Part 2 - Long Term Care (LTC)



Appeal Form Completion (appeal form) (Revision Date May 29, 2020) | (792KB)
CIF Completion (cif co) (Revision Date May 29, 2020) | (813KB)
CIF Submission and Timeliness Instructions (cif sub) (Revision Date May 29, 2020) | (138KB)
Distinct-Part Long Term Care Facilities (distinct) (Revision Date May 29, 2020) | (17KB)
EPSDT (epsdt) (Revision Date May 29, 2020) | (153KB)
Forms: Legibility and Completion Standards (forms leg) (Revision Date May 29, 2020) | (99KB)
Forms Reorder Request: Guidelines (forms reo) (Revision Date May 29, 2020) | (86KB)
Forms Reorder Request: Long Term Care (forms reo ltc) (Revision Date May 29, 2020) | (251KB)
Incontinence Medical Supplies (incont) (Revision Date May 29, 2020) | (170KB)
Leave of Absence, Bed Hold, and Room and Board (leave) (Revision Date May 29, 2020) | (466KB)
Form: SNF/ICF Physician Recertification For Medi-Cal (Revision Date May 29, 2020) | (20KB)
Mental Disease Institutions Directory (mental) (Revision Date May 29, 2020) | (34KB)
Other Health Coverage (OHC) (oth hlth) (Revision Date May 29, 2020) | (137KB)
Patient Plans of Care for Long Term Care (patient ltc) (Revision Date May 29, 2020) | (84KB)
Preadmission Screening Resident Review (PASRR) (preadmis) (Revision Date May 29, 2020) | (999KB)
Rates: Facilities (rate facil) (Revision Date May 29, 2020) | (117KB)
Rates: Facility Per Diem (rate facil diem) (Revision Date May 29, 2020) | (186KB)
Remittance Advice Details (RAD) (remit adv) (Revision Date May 29, 2020) | (141KB)
Rural Hospital Swing Bed Program (rural hosp) (Revision Date May 29, 2020) | (29KB)
Share of Cost (SOC): 25-1 for Long Term Care (share ltc) (Revision Date May 29, 2020) | (765KB)
Sign Language Interpretation (sign) (Revision Date May 29, 2020) | (200KB)
Subacute Care Programs: Adult (subacut adu) (Revision Date May 29, 2020) | (106KB)
Subacute Care Programs: Billing Codes (subacut code) (Revision Date May 29, 2020) | (82KB)
Subacute Care Programs: Pediatric (subacut ped) (Revision Date May 29, 2020) | (114KB)
TAR Completion for Long Term Care (tar comp ltc) (Revision Date May 29, 2020) | (1065KB)
Form: Call List for NF Placement (tar crit dp 3form) (Revision Date May 29, 2020) | (16KB)
TAR Deferral/Denial Policy (Frank v. Kizer) (tar defer) (Revision Date May 29, 2020) | (479KB)
TAR Field Office Addresses (tar field) (Revision Date May 29, 2020) | (260KB)
TAR for Long Term Care: 20-1 Form (tar ltc) (Revision Date May 29, 2020) | (55KB)
TAR for Long Term Care: MDS Form (tar ltc mds) (Revision Date May 29, 2020) | (1928KB)
TAR Submission: Transmittal Form (tar submis) (Revision Date May 29, 2020) | (258KB)
TAR: Submitting Appeals (tar submit) (Revision Date May 29, 2020) | (86KB)


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