Release of Medicaid Information to the Facility. To facilitate the Medicaid application and annual recertification, the Facility requests access to the Resident's Department of Social Services (“DSS”) Medicaid application and recertification file. This authorization is at Addendum III.
Release of Medicaid Information to the Facility. The Resident/Resident Representative/Sponsor/Financial Agent are required to provide complete and full disclosure of the Resident’s (and Resident’s spouse’s) financial resources to the Facility in the Application for Admission. Included with this, the Resident/Resident Representative/Sponsor are required to list all gifts or transfers of the Resident’s and/or Resident’s spouse’s assets made within the last sixty (60) months prior to the date of admission in excess of two-thousand dollars ($2,000.00), or that could be construed by the Department of Social Services to affect a decision on the Resident’s Medicaid application at a future date. To facilitate assistance in the Medicaid application process, the Facility may request authorization to have access to the Resident’s Medicaid application and recertification file, such authorization taking effect currently or in the event the terms of this Agreement cannot be met without such authorization. With such authorization, the Facility can receive copies of all correspondence regarding the Medicaid application, can assist the Resident with the application process and can communicate with the Department of Social Services regarding the application or recertification. If the Resident, the Undersigned, and/or the Resident’s family requires the Facility’s assistance with filing the Medicaid application or with an appeal of the Medicaid denial, the Resident, the Undersigned, or a family member agrees to authorize the Facility, and the Facility’s agents to act on his/her behalf in the Medicaid process by executing a notarized Authorization to Represent or Agreement and providing it to the facility Social Worker. The Facility will make every effort to assist residents and their representatives to gather and submit information required by Medicaid, Medicare and other third-party payors. If the resident or representative refuses to cooperate with the facility’s efforts and does not provide the required information to the payor, claims will be rejected and the resident’s bill will not be paid. If the resident and/or representative do not take efforts to pay the bill within thirty (30) days, the facility may issue a discharge notice.
