GenIC #10 (Extension w/o change): Section 1115 Demonstration and Waiver Application

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

OMB: 0938-1148

IC ID: 229609

Documents and Forms

Document Name Document Type
Form CMS-10398 #10 GenIC #10 (Extension w/o change): Section 1115 Demonstration and Waiver Application Form
10 - Information on Cost Sharing Requirements.docx Instruction
10 - List of Eligibility Groups.docm Other-List of eligibility Groups
10 - List of Medicaid and CHIP Benefits.docm Other-List of Medicaid and CHIP Bene
10 - List of Waivers and Expenditure Authorities_ 6 28 12.docm Other-List of Frequently Requested W
CMS-10398 #10 Benefit Specifications and Provider Qualifications 10 - Benefit Specifications and Provider Qualifications.docx Form
CMS-10398 #10 Budget Neutrality Form 10 - Budget Neutrality Form_ 6 29 2012.docm Form and Instruction
CMS-10398 #10 Demonstration Financing Form 10 - Demo Financing Form.docm Form and Instruction
CMS-10398 #10 BN Table Shell 10 - Interim Section 1115 Demonstration Application BN Table Shell v2.xlsx Form
CMS-10398 #10 Long Term Services and Supports Form 10 - List of LTSS Benefits.docm Form
CMS-10398 #10 Long Term Services Benefit Specifications and Provider Q 10 - Long Term Services Benefit Specifications and Provider Qualifications.docx Form
CMS-10398 #10 Section 1115 Demonstration Program Application Guide 10 - New Demo App Template [rev 07-11-2012 by OSORA PRA].docx Form and Instruction
10 - Supporting Statement 1115 Demonstration and Application_11 16 17 rev.docx #0 - Supporting Statement IC Document