MedicaidAdministrativeMedium impact
Form FA-13A Updated to Rehabilitative Residential Treatment Services Absence Form
Nevada Medicaid·NV · Psychiatry·Provider Announcement
Effective date
Mar 20, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid updated Form FA-13A (RTC Absence Form) to the Rehabilitative Residential Treatment Services Absence Form with terminology changes and expanded provider eligibility. The form language changed from RTC to Psychiatric Residential Treatment Facility (PRTF) and added new provider types for residential mental health services.
Action Required
Immediately: Providers must discontinue use of previous versions of Form FA-13A and use the updated form dated 03/20/2026 for all Therapeutic Leave Days requests. Download the new form from the Nevada Medicaid Provider Portal Forms webpage. Note that requests submitted on old versions will be returned and require resubmission on the updated form.