GenIC # 59 (New) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations

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

OMB: 0938-1148

IC ID: 240771

Documents and Forms

Document Name Document Type
Form CMS-10398 #59 GenIC # 59 (New) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations Form
Video 1 - Overview of the Standardized Monitoring Report Process.docx cvpcorp-1115pmda.adobeconnect.com/pqopfoy48idv/ Instruction
Video 2 - Populating and Submitting Monitoring Templates.docx cvpcorp-1115pmda.adobeconnect.com/pklt7cdlhgjl/ Instruction
Video 3 - Downloading 1115 Monitoring Report Templates.docx cvpcorp-1115pmda.adobeconnect.com/p4l83cvhhqda/ Instruction
6 - 1115_SMI_Metrics_Tech_specs_v1 (version 2).pdf Instruction
8 - 1115-SMI-Monitoring-Protocol-Template-Instructions (version 2).pdf Instruction
9 - 1115-SMI-Monitoring-Report-Template-Instructions (version 2).pdf Instruction
12 - SMI_SED_HIT_Plan_Instructions (version 2).pdf Instruction
13 - smd18011.pdf Instruction
CMS-10398 #59 Implementation Plan Template 4 - smi-impl-plan-template (version 2).pdf Form
CMS-10398 $59 Monitoring Report Template 5 - 1115-SMI-Monitoring-Report-Template (version 2).pdf Form
CMS-10398 #59 Monitoring Protocol Template 7 - 1115-SMI-Monitoring-Protocol-Template (version 2).pdf Form
CMS-10398 #59 Monitoring Workbook 10 - 1115-SMI-Monitoring-Workbook_013020 (version 2).xlsm Form and Instruction
CMS-10398 #59 Current Availability Assessment 11 - 1115-smi-current-availability-assessment_013020 (version 2).xlsm Form and Instruction
GenIC #59 - Generic Supporting Statement (version 3).docx Generic Supporting Statement IC Document