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September 7, 2017

Status Change Form 1. What is the purpose of the status change form? a. The purpose of the status change form is to accurately track the status of each RCAP resident for coordination billing purposes. 2. When is a status change form required? a. A provider is required to submit a status change form when the status or location of the resident has changed. Examples of when to submit a status change form include the following:  resident withdrew from the program;  resident admitted to the hospital;  resident admitted to a nursing facility;  resident arrested;  resident moved – transferred to another RCAP facility;  resident used Leave of Absence (LOA) day;  resident income change;  resident name change;  change in residents level of care needs  address change  discharge from RCAP facility to community, facility ,etc.…  death of the RCAP resident.

Examples of How and When to Complete Status Change Form: a. If the resident goes home for the weekend with family this would be reported as an LOA day on the status change form. The form would reflect the date the resident left and returned to the facility.