1 Individuals with Tuberculosis

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

Medicaid and CHIP Program (MACPro)
S55-Individuals with Tuberculosis PRA document
Version 1.0
08/22/2017

Document Number: 243-QSSI-MACPro-PRA-S55-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S55-Individuals with Tuberculosis - Screenshots ............................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9

Section A. “Characteristics” ............................................................................. 1
Section B. “Financial Methodologies” .............................................................. 1
Section C. “Income Standard Used” – Path 1 ................................................. 1
Section C. “Income Standard Used” – Path 2 ................................................. 2
Section D. “Basis for Individuals with Tuberculosis Income Standard Maximum Income Standard” – Path 1 ............................................................. 2
Section D. “Basis for Individuals with Tuberculosis Income Standard Maximum Income Standard” – Path 2 ............................................................. 2
Section D. “Basis for Individuals with Tuberculosis Income Standard Maximum Income Standard” – Path 3 ............................................................. 3
Section D. “Basis for Individuals with Tuberculosis Income Standard Maximum Income Standard” – Path 4 ............................................................. 3
Section E. “Benefits for Individuals with Tuberculosis” and Section F.
“Additional Information” ................................................................................... 3

List of Figures
Figure 1: Section A .......................................................................................................... 1
Figure 2: Section B .......................................................................................................... 1
Figure 3: Section C. - 1 ................................................................................................... 1
Figure 4: Section C. – 2................................................................................................... 2
Figure 5: Section D – 1.................................................................................................... 2
Figure 6: Section D – 2.................................................................................................... 2
Figure 7: Section D – 3.................................................................................................... 3
Figure 8: Section D – 4.................................................................................................... 3
Figure 9: Sections E & F ................................................................................................. 3

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S55-Individuals with Tuberculosis - Screenshots

1. S55-Individuals with Tuberculosis - Screenshots
1.1

Section A. “Characteristics”

Figure 1: Section A

1.2

Section B. “Financial Methodologies”

Figure 2: Section B

1.3

Section C. “Income Standard Used” – Path 1

Figure 3: Section C. - 1

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1.4

S55-Individuals with Tuberculosis - Screenshots

Section C. “Income Standard Used” – Path 2

Figure 4: Section C. – 2

1.5

Section D. “Basis for Individuals with Tuberculosis Income
Standard - Maximum Income Standard” – Path 1

Figure 5: Section D – 1

1.6

Section D. “Basis for Individuals with Tuberculosis Income
Standard - Maximum Income Standard” – Path 2

Figure 6: Section D – 2

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1.7

S55-Individuals with Tuberculosis - Screenshots

Section D. “Basis for Individuals with Tuberculosis Income
Standard - Maximum Income Standard” – Path 3

Figure 7: Section D – 3

1.8

Section D. “Basis for Individuals with Tuberculosis Income
Standard - Maximum Income Standard” – Path 4

Figure 8: Section D – 4

1.9

Section E. “Benefits for Individuals with Tuberculosis” and
Section F. “Additional Information”

Figure 9: Sections E & F

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