Mad378 2025

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The document outlines the Long Term Care Medical Assessment form (MAD 378) used in the Medicaid program to evaluate and authorize prior approvals for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC). It includes sections for general patient information, facility details, medical assessments by healthcare providers, and third-party review. The assessment captures patient diagnoses, medications, and needs for specialized services to determine eligibility for Medicaid support under the Developmental Disabilities Waiver.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (120 Votes)

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