Get Icf-mr Lced Form Instructions - Opwdd - New York State

The ICF-MR Level of Care Eligibility Determination (LCED) Form is a critical document used for assessing an individual's eligibility for Home and Community Based Services (HCBS) waiver services. This guide provides clear instructions on how to fill out the form online, ensuring users can effectively navigate the process with confidence.

Follow the steps to complete the ICF-MR LCED Form online.

1. Press the ‘Get Form’ button to access the form in the editor and begin filling it out.
2. Enter the name of the individual in the designated field, including their first name, last name, and middle initial.
3. Input the address where the individual will reside while receiving HCBS waiver services.
4. Provide the individual's date of birth, ensuring to include the full month, day, and year.
5. Select the eligibility status for the individual by indicating whether they are considered ‘620’ or ‘621’, as applicable.
6. Fill in the responsible Medicaid district name in which the individual's Medicaid case is active; reach out to local Revenue Support Field Office for assistance if unknown.
7. Include the individual's Medicaid Identification Number (CIN) in the appropriate section.
8. Input the individual's TABS ID, which is the OPWDD Tracking and Billing System Identification Number.
9. Record the dates for all necessary pre-enrollment evaluations: physical, social, and psychological, ensuring they are current and accurately reflect the individual's needs.
10. In the eligibility information section, mark 'Yes' or 'No' for the diagnostic questions, ensuring that responses are supported by proper documentation.
11. Once all fields are filled, review the entire form for completeness and accuracy before finalizing.
12. When ready, save the completed form, ensuring to download or print a copy for your records, as well as share it if necessary.

Take the next step in ensuring eligibility by completing the ICF-MR LCED Form online.