Bundle: #42 (Covered Outpatient Drugs) #45 (Maternal and Infant Health Quality) and #47 (Health Home Core Sets)

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB: 0938-1148

IC ID: 222041

Documents and Forms

Document Name Document Type
42 - SPA Reimbursement Requirements Summary [rev 06-19-2016].docx Instruction
47 - Health Homes Quality Measures Consolidated IG [rev 06-20-2016 by OSORA PRA].pdf Instruction
CMS-10398 (#45) (Screen 1, Women) MIH Initiative Developmental Measure MIH_2015_by Women_1.pdf Form
CMS-10398 (#45) (Screen 2, Women) MIH Initiative Developmental Measure MIH_2015_by Women_2.pdf Form
CMS-10398 (#45) (Screen 3, Women) MIH Initiative Developmental Measure MIH_2015_by Women_3.pdf Form
CMS-10398 (#45) (Screen 4, Women) MIH Initiative Developmental Measure MIH_2015_by Women_4.pdf Form
CMS-10398 (#45) (Screen 5, Women) MIH Initiative Developmental Measure MIH_2015_by Women_5.pdf Form
CMS-10398 (#45) (Screen 6, Women) MIH Initiative Developmental Measure MIH_2015_by Women_6.pdf Form
CMS-10398 (#45) (Screen 1, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_1.pdf Form
CMS-10398 (#45) (Screen 2, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_2.pdf Form
CMS-10398 (#45) (Screen 3, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_3.pdf Form
CMS-10398 (#45) (Screen 4, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_4.pdf Form
CMS-10398 (#45) (Screen 5, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_5.pdf Form
CMS-10398 (#45) (Screen 6, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_6.pdf Form
CMS-10398 (#45) (Screen 7, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_7.pdf Form
CMS-10398 (#45) (Screen 8, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_8.pdf Form
CMS-10398 (#45) (Screen 9, Postpartum Women) MIH Initiative Developmenta MIH_2015_Postpartum Women_9.pdf Form
CMS-10398 (#45) (Screen 10, Postpartum Women) MIH Initiative Development MIH_2015_Postpartum Women_10.pdf Form
42 - Supporting Statement [rev 06-19-2016 by OSORA PRA].docx #42 - Supporting Statement (Covered Outpatient Drugs) IC Document
45 - Maternal and Infant Health Quality Supporting Statement [rev 06-19-2016 by OSORA PRA].docx 45 - Supporting Statement (Maternal and Infant Health Quality) IC Document
47 - Health Home Core Sets Supporting Statement [rev 06-19-2016 by OSORA PRA].docx 47 - Supporting Statement (Health Home Core Sets) IC Document
Bundled Burden Table (06-20-2016).xlsx Bundled Burden Summary IC Document