MedicaidDocumentationHigh impact
Nursing facility ineligible reassessment and certification forms (MA570)
UPMC Health Plan·PA · Geriatrics, Palliative Care·Education
We identified it
Aug 7, 2026
Summary
Pennsylvania's Community HealthChoices program now requires physicians to complete and return the MA570 certification form within 14 days of receipt to maintain patient eligibility for home- and community-based services. Failure to submit this form timely will result in delays or disruption of Medicaid coverage and may force patients into institutional settings. The form must specify the appropriate level of care (NFCE, NFI, or ICF/ORC) and be signed by an MD or DO.
Action Required
Within 14 days of receipt: Providers must complete, sign, and submit the MA570 certification form for all Community HealthChoices Medicaid patients requiring eligibility renewal. Forms must be returned to chcscentral@upmc.edu (secure email) or faxed to 1-844-890-7458. Billing/clinical staff must establish a tracking system to monitor MA570 form deadlines and flag incomplete submissions. Ensure providers understand the three levels of care definitions (NFCE, NFI, ICF/ORC) and that page 2 must be completed for ICF/ORC patients. Failure to submit forms within 14 days will result in service delays, coverage disruptions, and potential loss of Medicaid eligibility for affected patients.