Traditional MedicareAdministrativeMedium impact
Use of DHMH 257 and 259 Forms
Maryland Medicaid·MD · Geriatrics·Nursing Home
Effective date
Nov 30, 2007
We identified it
Jun 20, 2026
Summary
This policy establishes standardized procedures for using DHMH forms 257 and 259 for Medical Assistance reimbursement in Maryland nursing homes, including specific workflows for admissions, discharges, level of care changes, and hospice elections. The policy provides detailed instructions on when to submit each form and to which agencies.
Action Required
Immediately: Nursing home billing staff must use DHMH form 257 for all admissions and discharges to open/close LTC payment spans, and DHMH form 259 for transitions from Medicare co-pay to full Medicaid coverage. Submit form 257 directly to LDSS for Medicare coinsurance cases, and to UCA with form 387IB for straight Medicaid cases. For hospice elections, do not submit cancel payment forms as LTC spans will be end-dated automatically. Dual facilities must mark form 259 with 'DUAL CHRONIC-NF' and send to Medical Assistance Problem Resolution Division.