Status Change Form (SC-1) Process for Nursing Facilities

Learn more about the SC-1 process for Nursing Facilities, including what forms are required for different coverage types.

SC-1 Process for MassHealth FFS members

SC1 Process for MassHealth SCO members.csv

*If member is considered to be short term: A short-term SC-1 is required and must include the physician’s signature and date (block 24 and 25).  Please complete all blocks on the sc1 form. 

**Discharges include: Community/Hospital/transfer to nursing facility/Expired. It is important that all discharge SC-1s are submitted timely and include the address to which the member is discharged so members returning to the community may access needed services and benefits.

Download PDF of SC-1 Process for MassHealth FFS members

*SC-1/LOC Submission information for MassHealth Enrollment Center

EDMC fax: [phone]

SC-1/PPA service line: 508-828-4657

SC-1 Process for MassHealth SCO members

SC1 Process for SCO_0.csv

Please note: Across the top of the SC-1, please write the SCO Health plan member is enrolled into.

*If member is considered to be short term: A short-term SC-1 is required and must include the physician’s signature and date (block 24 and 25).  Please complete all blocks on the sc1 form. 

** Discharges include: Community/Hospital/transfer to nursing facility/Expired. It is important that all discharge SC-1s are submitted timely and include the address to which the member is discharged so members returning to the community may access needed services and benefits.

Download PDF of SC-1 Process for MassHealth SCO members

*SC-1/LOC Submission information for MassHealth Enrollment Center

EDMC fax: [phone]

SC-1/PPA service line: 508-828-4657

Date published:	April 3, 2024