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Form FA-19 Level of Care Assessment for Nursing Facilities - Nevada
What Is Form FA-19?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form FA-19?
A: Form FA-19 is the Level of Care Assessment for Nursing Facilities in Nevada.
Q: What is the purpose of Form FA-19?
A: The purpose of Form FA-19 is to assess the level of care needed by individuals who are seeking admission to a nursing facility in Nevada.
Q: Who is responsible for completing Form FA-19?
A: The individual's physician or other authorized healthcare professional is responsible for completing Form FA-19.
Q: What information is included in Form FA-19?
A: Form FA-19 includes information on the individual's medical conditions, functional abilities, cognitive abilities, and other factors that determine their level of care needs.
Q: How is Form FA-19 used?
A: Form FA-19 is used by the Nevada Medicaid program to determine eligibility for nursing facility services and to establish the appropriate level of care for reimbursement purposes.
Q: Is Form FA-19 specific to Nevada?
A: Yes, Form FA-19 is specific to Nevada and is used for nursing facility assessments in the state.
Q: Are there any fees associated with Form FA-19?
A: There are no fees associated with completing Form FA-19. However, there may be fees for the services provided by the healthcare professional who completes the form.
Q: Can I appeal the results of Form FA-19?
A: Yes, individuals have the right to appeal the results of Form FA-19 if they disagree with the level of care determination or eligibility decision.
Q: Who should I contact for more information about Form FA-19?
A: For more information about Form FA-19, you can contact the Nevada Division of Health Care Financing and Policy or speak with the individual's healthcare provider.
Form Details:
- Released on January 30, 2019;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form FA-19 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-19 Level of Care Assessment for Nursing Facilities - Nevada
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