3559 form-2025

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The document LDSS-3559 is a report form used by residential health care facilities to notify local departments of social services about the admission, discharge, readmission, or change in status of Medicaid recipients. It includes essential patient information, placement type, and details regarding Medicaid managed care notifications. The form must be submitted within 48 hours of any status change to ensure timely Medicaid payments. Additionally, it requires a physician's statement for non-permanent placements to determine eligibility and payment responsibilities.

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