MedicaidDocumentationMedium impact
Revised Freedom of Choice Consent Form and Medical Day Care Documentation Chart
Maryland Medicaid·MD · Geriatrics·Provider Transmittal
Effective date
May 15, 2015
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has revised the Freedom of Choice Consent Form and Medical Day Care Documentation Chart for the Medical Day Care Services Waiver program. The updated forms now require physician orders for initial enrollments and replace certain documentation requirements with new forms (InterRAI Results Summary and LTSSMaryland AERS Recommended Plan of Care).
Action Required
Immediately: Begin using the revised Freedom of Choice Consent Form (dated April 2015) and discontinue using the form from Medical Day Care Transmittal No. 82 (April 17, 2013). Update documentation processes to include physician orders for all initial Medical Day Care Waiver enrollments. Replace Delmarva Certification with InterRAI Results Summary page and STEPS Recommended Plan of Care with LTSSMaryland AERS Recommended Plan of Care. Submit required documentation to Division of Community Long Term Care at (410) 767-1444.