Get Recertification Of Need For Infants, Toddlers And ...

The Recertification of Need for Infants, Toddlers and Families form is essential for determining eligibility for the Medicaid Waiver. This guide provides a detailed overview of how to complete the form online, ensuring that users can navigate the process with confidence.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form. This will allow you to begin the online submission process.
2. Fill in the individual's name, parent or legal guardian's information, current address, and date of birth in the designated fields.
3. Enter the social security number and access number as required. Ensure these details are accurate to avoid any delays.
4. In the Qualified Professional Certification section, complete either Section A or Section B. Select Section A if the individual continues to need the ICF/MR/ORC level of care based on the criteria established. If not, choose Section B.
5. For the selected section, provide the signature, date, address, and telephone number of the qualified professional certifying the information.
6. In the Determination by the Department of Public Welfare section, input the name of the County MH/MR program. The program will determine if the individual requires ICF/MR/ORC level of care.
7. Ensure to include the telephone number and signature of the County MH/MR program representative, along with the date of determination.
8. Once all sections are completed, review the entire form for accuracy. You can then save changes, download the completed form, print it, or share it as needed.

Complete your forms online today for a smooth submission process.