Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348

Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348 (CMS-576 and CMS-576A)

OMB: 0938-0512

IC ID: 8133

Documents and Forms

Document Name Document Type
Form CMS-576A Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348 Form and Instruction
CMS-576A Health Insurance Benefits Agreement CMS-576A form. 03.23.23.pdf Form and Instruction
CMS-576 ORGAN PROCUREMENT ORGANIZATION (OPO) REQUEST FOR DESIGNATION AS AN OPO CMS-576 form..03.23.23.pdf Form and Instruction
Change Crosswalk for CMS-576. 03.23.23.pdf Crosswalk IC Document
Change Crosswalk for CMS-576A 03.21.23.pdf Crosswalk IC Document