Get Dmas 96

This guide provides comprehensive instructions for filling out the Medicaid funded long-term care service authorization form (Dmas 96) online. Whether you are a first-time user or have experience with digital forms, this guide will walk you through each section of the form step-by-step.

Follow the steps to successfully complete the Dmas 96 form online.

1. Press the ‘Get Form’ button to access the Dmas 96 online form and open it in your preferred digital editor.
2. In the recipient information section, enter the last name and first name of the individual. Both fields are required. Also, include their birth date in the MM/DD/CCYY format, and enter their social security number and Medicaid ID if applicable. Indicate the individual's sex by entering 'F' for female or 'M' for male.
3. For Medicaid eligibility information, indicate whether the individual is currently Medicaid eligible. Use '1' for yes, '2' for anticipated eligibility within the specified time frames, and '3' for no future eligibility anticipated. If the individual is not currently eligible, indicate if they have formally applied for Medicaid.
4. On the section regarding auxiliary grant eligibility, select the appropriate code ('0', '1', or '2') based on the individual's circumstances.
5. In the Medicaid authorization section, input the numeric code corresponding to the pre-admission screening level of care that is authorized. Only one code can be entered.
6. If the individual is being approved for nursing facility care, specify the expected length of stay using the appropriate codes.
7. Provide the name and provider number of the Level I/ALF screening agency. If multiple screeners are involved, ensure to list them.
8. Complete the Level II assessment determination if applicable, entering the name and ID number of the screener and indicating if the individual has expired after the assessment.
9. Have all required signatories, including Level I/ALF screeners and the Level I physician, sign and date the form as specified.
10. Once completed, save any changes made, and download, print, or share the completed form as necessary.

Start completing your Dmas 96 form online today to ensure efficient processing of your long-term care service authorization.