Online Submission System

Thank you for visiting the Bureau of Long Term Care online submission system.

On this site you can download forms as well as upload documents.

Let's get started.

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For assistance, you can chat with one of our staff by clicking the link below or call 877-799-4430

First Time User Registration

To have full access to the Online Forms Submission System, including receiving the most up to date version of all forms please enter your email below and select SUBSCRIBE.

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Welcome

What would you like to do?

I am the parent of a child with Katie Beckett (KB) documents to upload.

I need to complete PASRR documentation

I am a provider for the Aged & Disabled (A&D) Waiver and Personal Care Service (PCS) programs and I need to upload or download forms.

I am a provider for the Aged & Disabled (A&D) Waiver and Personal Care Service (PCS) programs. I am submitting a Service Plan, RN Supervisory Nurse Visit form, or other supporting documents.

Please note: Only these specific documents may be uploaded using this link. For all other forms, you must select the second checkbox above.

I need to complete Case Management forms.

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Katie Beckett Page

Instructions to upload Katie Beckett documentation

Please note that only one document can be uploaded at a time. If you have multiple documents, you must enter them separately or combine into a single PDF file.

1. Enter the Medicaid Number for the child participant.

2. Navigate to the file for upload to your computer.

Drop file(s) here

		Select Files


		Select Files

Cancel

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Please use a browser with HTML5 support; or install Microsoft Silverlight v3 or later to view this content and have an ability to upload files.

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3. Select the file for upload.

4. Click the Open button.

5. Select the Upload button.

6. Verify that the selected document is uploaded in the Select Files field.

7. Select Upload.

Upload

Cancel

PASRR Page

Please complete the PASRR Form. You must complete all required fields and select SAVE.

Instructions to upload supporting documentation

Please note that only one document can be uploaded at a time. If you have multiple documents, you must enter them separately or combine into a single PDF file.

1. Navigate to the file for upload to your computer.

2. Select the file for upload.

Drop file(s) here

		Select Files


		Select Files

Cancel

Common error text is displayed here

Please use a browser with HTML5 support; or install Microsoft Silverlight v3 or later to view this content and have an ability to upload files.

Remove

3. Click the Open button.

4. Select the Upload button.

5. Verify that the selected document is uploaded in the Select Files field.

6. Select Upload.

Upload

Cancel

7. Select from the dropdown the email for the appropriate Medicaid regional office. You must select the email address for the form and documents to route to the appropriate office.

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A&D Waiver/PCS Forms Page

Upload Forms

Download Forms

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A&D Waiver/PCS Upload Forms Page

Instructions to Upload Forms

Please note that only one document can be uploaded at a time. If you have multiple documents, you must enter them separately or combine into a single PDF file.

1. Navigate to the file for upload to your computer.

Drop file(s) here

		Select Files


		Select Files

Cancel

Common error text is displayed here

Please use a browser with HTML5 support; or install Microsoft Silverlight v3 or later to view this content and have an ability to upload files.

Remove

2. Select the file for upload.

3. Click the Open button.

4. Select the Upload button.

5. Verify that the selected document is uploaded in the Select Files field.

6. Select Upload.

Upload

Cancel

A&D Waiver/PCS Fillable Files Download Page

Instructions to Download Fillable Form

The Following is a list of all form templates available online. The forms are to be used for both adult and child participants unless otherwise specified. Please carefully review the document name and description to ensure you are downloading the correct form. Select the DOWNLOAD icon to download the template to your computer.

Document Name

Description

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A&D Waiver/PCS Page

Instructions to Upload Forms or Documentation

Please note that only one document can be uploaded at a time. If you have multiple documents, you must enter them separately or combine into a single PDF file.

1. Enter the Medicaid Number for the participant.

2. Navigate to the file for upload to your computer.

Drop file(s) here

		Select Files


		Select Files

Cancel

Common error text is displayed here

Please use a browser with HTML5 support; or install Microsoft Silverlight v3 or later to view this content and have an ability to upload files.

Remove

3. Select the file for upload.

4. Click the Open button.

5. Select the Upload button.

6. Verify that the selected document is uploaded in the Select Files field.

7. Select one of the following checkboxes.

Service Plan

RN Supervisory Form

Supporting Documents

8. Select Upload.

Upload

Cancel

Case Management Page

Instructions to use Case Management Forms

Following are a list of interactive forms for Case Management. Select the OPEN icon and complete the form in it's entirety and select Submit. The form will be sent to the BLTC automatically. A PDF version will also be populated to download for your records.

Document Name

Description

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Cancel

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