GenIC # 58 (New): Medicaid Section 1115 Eligibility and Coverage Demonstration Implementation Plan and Monitoring Reports Documents and Templates

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

OMB: 0938-1148

IC ID: 237468

Documents and Forms

Document Name Document Type
Form CMS-10398 #58 GenIC # 58 (New): Medicaid Section 1115 Eligibility and Coverage Demonstration Implementation Plan and Monitoring Reports Documents and Templates Form and Instruction
58 - Medicaid Section 1115 Eligibility and Coverage Demonstration Monitoring Report Instructions.docx Instruction
58 - Monitoring Metrics for Demonstrations with Community Engagement and Other Eligibility and Coverage Policies.pdf Instruction
58 - Section 1115 Eligibility and Coverage Demonstrations Monitoring Metrics Technical Specifications.pdf Instruction
smd18002.pdf Other-SMDL
CMS-10398 #58 Implementation Plan Template 58 - Medicaid Section 1115 Eligibility and Coverage Demonstration Implementation Plan Template.pdf Form and Instruction
CMS-10398 #58 Monitoring Protocol - Planned Metrics 58 - Medicaid Section 1115 Eligibility and Coverage Demonstration Monitoring Protocol.xlsx Form and Instruction
CMS-10398 #58 Monitoring Report 58 - Medicaid Section 1115 Eligibility and Coverage Demonstration Monitoring Report.docx Form and Instruction
GenIC 58 - Supporting Statement (2019 version 3).docx Generic Supporting Statement IC Document