1 Individuals Eligible for Family Planning Services

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

Medicaid and CHIP Program (MACPro)
S59 – Individuals Eligible for Family Planning
Services RU PRA Document
Version 1.0
08/20/2017

Document Number: 228-QSSI-MACPro-R5.1-S59-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S59 - Individuals Eligible for Family Planning Services Screenshots ................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Package Header ............................................................................................. 1
A. Characteristics, B. Individuals Covered – Path 1 ........................................ 1
B. Individuals Covered – Path 2 ...................................................................... 2
C. Income Standard Used – Path 1................................................................. 2
C. Income Standard Used – Path 2................................................................. 2
C. Income Standard Used – Path 3................................................................. 3
D. Financial Methodologies – Path 1............................................................... 3
D. Financial Methodologies – Path 2............................................................... 4
D. Financial Methodologies – Path 3 – Screenshot 1...................................... 4
D. Financial Methodologies – Path 3 – Screenshot 2...................................... 5
E. Basis for Income Standard - Maximum Income Standard, F. Family
Planning Benefits and G. Additional Information (optional) ............................. 5

List of Figures
Figure 1: Package Header .............................................................................................. 1
Figure 2: Section A, Section B – Path 1 .......................................................................... 1
Figure 3: Section B – Path 2 ........................................................................................... 2
Figure 4: Section C - Path 1 ............................................................................................ 2
Figure 5: Section C - Path 2 ............................................................................................ 2
Figure 6: Section C – Path 3 ........................................................................................... 3
Figure 7: Section D – Path 1 ........................................................................................... 3
Figure 8: Section D - Path 2 ............................................................................................ 4
Figure 9 : Section D - Path 3 - Screenshot 1 ................................................................... 4
Figure 10 : Section D - Path 3 - Screenshot 2 ................................................................. 5
Figure 11 : Section E, Section F and Section G .............................................................. 5

List of Tables
No table of figures entries found.

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Package Header

1. S59 - Individuals Eligible for Family Planning Services
Screenshots
1.1

Package Header

Figure 1: Package Header

1.2

A. Characteristics, B. Individuals Covered – Path 1

Figure 2: Section A, Section B – Path 1

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1.3

B. Individuals Covered – Path 2

B. Individuals Covered – Path 2

Figure 3: Section B – Path 2

1.4

C. Income Standard Used – Path 1

Figure 4: Section C - Path 1

1.5

C. Income Standard Used – Path 2

Figure 5: Section C - Path 2

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1.6

C. Income Standard Used – Path 3

C. Income Standard Used – Path 3

Figure 6: Section C – Path 3

1.7

D. Financial Methodologies – Path 1

Figure 7: Section D – Path 1

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1.8

D. Financial Methodologies – Path 2

D. Financial Methodologies – Path 2

Figure 8: Section D - Path 2

1.9

D. Financial Methodologies – Path 3 – Screenshot 1

Figure 9 : Section D - Path 3 - Screenshot 1

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D. Financial Methodologies – Path 3 – Screenshot 2

1.10 D. Financial Methodologies – Path 3 – Screenshot 2

Figure 10 : Section D - Path 3 - Screenshot 2

1.11 E. Basis for Income Standard - Maximum Income Standard, F.
Family Planning Benefits and G. Additional Information (optional)

Figure 11 : Section E, Section F and Section G

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