This version of the form is not currently in use and is provided for reference only. Download this version of Form ODM01717 for the current year.
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form ODM01717?
A: Form ODM01717 is the Notice of Proposed Enrollment in the Coordinated Services Program (CSP) in Ohio.
Q: What is the Coordinated Services Program (CSP)?
A: The Coordinated Services Program (CSP) is a program in Ohio that provides coordinated care and services to individuals with complex health needs.
Q: Who is eligible for the Coordinated Services Program (CSP)?
A: Individuals who are eligible for Medicaid and have complex health needs may be eligible for the Coordinated Services Program (CSP).
Q: What is the purpose of Form ODM01717?
A: The purpose of Form ODM01717 is to notify individuals of their proposed enrollment in the Coordinated Services Program (CSP) in Ohio.
Q: What information is included in Form ODM01717?
A: Form ODM01717 includes information such as the individual's name, Medicaid number, proposed CSP enrollment date, and contact information for questions or concerns.
Q: Is enrollment in the Coordinated Services Program (CSP) mandatory?
A: Enrollment in the Coordinated Services Program (CSP) is not mandatory. It is optional for eligible individuals.
Q: What should I do if I have questions or concerns about my proposed enrollment in the Coordinated Services Program (CSP)?
A: If you have questions or concerns about your proposed enrollment in the Coordinated Services Program (CSP), you can contact the phone number or email provided on Form ODM01717.
Form Details:
Download a fillable version of Form ODM01717 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.