Level of Care Form
The Level of Care form is used to identify the medical necessity for individuals receiving Medicaid. The Level of Care form is used for the following types of requests:
- Nursing Home Placement – long and short term stays
- Waiver Services – including Home and Community Based Services and/or Personal Care
- Swing Bed – long and short term stays
A Level of Care screen must be completed on all clients receiving or that have applied for Medicaid. If required, the Level of Care form must be approved prior to admission to the nursing facility.