HomeMy WebLinkAbout0349 SEA STREET - HOSPITAL/NURSING HOMES (2) 34° S:QcL Nannt-S
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M ARY YEE JCNC - SEP 13 1988
CJv.•551OVEA. -
T"o.,as K. `Y„ IMPORTANT NOTICE OF 1988 a�=a GoO_ (617)
issIo.N_a 45 t-5330
Fraser Rest Home LONG-TERM CARE FACILITY
349 Sea St. PROSPECTIVE RATE
Hyannis, MA 02601
Dear Administrator:
Please be advised that in accordance with the princioles contained in Regulation
114.2 CMR 4.00 , REGULATIONS GOVERNING THE DETERMINATION OF RATES OF PAYMENT TO
LONG-TERM CARE FACILITIES TO BE PAID BY ALL GOVERINMEINTAL UNITS FOR SERVICES
RENDERED PUBLICLY AIDED PATIENTS , EFFECTIVE JAA.I{UARY 1 , 1988 and in particular
the orovisions of Section 4.04, the Rate Setting Commission has voted to adoot
the following prospective rate for your facility.
1988 Prospective
Per Diem Rate
_28.38 Eff. 5/l/88
S
The effective date of this prospective rate shall be from January 1 , 1928 to
December 31 ,1998 unless othergise indicated above.
If You desire to appeal from this prospective rate of pa_rrent, you crust file
your apoeal with the Division of Administrative Law Aooeals , Executive Office
of Administration and Finance, Room 1021 , One Ashburton Place, Boston, MA 02108,
within thirty (30) days after said prospective rate is filed with the State
Secretary in accordance with G.L. , c.6A, s.36.
Any such appeal must be filed in accordance with the New Standard Adjudicatcry
Rules of Practice and Procedure, 801 CMR, and is governed by the provisions of
Rate Settina Commission's Regulation 114.2 CMR 4.00, Section 4.15.
Enclosed . is a ,caoy of the schedules used in the computation of the prospective
rate of payment.
john
ruly yours ,
SEP 9 1988 /l/�
Date Filed . Dale
with State Secretary ive Secret a y
JAO:tb
EncI .
ummunwenlo of Aussodoffts
Executive Office of Human Services
Department of Public Welfare
Local Office.
1IMPORTANTE! ESTA NOTIFICACION AFECTA SUS DERECHOS Y OBLIGACIONES Y DEBER SER TRADUCIDA
INMEDIATAMENTE.
Name S T �pJ c i 1'u;r Z Date l�
Address ,, City/ZIP
NOTICE OF APPLICATION APPROVAL
Your application for has been approved effective ���—2
at $y yl�j .�, per month. l
l� k shortly'tor the` eriod from 7-
You w��� rece(ve.you,r first check s o y p T�L �
Medical Services
❑ You are eligible for General Relief Medical Services. A Medicaid card will be sent to you each month. You must
show the card to the medical provider whenever you receive medical services.
If you have unpaid medical bills for services received on or after the date of your application, you should contact the
medical provider and instruct him/her to bill Medicaid.
❑ An application for Medical Assistance is enlosed. It must be completed if:
If you want medical assistance for your child(ren) under 21 years of age.
If you are disabled, you may be eligible for medical assistance.
Food Stamp Information:
❑ You are eligible to receive food stamps from to
You will receive your Authorization to Participate (ATP) on the of each month.
Your first ATP includes your food stamp benefits for the period from
to Your ATPs for the following month will be for $
❑ You received an Over-the-Counter ATP for $ for the period from
to
❑ When you applied for assistance you were told to file a separate application for food stamps as a Non-Public
Assistance household.
❑ You are presently a member of a Food Stamp household.
❑ You have chosen not to receive food stamps. If in the future you want to receive food stamps, contact your Finan-
cial Assistance Social Worker.
If,you disagree with this decision or the amount of aid you have a right to a fair hearing.The reverse side of this notice
contains important information about your hearing rights.To request a hearing, complete the reverse side of one copy
of this notice.
Fifranc(at Assistance Soc(af Worker Telephone
I
DEPARTMENT USE ONLY
REGION OFFICE CATEGORY CASE ASSIGNMENT NUMBER ACTION REASON
NFL-4(Rev.2/66)
i
r-
IX
*ar RESIDING IN A.RESTHOmjo
GENERAL RELIEF RECIPIENTS E
INCOME
SOC. SEC.
RETIRE.MEITT + Q
OTHER + U
TOTAL MONTHLY INCOME _
PERSONAL NEEDS '
REST HOME COST
HEALTH INSURANCE - D PER DIEM
AVAILABLE. INCOME yL`��� X 7 DAY/%E R
X 4.333
MONTHLY COST
MONTHLY REST HOME COST
AVAILABLE INCOME
MONTHLY GENERAL RELIEF BUDGET . _ Li' 7,
2
7 3, 7.6 �1
BI WKLY CMEC{S TO BE RECEIVED ON' AND OF EACH MONTH
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