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Questions? | Policy Manual | Training Information

The client completes this form, including question 6 which asks if they have received medical care or had medical expenses within the three months before the month they want MA payment of LTC services to begin. The form then gives direction that if the answer to this question is yes, client is to provide details on the services as well as copies of bills or receipts for each expense.

The client completes this form to report all medical care and expenses incurred up to three months before the month in which the MA-LTC request form was received. Verification of medical expenses is requested on the form.

This form is signed by the client and given to a medical provider to verify that the service was medically necessary if it was not provided by a medical professional, ambulance service, pharmacy, or medical facility.

You complete this form to track the use of medical expenses that meet all of the conditions and that are allowed as a deduction.

Send this form to the client to notify him or her of how reported medical expenses were evaluated and used (or not used), if the information cannot be added to a MAXIS system notice.