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Provider Alert
The Health Care Authority is sending this message on behalf of
the Department of Social and Health Services.
Retroactive to March 1, 2016, Home and Community
Services in the Aging and Long Term Services Administration implemented a new
statewide Intake and
Referral form DSHS 10-570.
The new form is used to send information to Social Services
Intake regarding a person requesting a functional assessment for long-term
services and supports (LTSS). This form replaces all regional forms that
are in use currently around the state.
The new form does not take the place of DSHS 15-031 Notice
of Action-Adult Residential Services used to report changes to the
DSHS financial worker on all active and pending Classic Medicaid
recipients.
The link to DSHS
15-031 includes current instructions on the type of Medicaid case and
whether the Notice of Action
is necessary.
Please do not reply directly to this
message. If you have feedback or questions, please visit the HCA
website for contact information.
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