List of Questions:

1. I am involved with the operation of an adult care home. We have residents at our facility that may be eligible for Enhanced Personal Care. Who Provides those services?
2. How do we refer these individuals for services?
3. Where can I obtain a DMA 3050 form?
4. Where can I obtain a Medicaid Provider Manual?
5. I know and individual/family member who might need ACM. How can I get a referral?

Answers:

1. I am involved with the operation of an adult care home. We have residents at our facility that may be eligible for Enhanced Personal. Who provides those services?

   Services for Adults provides Administrative Case Management to residents of Adult Care Homes who are eligible for Enhanced Personal Care. Residents must be eligible for Special Assistance Medicaid and need total or extensive assistance with toileting, feeding, ambulating, or any combination thereof.
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2. How do we refer these individuals for services?

Submit the Adult Care Home Personal Care Physician Authorization and Care Plan form (DMA3050) and a current FL2 form to DSS/ASW Admin Case Management fax # 704-336-7965. Social workers will visit you and your residents to determine if they are eligible for Enhanced Personal Care, based on your facility's assessment.  You may call Cordelia Jackson (704-336-8942) or Patti Mott (704-336-6964) to discuss referrals.
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3. Where can I obtain the DMA3050 form?

   To obtain copies of the DMA3050 form, contact the Division of Medical Assistance at 1-919-857-4020.  The form can also be obtained via the internet site: http://info.dhhs.state.nc.us/olm/forms/dma/

4. Where can I obtain a Medicaid Provider Manual?

The Provider Manual can be obtained by calling the DMA Adult Care Home Services Unit at: 1-919-857-4020.
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5. I know an individual/family member who might need ACM.  How can I get a referral?

   Contact the administrator of the care facility where the individual resides and that administrator will request a referral from the ACM Unit if appropriate.

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