LDSS. For more details please refer to the Action Transmittal #09-19 and Action Transmittal #12-02.



 Drop Off Library

Electronic QA Form FY 2014 2359.xls
8/15/2013 3:54 PMSystem Account
Electronic QA Form FY 2014 541.xls
8/15/2013 3:53 PMSystem Account
QA Payment Report Instructions FY14.docx
8/15/2013 3:54 PMSystem Account