Get Map-24 - Kymmis.com

This guide provides clear step-by-step instructions for users on how to effectively fill out the MAP-24 form online. Whether you are familiar with digital document management or new to the process, this guide will help you navigate each section with confidence.

Follow the steps to complete the MAP-24 form with ease.

1. Press the ‘Get Form’ button to access the MAP-24 document and open it in your preferred browser.
2. Fill in the date at the top of the form. This date should reflect when you are completing the document.
3. In the 'To:' section, enter the local office you are addressing the form to, specifically mentioning the Department for Community Based Services under the Cabinet for Families & Children.
4. Complete the 'From:' section by including the facility or waiver agency name and provider number. Ensure all details are accurate.
5. In the 'Subject:' line, enter the recipient's name followed by their Social Security or Medicaid number, ensuring that you do not confuse these identifiers.
6. Next, document the previous address of the recipient to maintain an accurate record.
7. Include the responsible relative’s name and their address in the designated area.
8. Indicate the date the recipient was admitted to the facility or waiver agency in the corresponding field.
9. Specify the payment status title as XVIII or XIX in the relevant section, ensuring you select the correct title based on eligibility.
10. Mark the type of bed placement: NF bed, ICF/MR/DD bed, Home & Community-Based Waiver Service, MH bed, EPSDT Bed, or SCL Waiver Service, as appropriate.
11. If applicable, note the discharge date from the facility or waiver agency.
12. Document the home address or name and address of the new facility or waiver agency where the recipient is being discharged.
13. If the recipient expired, record the date of expiration in the designated space.
14. If the recipient was re-instated to Home & Community Based or SCL waiver services within 60 days of NF admission, fill in the re-instated date.
15. For Home & Community Based waiver clients, indicate the last date service was provided.
16. Once all sections are completed, review your entries for accuracy and completeness.
17. You can now save your changes, download, print, or share the form as needed to complete the submission process.

Complete the MAP-24 form online today to ensure timely processing of your document.