Get Ny Request For Service Authorization (rsa) 2023-2025

This guide provides a detailed overview of how to accurately complete the NY Request For Service Authorization (RSA) form online. It is designed to assist users in navigating the form efficiently and effectively, ensuring that all necessary information is submitted.

Follow the steps to complete the RSA form online successfully.

1. Click ‘Get Form’ button to start the process of obtaining the NY Request For Service Authorization form.
2. Enter the individual’s information, including their full name, date of birth (DOB), and TABS ID if applicable. Indicate if the individual is a child under 18 and requesting a waiver of parental deeming.
3. In the services requested section, select the service type from the drop-down list provided. Complete the annual service units fields as needed, according to the specific service type selected.
4. Provide a brief explanation of the need for each service. Make sure to include justification that outlines the goals and outcomes that this service will help the individual achieve.
5. If known, enter the service provider name for each requested service. Note that the Care Coordination Organization (CCO) should make efforts to secure commitments from providers prior to submission.
6. Fill out the CCO information, including the staff name, email, and phone number. Also, provide contact details for a supervisor.
7. Read the CCO signature and attestation statement carefully. Sign and date the form to confirm that an in-depth person-centered conversation has taken place.
8. Once the form is completed, save any alterations, and choose to download or print the form for your records or sharing.

Complete your NY Request For Service Authorization form online to ensure timely processing.