CMS-179 4.19(g)

State Plan Under Title XIX of the Social Security Act (Base plan pages, Attachments, Supplements to Attachments) (CMS-179)

Exhibit AD 508 (rev OSORA PRA)

State Plan Under Title XIX of the Social Security Act (Base plan pages)

OMB: 0938-0193

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Form Approved CMS-179
OMB No. 0938-0193
63
Revision:

HCFA-AT-80-38(BPP)
May 22, 1980
State:

Citation
42 CFR 447.201
42 CFR 447.202
AT-78-90

4.19(g)The Medicaid agency assures appropriate
audit of records when payment is based on
costs of services or on a fee plus
cost of materials.

______________________________________________________________________________
TN No.
Supersedes
Approval Date
Effective Date
TN No.
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The valid OMB number for this information collection is 0938-0193 (Expires: TBD). The time required to complete this information collection is estimated to
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you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please writ e to: CMS, Attn: PRA Reports Clearance
Officer, 7500 Security Boulevard, Baltimore, Maryland 21224-1850.


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AuthorCMS
File Modified2019-02-22
File Created2018-09-21

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