MaineCare Home Health Discharge Notice

MAINECARE HOME HEALTH DISCHARGE NOTICE

Date: ____________________ MaineCare #: _______________________

Member: ___________________________ Address: ___________________________

___________________________

Dear ______________________,

What will happen next?

1. A nurse from Goold Health Systems will come to your home to review your medical and nursing needs including:

· How much help you need with nursing care; and

· How much help you need with your personal care (dressing and bathing), and how much help you need with chores around your home (housework, laundry and groceries).

2. After the assessment is completed, the nurse will tell you if you are eligible for a MaineCare long-term care program.

If you ARE eligible for a MaineCare long-term care program, your current Home Health services will

stay in place until the new program services start.

If you ARE NOT eligible for a MaineCare long-term care program, your current Home Health Services

will end on _____________________________.

£ on ___/___/___.

In reviewing your needs and plan of care, __________________________________ has decided that as of ____________________, you are not medically eligible for Home Health Services as described in Section 40.02-3 of the MaineCare Benefits Manual. This means that MaineCare will no longer pay for your home health care as of ____/____/____, 14 days from today.

If you have questions concerning this decision, you may contact us at _______________ or you may contact the Bureau of Elder and Adult Services at 1-800-262-2232. A copy of Section 40.02-3 is available on request.

Sincerely,

_____________________________________

_____________________________________ (Agency Name)

Encl. Hearing Rights HH Denial Letter - BEAS 7_1_03