Fill Out a Valid Kentucky Map 351 Form Fill Out Your Form

Fill Out a Valid Kentucky Map 351 Form

The Kentucky Map 351 form is an essential document used for assessing eligibility for Medicaid waiver programs in Kentucky. This form collects vital information about the member's demographics, health status, and daily living activities. Understanding how to properly complete this form can significantly impact access to necessary services and support for individuals in need.

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Common mistakes

Filling out the Kentucky Map 351 form can be straightforward, but mistakes often occur. One common error is failing to provide complete and accurate demographic information. The section requires precise details such as the member's name, date of birth, and Medicaid Member ID. Omitting any of this information can delay processing and lead to unnecessary complications.

Another frequent mistake involves incorrect selection of the type of program applied for. The form includes several options, and selecting the wrong one can result in a misalignment with the member’s needs. It’s essential to double-check that the chosen program matches the member’s circumstances.

Additionally, individuals often neglect to verify that all required signatures are present. The MAP 350 Form must be signed to confirm that the member’s freedom of choice has been explained. Missing signatures can halt the application process and cause frustration.

Misunderstanding the medical diagnosis section is also a common issue. Providing inaccurate or incomplete diagnosis codes can lead to misinterpretation of the member's needs. Ensure that all diagnoses are listed clearly, including the appropriate DSM or ICD-9 codes.

People sometimes overlook the importance of the assessment provider information. Incomplete details about the assessment provider can create confusion. Make sure to include the provider's name, number, and contact information accurately to facilitate communication.

Another mistake is failing to answer all questions in the Activities of Daily Living section. Each question should be addressed thoroughly, as this section is crucial for understanding the member's level of independence. Incomplete answers can result in an inaccurate assessment of the member's needs.

Finally, individuals may forget to review the entire form before submission. A final check can catch any errors or omissions that might have been overlooked initially. Taking this extra step can save time and ensure a smoother process.

Document Breakdown

Fact Name Details
Form Title Kentucky MAP 351 - Medicaid Waiver Assessment
Governing Authority Commonwealth of Kentucky Cabinet for Health and Family Services
Revision Date Revised in July 2008
Purpose To assess eligibility for various Medicaid waiver programs
Sections Included Demographics, Waiver Eligibility, Assessment Provider Info, Self-Assessment, Activities of Daily Living, Instrumental Activities of Daily Living, Neuro/Emotional/Behavioral
Eligibility Types Includes Home and Community Based Waiver, Acquired Brain Injury Waiver, and others
Member Information Requires personal details such as name, date of birth, and Medicaid ID
Assessment Provider Information about the assessment provider must be filled out
Activities of Daily Living Evaluates the member's independence in daily activities like dressing, grooming, and eating

Detailed Steps for Filling Out Kentucky Map 351

Completing the Kentucky Map 351 form is a vital step in the Medicaid waiver assessment process. This form collects essential information about the member's demographics, eligibility, and needs, which will help determine the appropriate services and support. Follow these steps carefully to ensure accurate and complete information is provided.

  1. Member Demographics: Fill in the member's name (last, first, middle), date of birth, Medicaid Member ID number, street address, county code, sex, and marital status. Include the city, state, and zip code, along with the names and phone numbers of emergency contacts. Also, provide the member's phone number and indicate if the member can read and write, as well as their height and weight.
  2. Member Waiver Eligibility: Select the type of program applied for by checking the appropriate box. Indicate the type of application (certification, re-certification, or re-application) and specify the member's admission source (home, hospital, nursing facility, etc.). Enter the certification period dates and the certification number. Confirm that the member's freedom of choice has been explained and verified.
  3. Physician Information: Provide the physician's name, license number, and phone number. Enter the member's primary diagnosis and any additional diagnoses, including their respective ICD-9 or DSM codes. Note if the member has specific mental health or developmental disabilities and their onset dates.
  4. Assessment Provider Information: Fill in the assessment or reassessment provider's name, provider number, and phone number. Include the provider's street address and contact person.
  5. Self-Assessment: For SCL, MP, and ABI waivers, provide information about community inclusion, relationships, rights, dignity and respect, health, and lifestyle. Use additional pages if necessary to elaborate on each topic.
  6. Activities of Daily Living: Answer questions regarding the member's independence in various activities, such as dressing, grooming, bathing, toileting, eating, ambulation, and transferring. Provide comments and check applicable options if assistance is needed.
  7. Instrumental Activities of Daily Living: Indicate the member's ability to prepare meals, shop, perform light and heavy housekeeping, do laundry, manage medications, handle finances, and use the telephone. Again, provide comments and check applicable options for assistance needs.
  8. Neuro/Emotional/Behavioral: Answer whether the member exhibits behavior problems and provide details if applicable. Include dates of any functional analysis or behavior support plans if relevant.