CMS-10434 #15 Eligibility Determinations and Fair Hearings

Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
A3-Eligibility Determinations and Fair Hearings
RU PRA document
Version 1.0
08/21/2017

Document Number: 235-QSSI-MACPro-PRA-A3-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. A3- Eligibility Determinations and Fair Hearings Screenshots............................ 1
1.1
1.2
1.3

Section A. Eligibility Determinations (including any delegations) – Screenshot
1 ...................................................................................................................... 1
Section B. Fair Hearings (including any delegations) ...................................... 2
Section C. Evidentiary Hearings and Section D. Additional information
(optional) ......................................................................................................... 3

List of Figures
Figure 1: Section A Screenshot 1 .................................................................................... 1
Figure 2: Section A Screenshot 2 .................................................................................... 2
Figure 3: Section B .......................................................................................................... 2
Figure 4: Section C and D ............................................................................................... 3

List of Tables
No table of figures entries found.

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A3- Eligibility Determinations and Fair Hearings Screenshots

1. A3- Eligibility Determinations and Fair Hearings
Screenshots
1.1

Section A. Eligibility Determinations (including any delegations)

Figure 1: Section A Screenshot 1

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A3- Eligibility Determinations and Fair Hearings Screenshots

Figure 2: Section A Screenshot 2

1.2

Section B. Fair Hearings (including any delegations)

Figure 3: Section B

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1.3

A3- Eligibility Determinations and Fair Hearings Screenshots

Section C. Evidentiary Hearings and Section D. Additional
information (optional)

Figure 4: Section C and D

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