Washington Dc Department of Health Care Finance Forms
The Washington, D.C. Department of Health Care Finance is responsible for administering and overseeing health care programs and services in the District of Columbia. They work to ensure that residents have access to affordable, quality health care and provide various programs and resources to assist individuals with their health care needs.
Documents:
23
This Form is used for reporting a defective prior authorization form in Washington, D.C.
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This document is used for transferring an Electronic Payment Waiver (EPD) in Washington, D.C.
This Form is used for requesting prior authorization for medical services and treatments in Washington, D.C.
This form is used for attesting to the annual level of need for long-term care services and supports in Washington, D.C.
This document is used for pre-admission screening and resident review for individuals with serious mental illness, intellectual disabilities, or related conditions in Washington, D.C.
This form is used for requesting placement in a nursing facility outside of Washington, D.C. for individuals who require specialized care that cannot be provided in the local area.
This document is used for establishing a legal agreement between a beneficiary and a nursing facility in Washington, D.C. It outlines the terms and conditions of the placement and the responsibilities of both parties.
This document is a Proof-Of-Contact form specifically for in-state nursing facilities located in Washington, D.C. It serves as evidence of communication between the facility and individuals involved.
This form is used for transferring long-term care services between providers in Washington, D.C.
This form is used for substance use disorder attestation in Washington, D.C. It is used to confirm the individual's commitment to abstain from substance use and comply with treatment.
This Form is used for attesting to Substance Use Disorder in Washington, D.C. for the CPC-Hie program.
This form is used for granting permission to share private/protected health information in Washington, D.C.
This document is a Medicare Savings Program application specifically for the Qualified Medicare Beneficiary (QMB) program eligibility in Washington, D.C. It helps individuals apply for financial assistance to cover Medicare costs.
This form is used for applying for supplemental long term care benefits in Washington, D.C.
This form is used for retro eligibility attestation for long term care services and supports in Washington, D.C.
This document is for referring children and adolescents in Washington, D.C. to the Supplemental Security Income Program.
