Download New Hampshire 3820 Template in PDF

What is the New Hampshire 3820 form used for?

The New Hampshire 3820 form is specifically designed for the Bureau of Elderly & Adult Services. It is used for reporting changes in the status of residents in long-term care nursing facilities, including transfers between facilities, discharges, and other significant status updates. This form is intended only for current Intermediate Care Facilities (ICF) Medicaid clients.

Who needs to fill out the New Hampshire 3820 form?

Facility representatives, such as administrators or designated staff of the nursing home or long-term care facility, are responsible for completing and submitting the 3820 form. This is necessary whenever there's a change in a resident's Medicaid status, transfer, discharge, or death.

What information is required on the 3820 form?

The form requires detailed information about the resident, including their name, Medicaid ID number, and the facility's contact information. It also asks for specifics regarding the change of status, such as Medicare start and stop dates, dates of death, transfer details (including the name of the facility transferred from and to), and discharge details, including the discharge to a community under the CFI program.

How is the 3820 form submitted?

The completed 3820 form should be faxed to the Bureau of Elderly & Adult Services at the fax number provided on the form: (603) 271-7985.

What happens after submitting the form?

Upon receiving the form, the Bureau of Elderly & Adult Services will process the information to update the resident's status in their systems. If a transfer is reported, a new Notice of Medical Eligibility will be sent to the new facility. Facilities might be contacted for additional information if necessary.

Is there a deadline for submitting the 3820 form?

While the form itself does not specify a deadline, it’s crucial to submit changes of status as soon as possible to ensure that records are accurate and that residents receive appropriate care and billing is correctly processed.

Can the 3820 form be used for new admissions?

No, the 3820 form is primarily used for changes in status, including transfers, discharges, and death of current residents. New admissions to a facility would require different documentation and procedures.

What if there are errors on the submitted 3820 form?

If errors are discovered on a submitted form, it's important to contact the Bureau of Elderly & Adult Services immediately to correct the information. Providing accurate and up-to-date information ensures that residents receive the care they need and that facilities are properly compensated.

Are there any penalties for not submitting or incorrectly filling out the 3820 form?

Specific penalties are not outlined in the form’s instructions, but failing to report changes in a timely and accurate manner can lead to billing errors, issues with resident care, and potential audit problems for the facility. It’s crucial to adhere to all Medicaid regulations and reporting requirements to avoid these complications.

Filling out New Hampshire's Form 3820, a critical document for managing Long Term Care Nursing Facility Change of Status/Transfer/Discharge information, requires meticulous attention to detail. However, some common mistakes significantly hinder the process, affecting both the resident in question and the administrative workflow. Recognizing and avoiding these errors can streamline the process, ensuring accuracy and efficiency.

The following outlines ten frequent errors made when completing the form:

1. Incorrect Resident Information: Entering inaccurate details like the resident's name, Medicaid ID number, or misstating the resident’s current status can lead to significant delays in processing the form.
2. Failing to Specify the Type of Status Change: Not clearly indicating whether it's a transfer, discharge, or a change in Medicaid/Medicare status can cause confusion and improper handling of the case.
3. Omitting Medicare Start and Stop Dates: When applicable, neglecting to fill in the Medicare start and stop dates leaves out crucial information needed for processing changes in coverage.
4. Misreporting Transfer Information: Inaccurate details about the facility from or to which a resident is being transferred can disrupt the transition process.
5. Forgetting to Include Contact Information: Leaving out the phone or fax numbers for either the current or new facility impedes communication.
6. Incorrect Dates: Misstating dates related to Medicaid start, transfers, or discharge can create disparities in records and billing.
7. Neglecting to Report Discharge to Community: Not documenting a resident's discharge to the community or failing to provide a community address and phone number can result in a lack of necessary follow-up or support.
8. Leaving Signatures Blank: The omission of the required signatures from facility representatives or BEAS representatives invalidates the form.
9. Failure to Specify the Date of Death: For residents who have passed away, not indicating the date of death overlooks a critical update to the resident's status.
10. Incorrect Change of Date Requests: When requesting changes to previously submitted dates, such as Medicaid start or original discharge dates, providing inaccurate information can lead to administrative difficulties.

To ensure the effective processing of Form 3820, it is crucial to pay careful attention to detail and double-check all provided information for accuracy. Avoiding the common mistakes listed above not only facilitates smoother transitions for residents but also supports the efficiency of facility operations and inter-facility communication. Proper completion of this form is a shared responsibility that requires thorough review and due diligence.

Remember, this document plays a significant role in the lives of residents and the administrative framework of long-term care facilities. By dedicating the necessary time and attention to accurately complete Form 3820, staff can significantly contribute to the well-being of New Hampshire’s elderly and adult residents requiring care.

When dealing with the complexities of elderly and adult care in New Hampshire, particularly in the realm of transitioning between care facilities or status changes, the New Hampshire Form 3820 plays a crucial role. This document, known fully as the Bureau of Elderly & Adult Services Long Term Care Nursing Facility Change of Status/Transfer/Discharge Form, is a critical piece in ensuring that individuals receive the proper care coordination and benefits alignment. However, this form does not stand alone. A variety of other documents often accompany Form 3820, each serving its unique purpose in the comprehensive care and administrative process.

• Medical Eligibility Determination Form - This document assesses an individual’s health status to establish eligibility for certain Medicaid programs or services.
• Advance Directive/Living Will - These legal documents specify an individual's preferences for medical care, should they become unable to make decisions for themselves.
• Power of Attorney (POA) - A legal document that grants someone the authority to make decisions on behalf of the person, including financial and health-related decisions.
• Income and Asset Verification Forms - Used to verify the financial status of an individual applying for Medicaid, to ensure eligibility for Medicaid coverage.
• Personal Data Sheet - Provides basic personal information about the resident, including contact info for next of kin, medical history, and preferences.
• Medication Administration Records (MAR) - Tracks medications prescribed and administered to the resident, ensuring proper medication management.
• Service Plan or Care Plan - Outlines the specific services and care activities that will be provided to meet the individual's needs.
• Discharge Planning Checklist - Guides the care team and the resident through the process of safely transitioning from the facility to another care setting or home.
• Privacy Notice Acknowledgement Form - Confirms that a resident has received a notice of privacy practices, detailing how their personal health information may be used and disclosed.

Together, these documents form a comprehensive toolkit ensuring that transitions and status changes are handled with the utmost care and diligence. The Form 3820, while significant, is only a part of the larger procedural landscape. Proper completion and management of these forms facilitate coordination among healthcare providers, caregivers, and administrative entities, ultimately supporting the wellbeing and rights of those receiving care.

The New Hampshire 3820 form, utilized by the Bureau of Elderly & Adult Services for managing long-term care nursing facility statuses including changes, transfers, and discharges, bears similarities to other documents within the healthcare and social services sectors. These documents serve various functions, ranging from notifying authorities about patient status changes to requesting benefits or services for individuals.

Advance Directive Forms: The New Hampshire 3820 form shares a common purpose with Advance Directive Forms in that both are used within healthcare settings to communicate crucial decisions. While the 3820 form focuses on informing the necessary parties about the logistical facets of a Medicaid client’s status in a nursing facility, Advance Directive Forms are designed to document a person's preferences regarding medical treatment and interventions in scenarios where they might not be able to communicate their wishes due to medical conditions. Both forms are essential in ensuring that individual preferences and status changes are documented and respected, aiding healthcare providers in delivering care that is in line with the patient's or resident's desires and needs.

Medicaid Eligibility Forms: Another similar type of document is the Medicaid Eligibility Form, which is utilized to assess and determine an individual's eligibility for Medicaid benefits, including long-term care services. Similar to the 3820 form, Medicaid Eligibility Forms require detailed information about the individual, including personal details, financial situation, and medical status. Both forms are critical in the process of applying for and managing Medicaid benefits, especially in the context of long-term care. The New Hampshire 3820 form, specifically, plays a role in continuing this process, as it deals with changes affecting an already established benefit scenario, demonstrating the ongoing nature of Medicaid administration.

Transfer/Discharge Summary Forms: Drawing parallels with the 3820 form, Transfer/Discharge Summary Forms in medical and long-term care settings are crucial for providing a comprehensive outline of a patient's or resident's care timeline, health status, and future care needs upon their transfer or discharge. These forms ensure continuity of care by detailing the individual’s condition, treatment received, and recommendations for further care. Both the Transfer/Discharge Summary Forms and the New Hampshire 3820 form are integral in facilitating smooth transitions between care settings, ensuring that receiving facilities or community care programs have the necessary information to provide appropriate and seamless care continuation.

When filling out the New Hampshire 3820 form, a document designed for notifying about a long-term care nursing facility change of status, transfer, or discharge, it's crucial to adhere to certain guidelines to ensure the form is completed properly and efficiently. The following lists outline the do's and don'ts that individuals must consider.

Things You Should Do

• Double-check the Resident's Name, including Last, First, and MI (Middle Initial), to ensure accuracy.
• Enter the Medicaid ID Number carefully to avoid any discrepancy, as this is a vital piece of information for the Medicaid services to correctly process the form.
• Make sure to provide accurate dates, including the Medicare Start Date, Stop Date, Resume Medicaid Status Date, and Date of Death (if applicable), as these dates are critical for eligibility and billing purposes.
• Fully complete the transfer information, including the name of the facility being transferred from and to, along with accurate phone and fax numbers. This information is essential for a smooth transition.
• For discharges to the community, ensure to fill in the Anticipated or Actual Date of Discharge to Community and the community address. This helps in providing seamless care post-discharge.
• Sign the form both as the Facility Representative and get it signed by the BEAS Representative to validate the form.

Things You Shouldn't Do

• Avoid leaving blank fields, especially critical information like Medicaid ID Number and contact information for the facilities, as incomplete forms can lead to processing delays or rejections.
• Do not guess dates or information. If uncertain, verify the information before submitting the form to avoid errors in the resident's medical records and billing issues.
• Refrain from using unclear handwriting. Since the form requires a fax submission, unclear handwriting can lead to misinterpretation of the data.
• Never forget to include the original and actual dates for Medicaid start, transfer, and discharge. This precision is necessary for compliance and correct record-keeping.
• Avoid submitting the form without the necessary signatures. Unsigned forms are often considered invalid and can lead to unnecessary complications.
• Do not disregard the importance of faxing the completed form to the correct number, (603) 271-7985, as sending the form to the wrong destination can cause significant delays.

Adhering to these instructions will help ensure the New Hampshire 3820 form is filled out correctly and processed without delay, facilitating the necessary changes in care and service for the resident with efficiency.

There are several misconceptions about the New Hampshire 3820 form, which is officially known as the Bureau of Elderly & Adult Services Long Term Care Nursing Facility Change of Status/Transfer/Discharge Form. Understanding these misconceptions can help in accurately completing and using the form.

• It's only for internal use within nursing facilities: Although the New Hampshire 3820 form is frequently utilized by nursing facilities to communicate changes in a resident's status to the Bureau of Elderly & Adult Services, it is not solely for internal use. The information is critical for Medicaid billing and ensuring that residents receive continuous coverage and care during transfers or status changes.

• It is applicable to all residents in long-term care: The form is specifically designed for current Institutional Care Facility (ICF) Medicaid clients. It is not intended or required for residents who do not participate in the Medicaid program or those receiving other types of long-term care services outside of ICF Medicaid coverage.

• It can be used for initial Medicaid applications: The purpose of this form is to report changes in a resident's status, such as transfers between facilities, discharges to the community, or the start and stop dates of Medicare coverage. It is not used for initial applications for Medicaid or to establish Medicaid eligibility.

• Any change of information can be reported with this form: The 3820 form is specific to reporting certain changes in status, including transfers, discharges, and significant insurance coverage changes. It is not a catch-all form for any minor updates or changes in a resident's information. For other types of updates, different protocols or forms may be required.

• The form is only relevant at the time of discharge: While it is crucial for documenting discharges to the community, the New Hampshire 3820 form is also essential for other significant events in the care continuum of a Medicaid resident in a nursing facility. This includes transfers between facilities and changes in Medicare status. Timely updates ensure appropriate coverage and care coordination.

Correcting misunderstandings about the New Hampshire 3820 form helps in its proper application and ensures that residents' transitions are smoothly facilitated, maintaining continuity of care and compliance with Medicaid requirements.

Filling out and using the New Hampshire 3820 form is crucial for managing changes in status for residents within long-term care facilities. Here are five key takeaways to understand:

1. The form is specifically designed for current Intensive Care Facility (ICF) Medicaid clients in New Hampshire, ensuring accurate record-keeping and funding adjustments for residents experiencing status changes, including transfers and discharges.
2. It is mandatory to provide detailed information such as the resident's name, Medicaid ID Number, and the facility's contact information to facilitate efficient communication and processing.
3. Status changes that necessitate the use of this form include the start and stop dates for Medicare coverage, resumption of Medicaid status, date of death, transfers between facilities, changes in the Medicaid start date, and the discharge of residents to the community.
4. For residents transferring between facilities or being discharged to the community, the form requires specific details about the facilities involved or the community address to which the resident is being discharged, ensuring a smooth transition.
5. Both the facility representative and a Bureau of Elderly & Adult Services (BEAS) representative must sign the form, underscoring the collaborative effort between healthcare facilities and state agencies in managing the care of elderly and adult residents effectively.

It is important to fax the completed form to the Bureau of Elderly & Adult Services at the provided fax number to ensure timely processing. This procedural step is critical in maintaining current and accurate Medicaid coverage for residents, thereby facilitating their care and ensuring compliance with state regulations.